Health Insurance in East Africa: What Changed in October 2026

October 2026 brought a cluster of health insurance developments across East Africa. Kenya's Social Health Authority (SHA) is moving from enrolment to the harder work of contracting and paying providers well. Tanzania is widening its new universal health insurance scheme, Uganda's long-debated national scheme is back on the political agenda, and Rwanda is asking whether its community-based scheme could carry other types of cover.

This briefing summarises what happened, based on official statements and published reports, and what it means for insurers, healthcare providers and employers.

Kenya: SHA turns to contracting and claims discipline

Enrolment. Speaking at Mashujaa Day celebrations in Eldoret on 20 October, President William Ruto said the number of Kenyans registered for social health insurance had grown from seven million in 2022 to 33.3 million under SHA. Some outlets also reported him citing about KSh 107 billion paid to health facilities. These are government figures: registration is not the same as active, contributing membership, and the numbers have not been independently audited.

A new contracting cycle. In early October, the Ministry of Health and the Council of Governors agreed the framework for SHA's 2026–2029 contracting cycle, known as HAKIKA. Key terms reported from the joint communiqué, signed by Health Cabinet Secretary Aden Duale and Mombasa Governor Abdulswamad Nassir, include:

• existing contracts with county facilities were extended to 14 October, described as the final cut-off;
• each eligible facility signs its own contract, with payments going to its Facility Improvement Financing account;
• facilities that meet the main requirements but lack NSSF, NEMA, fire safety, NCPWD or Data Protection Commissioner documents receive a 30-day conditional window to comply;
• clean claims are to be paid within 90 days of receipt; where a fund lacks money, unpaid clean claims become certified liabilities to be settled within the same financial year;
• Level 5 hospitals are to be supported to move to the Health Management Information System by 30 October.

Cancer services. A joint notice from SHA and the National Cancer Institute of Kenya (NCI), reported on 16 October, says SHA will contract facilities for cancer services only after verifying valid NCI certification, the approved scope of services, capacity, staff and regulatory approvals. Facilities offering chemotherapy, radiotherapy or brachytherapy need to show the equipment, licensed personnel and permits behind each service.

More public employees move to SHA. In January the Ministry of Health announced that the National Police Service and the Kenya Prisons Service would be enrolled in SHA from 1 April 2026, following the move of teachers in late 2025.

Kenya's private medical insurance: growing, but under pressure

Private medical cover continues to grow even as SHA becomes the base layer of financing. According to the Insurance Regulatory Authority's (IRA) annual statistics for 2025, reported in September:

• gross direct premiums across the industry rose 16.5% to KSh 466.58 billion, and insurance penetration reached 2.63% of GDP;
• medical insurance premiums rose 22.3% to KSh 93.20 billion, making medical the largest class of general insurance.

The cost side is tightening. IRA figures for the first quarter of 2026, as reported by the business press, put the claims incurred ratio for general insurance at 74.2%, up from 72.0% a year earlier, with medical business accounting for 46.2% of incurred claims. Fraud cases reported to the Insurance Fraud Investigation Unit rose to 52 in the quarter, from 35 a year earlier.

Tanzania: universal health insurance reaches households

Tanzania's universal health insurance scheme, Bima ya Afya kwa Wote, took effect on 26 January 2026. Households of up to six people (the principal member, a spouse and up to four dependants) pay TZS 150,000 a year, while the government continues to finance cover for vulnerable groups, including older people, children, pregnant women and people with disabilities.

Implementation is proceeding region by region. On 21 October, Kigoma Region reported that 11,454 households, 76% of its first-phase target of 15,037, covering 33,446 people, had registered, and launched a second phase at Rusimbi Dispensary with 1,264 households verified. The regional NHIF manager said the first phase had exposed registration and verification problems that are now being addressed.

Uganda: a renewed push for a national scheme

Uganda still has no national health insurance scheme. At the sixth International Annual Insurance Conference in Gulu on 22 October, Justice Minister Norbert Mao pledged to work with other ministries to fast-track the proposed National Health Insurance Scheme and to agree a timetable, citing Ghana as an example. Industry representatives asked the government to speed up the process.

The case is clear from the numbers. Uganda's Insurance Regulatory Authority says more than 90% of Ugandans pay for medical care directly out of pocket. Gross written premiums across the insurance industry rose 14.72% to about UGX 2.024 trillion in 2025, but penetration remained below 1% of GDP in 2024.

Rwanda: Mutuelle de Santé as a platform

Rwanda's community-based scheme, Mutuelle de Santé, marked 25 years in February 2026 with revised, tiered contributions. Reported per-person annual amounts range from RWF 4,000 (fully paid by government for the poorest category) to RWF 8,000 or 20,000 for higher-income earners. Officials said contributions had not risen for a decade, while the cost of members' care had grown from RWF 39 billion to 98 billion a year.

On 20 October, at the International Conference on Inclusive Insurance in Kigali, a senior Ministry of Finance official said the government could work with RSSB and insurers to bundle community-based health insurance with other products, such as cover for farms, climate shocks and small businesses. He described the idea as something to explore within Rwanda's regulatory framework, not a decision. Rwanda's National Insurance Strategy aims to raise insurance penetration from 1.9% to 5% of GDP by 2035.

What this means

For insurers and medical schemes. In Kenya, SHA is becoming the first layer of cover for most of the population. Private products will be judged on how well they complement it: covering what SHA does not, at a price employers and individuals accept. With medical business carrying the largest share of claims, benefit design, provider contracts and fraud controls matter as much as growth.

For healthcare providers. SHA's contracting terms reward facilities that keep their licences, compliance documents and claims in order. A 90-day payment standard is helpful, but facilities should still plan cash flow around actual payment times and keep rejected-claim rates low.

For employers. Corporate medical schemes designed before SHA may now duplicate it. Renewal season is a good time to review what your scheme covers, what SHA covers and where the real gaps are for your staff.

For governments and development partners. Tanzania's household premium and Uganda's search for a funding model show the same challenge: enrolling informal-sector households at a price they can pay, and then purchasing care that delivers value for the money collected.

OGHC advises insurers, providers, employers and public institutions on these questions. Talk to us about your scheme or contracts.

Sources

• The Star, Ruto's 2027 pitch to hustlers (21 Oct 2026); People Daily, SHA has reached 33.3 million Kenyans
• The Standard, SHA gives counties 30 days to secure health facility contracts (Oct 2026); Lawyard, October 14 SHA contract deadline (6 Oct 2026)
• K24 Digital, SHA shuts the door on uncertified cancer centres (16 Oct 2026)
• Capital FM via allAfrica, Police, Prisons to join SHA from April 1 (26 Jan 2026)
• The Standard, Insurance premiums cross Sh466b mark (3 Sep 2026)
• The Sharp Daily, Kenya's insurance sector faces rising claims (28 Aug 2026)
• TanzaniaInvest, Tanzania starts universal health insurance scheme (27 Jan 2026); Tanzania Insight, Kigoma registers 11,454 households (21 Oct 2026)
• Daily Monitor, Mao pledges to push govt to roll out national health insurance (23 Oct 2026); Nile Post, Mao pledges push for national health insurance (24 Oct 2026)
• Pure Africa News, RSSB highlights health gains as community-based insurance fees are updated (25 Feb 2026); KT Press, Can health insurance also cover your farm or business? (21 Oct 2026)

This briefing summarises public reports as of 24 October 2026 and is not legal or financial advice.