Flaws in Kenya's AI-driven health reforms are driving up costs for the poorest, an investigation has found. The system, a key electoral promise of President William Ruto, was launched in October 2024 to replace the decades-old national insurance system. Billed as 'accelerating digital transformation', it aimed to expand access to care for Kenya's large informal economy, which comprises 83% of the workforce.
Algorithmic Inequity
The AI system uses a predictive machine learning algorithm to determine healthcare contributions through means-testing. However, an investigation by Africa Uncensored, Lighthouse Reports, and the Guardian found that it systematically overcharges the poorest Kenyans while undercharging the wealthiest. The algorithm overestimates incomes of the poor and underestimates those of the rich.
Grace Amani, a volunteer registrar, witnesses families struggling to feed themselves being charged premiums of 10% to 20% of their meager incomes. Critically ill patients are denied treatment because they cannot afford the AI-determined fees. 'People are dying, people are suffering,' she said.
Systemic Failures
The Social Health Authority (SHA) has faced criticism for misclassifying people and setting unaffordable premiums. Those without private insurance who don't pay risk being turned away from hospitals. On social media, Kenyans share stories of unaffordable charges, with one single mother facing a monthly contribution of 3,500 Kenyan shillings.
David Khaoya, a health economist, revealed that the government chose to prioritise accurately evaluating the wealthy, even if it meant overcharging the poor. The system uses proxy means testing (PMT), a World Bank-backed method that estimates incomes based on possessions and life circumstances. Similar systems worldwide have been found to make significant errors, with some excluding up to 82% of the intended population.
Opaque and Unfair
In Kenya, the SHA system overcharges more than half of poor households, according to the audit. A pre-implementation report by IDinsight warned that the system was flawed and 'inequitable, particularly for low-income households', but the government deployed it anyway. Of over 20 million registered, only 5 million regularly pay premiums. Hospitals report large deficits due to unpaid reimbursements.
Dr Brian Lishenga, chair of Kenya's Rural and Urban Private Hospitals Association, called the system 'an experiment that has failed' and 'a really poor tool for identifying poor households'. The investigation highlights how the algorithm reduces trust in government services, with many Kenyans unable to access necessary care.
