From Policy to Practice: Assessing the Transition from NHIF to SHA Across Public Health Facilities in Navakholo Sub-County, Kenya.

The transition from the National Hospital Insurance Fund (NHIF) to the Social Health Authority (SHA) under the Social Health Insurance Act, 2023 represents a major health financing reform aimed at improving healthcare access, financial risk protection, and service quality. However, its implementation has been characterized by operational and technical challenges, including limited system interoperability, legacy data migration errors, system downtime, registration bottlenecks, biometric integration difficulties, and database incompatibilities, raising concerns about its effect on healthcare service delivery. Against this background, this study examined the influence of SHA implementation on healthcare service delivery in public hospitals in Navakholo Sub-County, Kakamega County, Kenya. Guided by the Health Systems Theory the study adopted a descriptive survey design using a mixed-methods approach. The target population comprised 1,938 healthcare workers and patients from public hospitals, from which a sample of 485 respondents was selected through stratified, systematic, and purposive sampling techniques. Primary data were collected using structured questionnaires with open-ended items, while secondary data were obtained from policy documents and relevant literature. A total of 401 questionnaires were completed and returned, yielding a response rate of 82.6%.Quantitative data were analyzed using descriptive statistics and Multivariate Analysis of Variance (MANOVA), whereas qualitative data were analyzed thematically. The MANOVA results indicated no statistically significant differences in healthcare service delivery outcomes across hospital levels (Pillai's Trace = 0.030, F (15, 1185) = 0.797, p = .683), suggesting relatively consistent experiences of Social Health Authority implementation across facility categories. However, qualitative findings revealed persistent shortages of medicines, medical supplies, and equipment, declining service quality, reduced utilization of public health facilities, inadequate staffing, low staff morale, delayed provider reimbursements, weak stakeholder coordination, and governance inefficiencies. The study concludes that although Social Health Authority has introduced important health financing reforms, its implementation remains constrained by administrative, financial, and operational challenges. It therefore recommends strengthening financial accountability, improving stakeholder coordination and administrative capacity, ensuring timely provider reimbursements, and addressing resource shortages to enhance healthcare service delivery and advance the realization of Universal Health Coverage in Kenya.