What SHA covers for dental and optical care in Kenya

The Social Health Authority (SHA) replaced the National Hospital Insurance Fund (NHIF) in October 2024. Many people still say "NHIF" or "SHIF" in conversation, and the terms are easy to confuse, so a quick explanation first.

SHA is the government body. It manages three funds. According to SHA's own website, the Primary Healthcare Fund pays for outpatient care, maternal and child health, cancer screening, optical health and some other services; the Social Health Insurance Fund (SHIF) pays for inpatient care, maternity, renal care, mental health and surgery; and the Emergency, Chronic and Critical Illness Fund covers ambulance evacuation, accident and emergency care and chronic illness. The oral health package sits under the Social Health Insurance Fund.

What the dental (oral health) package includes

SHA publishes its benefit tariffs online. The oral health package has an annual limit of KES 2,000 per household per year, with these tariffs per service:

• Screening and consultation: KES 300
• Tooth extraction: KES 650
• Dry socket debridement (cleaning a painful socket after extraction): KES 750
• Management of odontogenic infections such as caries and periodontal disease: KES 700
• Atraumatic Restorative Treatment with glass ionomer cement (a simple filling placed without drilling): KES 1,000
• Suturing under local anaesthesia: KES 1,000
• Scaling and polishing for gingivitis and periodontitis: KES 1,200
• Herpetic wound cleaning: KES 600

Two things follow from the numbers. First, KES 2,000 covers roughly one or two basic procedures a year for the whole household. Second, the package does not list root canal treatment, crowns, braces, implants, dentures or conventional fillings, so those remain out-of-pocket or privately insured.

SHA's tariff page also states that oral health services are offered only where a facility has the capacity and its dental unit is willing to provide them at the stated tariff, and that the package is rolled out subject to availability of resources. For the optical package, SHA states that services are delivered at Level 2, 3 and selected Level 4 facilities contracted by SHA. In practice, ask the facility whether it is SHA-contracted for dental services before you sit in the chair.

What the optical package includes

The optical benefit is smaller still. According to SHA's tariff page, the annual limit is KES 1,000 per household, of which KES 950 is for dispensing spectacles. Eye examinations and consultations are handled under general outpatient services rather than this package. SHA states that spectacles for refractive error are limited to beneficiaries under 18 in the first year of implementation, with the scope to expand depending on uptake and financing.

How this compares and what critics say

When the scheme launched in September 2024, Citizen Digital reported that the dental limit of KES 2,000 compared with around KES 10,000 offered by other insurers, and that the optical limit of KES 1,000 compared with KES 7,000 to 10,000 elsewhere. The Standard reported similar concerns from health experts. In February 2025 the Kenya Dental Association met the Principal Secretary for Medical Services to ask that SHA be widened to cover comprehensive oral healthcare, and in March 2025 the Ministry of Health said it was reviewing the oral health benefits. The Ministry also noted that the 2023 Kenya Health Facility Census found only 13 per cent of facilities provide oral health services at all.

As of this guide's publication, SHA's published tariff page still shows the limits above. Check it directly for any update.

Contributions

SHA's premium rates page sets contributions at 2.75 per cent of gross monthly income for salaried workers, deducted by the employer, with a minimum of KES 300 per month and no upper cap. People without a salary pay 2.75 per cent of household income as assessed through means testing, again with the KES 300 floor, and SHA offers an instalment option it calls Lipa SHA Pole Pole.

How to register

According to SHA, all residents of Kenya are eligible, including citizens, refugees and other non-citizens. Kenyan citizens register with their national ID, children with a birth certificate, and foreign residents with an alien ID or refugee ID. A spouse and children can be added as dependants.

Registration routes reported by The Kenya Times when the scheme launched include dialling *147# on any mobile phone, using the portal at sha.go.ke, or visiting former NHIF branch offices. You will need your ID number and a phone number registered in your name.

Private dental insurance

Because the SHA dental benefit is small, many employers and individuals keep a private medical cover with a dental rider. Limits, waiting periods and excluded treatments vary widely between insurers, so read the policy schedule and ask your insurer, in writing, what is and is not covered before treatment. HealthNaro clinic profiles show accepted insurers where a clinic has supplied this information, but always confirm with the clinic too.

When to see a dentist

Do not wait for cover to improve before dealing with pain. See a dentist if you have toothache lasting more than two days, bleeding or swollen gums, a loose tooth, or a broken tooth. Seek emergency care immediately for facial swelling that spreads towards the eye or neck or makes breathing or swallowing difficult. SHA's emergency fund covers accident and emergency care separately from the dental limit.

This guide is general information and not medical, legal or financial advice. Benefit limits and tariffs can change; confirm current figures on sha.go.ke or with the facility before treatment.