OPINION: What Kenya's SHA can learn from Australia’s Medicare

As Kenya moves to institutionalise the Social Health Authority (SHA) as the vehicle for universal health coverage, the most important question is no longer whether the country should pursue universal healthcare. It is whether the system being built will deliver what universal healthcare promises: access to necessary care without financial hardship.

That is where Australia's Medicare offers Kenya an important benchmark and where the upcoming Kenya–Australia Summit in Sydney should look beyond the familiar subjects of trade, investment, education and migration to include healthcare as a serious pillar of bilateral cooperation. Kenya's health financing system is undergoing one of its most consequential transformations in decades. SHA replaced the National Hospital Insurance Fund (NHIF) in October 2024 and is intended to provide a broader foundation for universal health coverage. By June 2026, more than 31 million Kenyans had reportedly registered with SHA.

But registration numbers, impressive as they may be, are not the ultimate measure of SHA’s success. A person can be registered with a health insurance scheme and still struggle to obtain an appointment, find medicines, access diagnostics or afford treatment. Universal health coverage is ultimately about whether people can obtain the healthcare they need without being pushed into financial hardship.

Medicare is Australia's universal health insurance scheme. It provides Australians with access to a broad range of health and hospital services and contributes to the cost of medical care, medicines and other services. It is not perfect, nor should Kenya attempt to reproduce it wholesale. Australians still encounter gaps, waiting times and out-of-pocket costs. Indeed, Australia continues to reform Medicare, including strengthening primary healthcare and improving affordability.

Why is Australia’s Medicare a useful benchmark for Kenya?

The first lesson is that universal healthcare must be judged by access and affordability. Australia’s Medicare provides an important example through bulk billing, where participating healthcare providers accept the Medicare benefit as full payment for eligible services, allowing patients to receive those services without an upfront out-of-pocket payment.

While bulk billing is not universal across the Australian health system, it demonstrates how the design of a health financing system can reduce financial barriers at the point of care. SHA's growing membership is an important achievement. But the next phase must focus on whether that membership translates into meaningful access to healthcare.

Kenya should develop clear indicators that measure how quickly patients can obtain care, whether essential medicines and diagnostics are available, whether providers are accessible outside major urban centres and whether patients can move between levels of care without unnecessary encumbrances.

The second lesson is the importance of primary healthcare. Australia's ongoing efforts to strengthen Medicare recognise primary healthcare as a foundation of the health system. The country has expanded Medicare Urgent Care Clinics to provide an alternative point of access for people who might otherwise turn to hospital emergency departments.

Kenya has its own important foundation in community-based care, including the growing network of Community Health Promoters. The opportunity is to connect these community-level services to a functioning referral and financing system, so that primary healthcare is not merely the cheapest level of care but the most accessible and trusted entry point into the health system.

Third, SHA must make financial protection its defining promise. To succeed as a universal health coverage, illness should become less financially devastating for Kenyan households. This requires predictable benefits, reliable provider payments and effective protection against catastrophic health expenditure. Australia offers an important lesson in this regard. While Medicare subsidises eligible healthcare services, policymakers recognise that patients who require frequent medical care can still accumulate significant out-of-pocket costs.

The Medicare Safety Nets therefore provide an additional layer of financial protection once eligible out-of-pocket or gap expenses reach an annual threshold. The principle is important for Kenya; universal coverage should not end with enrolment, it must include mechanisms that protect households when their healthcare needs and therefore their costs become unusually high. For SHA, this could mean developing stronger protections for patients with chronic illnesses, repeated healthcare needs and other conditions that expose households to sustained medical expenditure.

Fourth, Kenya can learn from Australia's experience with continuous reform. Medicare is not a finished product. Australia continues to debate bulk billing, primary care, mental health, pharmaceutical access, rural healthcare and the sustainability of public financing. The Australian Government's 2026–27 health budget explicitly frames strengthening Medicare as an ongoing effort to ensure Australians can access affordable, high-quality healthcare when and where they need it.

Kenya should adopt the same mindset. Establishing SHA is not the end of health financing reform. It is the beginning of a long process of institutional learning. This is why healthcare belongs on the agenda of the Kenya–Australia Summit 2026, scheduled for 11 September in Sydney. The summit brings together government, business, universities and diaspora leaders, creating an opportunity to build partnerships that extend beyond conventional trade and investment.

A Kenya–Australia healthcare partnership could focus on health financing, primary healthcare, digital health, health workforce development, rural and remote healthcare, medicines supply chains, health data and research. Importantly, this should not be a one-way transfer of Australian knowledge to Kenya. Kenya has lessons of its own. Its community health model, experience with digital financial and health platforms, and efforts to reach populations outside formal employment provide areas where Australia can learn as well.

The most valuable outcome of the summit would therefore be a commitment to measurable institutional cooperation. Kenya could propose a Kenya–Australia health policy and research partnership that brings together the Ministry of Health, SHA, Kenyan universities, Australian health institutions and the Kenyan-Australian professional community. Such a partnership could examine how universal coverage can be financed sustainably, how primary healthcare can be strengthened and how health systems can use data to improve outcomes.

The Kenyan diaspora should also be part of this conversation. Thousands of Kenyans living and working in Australia represent not only a source of remittances but also a reservoir of professional knowledge. Healthcare professionals, researchers, technology specialists and other professionals can help create lasting institutional links between the two countries.

The test for SHA will ultimately be much simpler than the number of people registered. It will be whether a Kenyan family can seek healthcare when illness strikes without first asking whether they can afford it. Australia's Medicare does not provide all the answers. But its experience offers Kenya something invaluable; a living example of how universal healthcare can be built, tested, criticised and continuously improved.

The Kenya–Australia Summit should therefore put healthcare where it belongs, not at the fringes of the bilateral relationship, but at its centre.

[The writer is an Msc student in Public Health/Global Health at the University of New South Wales]