Why young women lead in SHA usage despite low economic empowerment

By  Moraa Obiria

Senior Gender Journalist

What you need to know:

• Only 20.7 per cent of women aged 18 - 24 are economically empowered, compared with 44.4 per cent of those aged 35 - 59.

The 2026 Economic Survey shows a significant gap in economic empowerment between younger and older women. 

Only 20.7 per cent of women aged 18 - 24 are economically empowered, compared with 44.4 per cent of those aged 35 - 59.

Yet, younger women appear to be making greater use of Social Health Authority (SHA) services. The Kenya Mini-Demographic and Health Survey(KDHS) 2025 - 26 found that, among registered women who sought healthcare, utilisation was highest among those aged 20 - 24, at 56.3 per cent, compared with 43.8 per cent among those aged 15 - 19.
University and college students

Julie Nyanchama, a global health leader and maternal and newborn health specialist and researcher, attributed the higher utilisation among younger women to university and college students being registered as dependants under their parents’ SHA membership.

She said this is an age group that is still in school and dependent on their parents, allowing them to access treatment through their parents’ cover.

Data from the Commission for University Education shows that female enrolment grew faster, rising from 237,191 in 2023 to 325,985 in 2025, a 37.4 per cent increase. 

By comparison, male enrolment increased from 321,778 to 381,165 over the same period, representing an 18.4 per cent rise.

Low insurance uptake

A study on the levels and determinants of health insurance coverage in Kenya, based on cross-sectional evidence from the KDHS 2022, found that age is a significant determinant of health insurance coverage in the country. 

Published in June 2026 in Healthcare, an international peer-reviewed open-access journal, the study established that people aged 19 - 25 are less likely to have health insurance coverage than those aged 46 - 55.

The study noted that the defunct National Health Insurance Fund covered secondary school students through the government-funded EduAfya scheme between 2018 and 2022 but did not have a scheme for university students.

It found that most people aged 19 - 25 are undergraduate students and are therefore largely neither employed nor covered under parental health insurance. It also noted that young adults in universities have limited knowledge of health insurance and generally only develop an interest in it as they age and enter the workforce.

SHA solution

However, the Social Health Insurance Regulations No. 49 of 2024 addressed this challenge by providing health insurance coverage for students up to the age of 25, it indicated.

“Therefore, the proportion of 19-25-year-olds with health insurance is expected to increase as soon as their parents become active SHIF (Social Health Insurance Fund) members,” it stated.

Under Regulation 2, a beneficiary includes a person who has not attained the age of 25 years and is undertaking a full-time course of education at a university, college, school or other educational institution. Or they are serving under articles or an indenture with a view to qualifying in a trade or profession, and is not receiving any income other than a scholarship, bursary or similar grant. 

Access to Helb loan

Agneta Mwangale, who graduated from Moi University last year, said a parent's SHA details are among the mandatory requirements when applying for funding through the Higher Education Loans Board(Helb).

“The form cannot be submitted without the SHA details. It will not go through because it will be incomplete. You must have them; otherwise, you have no choice,” she said.

A check of the Higher Education Financing Portal, through which applications are made, confirmed that applicants are required to provide details on their parent’s SHA deductions or medical contribution rates.

SHA Chief Executive Officer, Dr Mercy Mwangangi attributed the higher utilisation of healthcare services among women aged 20 - 24 to their reproductive needs, noting that more women in this age group seek antenatal, delivery and postnatal care. 

“Most adolescents under 18 are covered as dependants under a parent's or guardian's membership, while women aged 20 - 24 are more likely to be registered in their own right,” she said.

Emmy*, a 22-year-old undergraduate education student at Kaimosi Friends University, said she had been covered as a dependant under her mother's medical scheme until March this year.

“My mother is a teacher, so I have always been a dependant under her Mwalimu Cover, and I used those details to apply for Helb last year,” she said.

Kenya has special medical insurance arrangements for public-sector employees, including the Mwalimu Comprehensive Medical Cover and Usalama Cover. They provide teachers, police officers, prison officers, and their dependants with access to healthcare through the Public Officers Medical Scheme Fund.

The government has brought these medical schemes under SHA rather than having them operate as completely separate insurance arrangements.

However, Emmy said her mother had to register her separately as an adult in March this year after she was diagnosed with ovarian cancer and the allocation under her mother's cover had been depleted.

“My mother contributes for me, but before I could access chemotherapy, she had to pay half of the annual contributions. I can't remember how much she paid, but we were told my SHA cover could not be activated until that was done,” she said.

She said her Social Health Insurance Fund membership had since enabled her to access treatment.

For Lagosa*, a 22-year-old fourth-year gender and development studies student at Kenyatta University, neither she nor her parents have any health insurance cover.

She joined university in 2023, when the country was still using the National Hospital Insurance Fund (NHIF). She said health insurance details were not required when she applied for Helb funding.

“I wasn't asked for NHIF details when I was applying for HELB, and since I’m not a first-time applicant, I only click on the subsequent application, and it doesn't ask for SHA details,” she said.

“If I’m sick, my parents would pay out of pocket for me, but I'm grateful to God that I have been healthy most of the time throughout the years I've been at university. I can't remember the last time I was at the hospital,” she said.

Meanwhile, the mini-survey shows that 58 per cent of women who sought care in the public sector reported using SHA services, compared with 44 per cent of those who sought care in the private sector.

Among women aged 15-49 who used SHA services in the 12 months preceding the survey, the most commonly accessed service was outpatient consultation (62 per cent), followed by antenatal care (nine per cent).  

And delivery or maternity services and inpatient care or hospitalisation services were each accessed by 8per cent of women.

Names marked with an asterisk have been changed to protect their privacy.