INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025
The Power of Data Analytics on the Social Health Authority (SHA)
for Sustainable Universal Health Coverage (UHC) in Kenya
Dr Reuben Cheruiyot Lang’at, PhD
University of Kabianga P.O. Box 2030-20200 Kericho
Received: 02 November 2025; Accepted: 10 November 2025; Published: 22 November 2025
ABSTRACT
Universal Health Coverage (UHC) remains a key goal in Kenya's national health agenda. With the introduction
of the Social Health Authority (SHA) under the Social Health Insurance Act, 2023, there is an urgent need to
develop evidence-driven strategies to ensure sustainability and equity in health service delivery. This paper
explores how data analytics can be effectively leveraged by SHA to optimize provider management, beneficiary
targeting, claims processing, and policy formulation. It proposes a framework for integrating advanced analytics
into SHA operations to enhance transparency, efficiency, and long-term sustainability of UHC.
Key words: Data analytics, Evidence driven strategies, Universal Health Coverage
INTRODUCTION
The transition from the National Health Insurance Fund (NHIF) to the SHA marks a paradigm shift in Kenya's
healthcare financing. While SHA introduces three distinct funds (Primary Healthcare, Social Health Insurance,
and Emergency/Chronic Illness), it also creates a complex administrative and operational ecosystem that requires
accurate, timely, and actionable data. According to the Ministry of Health (2023), these changes are aimed at
improving accountability, service delivery, and financial risk protection. This paper argues that leveraging data
analytics is essential to achieving the promise of UHC in a resource-constrained setting (Githinji, 2023). The
World Bank (2020) emphasizes that data systems are vital for effective UHC monitoring and adaptive policy
responses, especially in low and middle-income countries.
LITERATURE REVIEW
Global studies indicate that data-driven health systems lead to better patient outcomes, reduced fraud, and
improved resource allocation. For instance, in Thailand, the use of electronic health records and centralized data
systems has significantly contributed to the success of their UHC implementation (World Health Organization
[WHO], 2022). Similarly, Rwanda’s Community-Based Health Insurance Scheme utilizes health informatics to
track utilization and target subsidies, enhancing efficiency and equity (Kalk, Paul, & Grabosch, 2020).
In Kenya, prior challenges with NHIF included data integrity issues, claim fraud, and poor targeting mechanisms
(Wamai, 2014). Fraudulent medical facilities were making claims even where services were not commensurate
to the amount requested and in some cases services had not been rendered at all. The current President of the
Republic of Kenya in one of his speeches in 2025 is on record having cited one case of a facility that had more
accountants than medical staff among the employees as an indication of how the facility was focusing more on
how to pursue fake claims as opposed to offering treatment. The president issued a warning to government
facilities that were still charging citizens for outpatient services, despite such services being government-paid
under the new Social Health Authority (SHA) program. He stressed that such individual institutions and
individual fraudsters would be made to face the law as a consequence. These shortcomings limited the reach
and effectiveness of the program, particularly among low-income groups who were supposed to be benefitting
from the service. According to Muchiri, Wanjala, and Kamau (2022), Kenya’s health financing model required
urgent reform to improve efficiency and service delivery. With the establishment of SHA, there is an opportunity
to build a more robust data governance framework and leverage analytics for sustainable health financing
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