County governors are demanding urgent amendments to the Social Health Authority (SHA) and related insurance laws, citing what they describe as punitive and discriminatory provisions that undermine devolved health functions and place an unfair financial burden on county governments.
Speaking during the induction of new members of the Council of Governors’ (CoG) Health Committee, the county chiefs expressed concern over clauses that require counties to remit statutory deductions to the SHA by the 9th of every month, even when the National Treasury delays disbursement of funds from the exchequer.
The governors argued that this clause — coupled with penalty provisions for late payment — unfairly punishes county administrations for circumstances beyond their control.
“It is unreasonable to expect counties to remit SHA deductions by the 9th when the National Treasury has not released funds,” said Tharaka Nithi Governor Muthomi Njuki, who serves as the CoG Whip. “The same law does not impose any penalties on the national government for failing to release funds on time. This imbalance must be corrected.”
Push for Legal Amendments Ahead of December Summit
The CoG Health Committee, now chaired by Mombasa Governor Abdulswamad Shariff Nassir, said it is drafting proposals to amend several contentious clauses in the SHA Act to better reflect the realities of devolution and health financing.
“We are not opposing the spirit of the law,” said Governor Nassir. “What we are asking for is fairness. Counties cannot be penalized for delays caused by the exchequer, and we must ensure that the framework supports both levels of government equally.”
The Council plans to submit its proposed amendments before the upcoming President’s Summit with governors scheduled for December 10, 2025, where health financing and governance will top the agenda.
According to the Public Finance Management Act, the National Treasury is required to disburse equitable share allocations to counties by the 15th of every month. However, governors say these timelines are frequently missed, leaving counties struggling to meet statutory obligations, pay staff, and sustain critical health services.
Counties Decry Mounting Financial Pressures
Governors argue that repeated cash flow delays have placed many counties in financial distress, with hospitals facing shortages of essential supplies and delays in salary payments for health workers.
The requirement for timely SHA remittances, they say, only compounds these challenges — particularly when penalties are imposed despite late exchequer releases.
“Counties are not refusing to pay. The issue is liquidity,” said one county finance executive present at the meeting. “When the national government delays disbursements, we have no funds to remit. Penalizing counties under such circumstances is both unjust and counterproductive.”
The CoG is pushing for a grace period in the law that allows counties to remit deductions once funds are received, rather than by a fixed date that does not align with the fiscal realities of intergovernmental financing.
Concerns Over Ambulatory Services Model
Beyond financial penalties, governors also raised concerns over the rollout of ambulatory services under the new health insurance framework. They warned that certain provisions could marginalize county-owned ambulance fleets in favour of private operators using digital taxi-style models.
“There must be clear guidelines and county involvement in standardizing and vetting vehicles to operate as ambulances,” said Governor Nassir. “If not handled carefully, this could make county-owned ambulances redundant, wasting years of investment in emergency medical systems.”
The governors are demanding that counties play a central role in the accreditation and regulation of ambulances operating within their jurisdictions to ensure compatibility with devolved health functions.
The Council further warned that health system reforms risk creating parallel structures if county governments are not adequately involved in implementation and oversight.
Maternal Health and Level 2 Facility Concerns
The CoG Health Committee also raised alarm over the quality of services at Level 2 health facilities, especially for expectant mothers, citing reports that some women have been unable to access basic maternity care despite policy provisions guaranteeing it.
Some counties reported that pregnant women are being referred to higher-level facilities unnecessarily, resulting in avoidable complications and fatalities.
“We are deeply concerned that mothers are dying in facilities that should be providing safe deliveries,” said one county official. “The current system is depriving counties and communities of close to KSh 2.6 billion meant for maternal health services.”
The governors are calling for a review of the service package allocation under the new insurance framework to ensure that Level 2 facilities are adequately equipped and funded to deliver essential maternal and child health services.
Health Financing Under Strain
Another pressing issue raised by the governors is the decline in donor funding for county health programs, which they say has exacerbated the resource gaps in devolved health systems.
Many development partners have scaled back direct support to county-level health projects, forcing counties to rely heavily on the equitable share and own-source revenue — both of which remain insufficient to cover the rising cost of service delivery.
“Health financing needs a complete rethink,” Governor Nassir emphasized. “Both levels of government must come together to design a sustainable model, especially as donor withdrawals continue to affect service delivery.”
The governors argue that the Social Health Authority and related insurance reforms must be accompanied by predictable, timely funding flows and fair intergovernmental cost-sharing arrangements to ensure smooth implementation.
Governors to Table Proposals Before Year-End
The CoG Health Committee is expected to finalize and present its proposed amendments and recommendations before the December summit with President Ruto. Key among the proposals will be:
- Aligning the SHA remittance deadlines with exchequer disbursement timelines.
- Introducing flexibility and grace periods for counties in meeting statutory obligations.
- Clarifying the regulatory framework for ambulatory services to include county participation.
- Ensuring full functionality and service delivery at Level 2 health facilities.
- Reviewing health financing mechanisms between national and county governments.
Governors maintain that the ongoing implementation of the Social Health Insurance framework must uphold the principles of devolution and equity enshrined in the Constitution.
“Counties are the backbone of Kenya’s health delivery system,” Governor Njuki said. “Any national law or policy that affects service delivery must reflect that reality. We want collaboration, not confrontation.”
As the December deadline approaches, all eyes will be on whether the national government accommodates the governors’ demands and revises the contentious clauses — a move that could determine the pace and success of Kenya’s landmark Social Health Authority reforms.
