Public health insurance compared
SHA, NHIF, CBHI, Uganda and South Africa
Side by side
| Kenya | Uganda | Tanzania | Ethiopia | South Africa | |
|---|---|---|---|---|---|
| Public scheme | Social Health Authority (SHA) | None in law yet | NHIF — universal health insurance | Community-based health insurance (informal sector) and social health insurance (employees), both run by EHIS | National Health Insurance Act 20 of 2023 — not in force |
| Since | 1 October 2024 (replaced NHIF) | Bill passed 2021, not signed | Universal cover from 26 January 2026 | CBHI: 1,195 districts in 2024/25. SHI: law of 2010, started for public health workers on 22 January 2026 | Act signed 15 May 2024; no section proclaimed while court challenges are pending |
| What you pay | 2.75% of income, min. KES 300/month, no ceiling | Private premiums only | Basic package TZS 150,000/household a year; other packages from TZS 168,000 per adult | CBHI: set by each region. SHI: equal % of salary from employer and employee (Proc. 690/2010) | Medical scheme contributions by income and number of dependants, not by health or age |
| Private cover | On top of SHA | Insurers and HMOs | Five NHIF packages + private insurers | Private insurers | 70 registered medical schemes (16 open, 54 restricted), 9.17 million beneficiaries (March 2026) |
Details: Kenya (and our SHA calculator), Uganda, Tanzania, Ethiopia (and social health insurance in Ethiopia), South Africa (and the NHI).
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Frequently asked questions
Does Uganda have national health insurance?
Not yet. A bill passed in 2021 was not signed, and IRA's 2024 report still describes the scheme as proposed.
How much is SHA compared with NHIF Tanzania?
SHA in Kenya is 2.75% of income with a KES 300 monthly minimum. Tanzania's NHIF basic universal package is TZS 150,000 a year per household of up to six people.
Does South Africa have national health insurance?
The National Health Insurance Act 20 of 2023 was signed on 15 May 2024, but no section has been proclaimed: on 24 February 2026 the Presidency said none would be until the Constitutional Court rules. Cover comes from medical schemes (medical aid).
Is there social health insurance in Ethiopia?
Yes in law since Proclamation 690/2010, for employees and pensioners. The press reported that it started on 22 January 2026 for government employees of the health sector, as a pilot.
Sources
- Kenya — Social Health Authority, premium rates
- Uganda — IRA 2024 Annual Insurance Market Report
- Tanzania — NHIF news, 23 January 2026
- Ethiopia — Ethiopian Health Insurance Service (5 July 2025)
- Ethiopia — Social Health Insurance Proclamation No. 690/2010 (WHO legislation database copy)
- Ethiopia — Addis Fortune, January 2026: social health insurance takes effect for public health-sector employees (press report)
- South Africa — Council for Medical Schemes, Annual Report 2025/26 (PMG copy)
- South Africa — Medical Schemes Act 131 of 1998 and Regulations (CMS consolidated copy, Web Archive)
- South Africa — The Presidency, statement on NHI Act litigation (24 February 2026)