Investigation Finds Kenya's AI Healthcare System Overcharges Poor Households

An investigation by Africa Uncensored, Lighthouse Reports, and the Guardian found that Kenya's AI-powered healthcare system systematically overcharges the poorest households by overestimating their incomes, while undercharging wealthier ones by underestimating theirs.

The system, managed by the Social Health Authority (SHA), was introduced in October 2024 to replace the country's previous national insurance framework. It targets Kenya's informal workforce, which comprises 83% of the workforce, including day laborers, hawkers, and farmers.

Government volunteers conduct household surveys asking about possessions such as toilet types, roof materials, and radio ownership. These details are input into a predictive machine learning algorithm that calculates annual healthcare premiums based on proxy means testing, a method estimating income from life circumstances.

The algorithm does not use large language models but relies on machine learning to perform means testing. An audit of thousands of real households showed the system overestimates incomes for more than half of poor households, leading to premiums between 10% and 20% of their actual incomes.

Residents in Nairobi's poorer areas have reported being charged amounts they cannot afford, resulting in denied access to treatment. For example, some individuals previously paying 500 Kenyan shillings now face bills of 1,030 Kenyan shillings, while a single mother was assessed at 3,500 Kenyan shillings monthly.

Grace Amani, a government volunteer registering households, stated that families struggle with these premiums and that some critically ill people cannot receive care. She added that people are dying at home due to inability to pay.

“People are dying, people are suffering,”