Picture a country where no one is put off seeking medical care because of cost. Where every Kenyan, whether in a bustling city or a remote village, can access quality healthcare without fear of financial ruin.
This is the dream of universal health coverage (UHC). It’s a promise anchored in Article 43 of the Constitution, which gives every citizen the right to health care.
But turning this dream into reality has proven to be a tough road, full of challenges, missed opportunities, and glimmers of hope.
Kenya’s journey towards UHC officially began in 2018 with a pilot programme in four counties -- Nyeri, Kisumu, Machakos, and Isiolo. Each county was selected because of its unique health challenges. Nyeri struggled with rising cases of diabetes and hypertension, Kisumu with infectious diseases such as malaria, Machakos with injuries from road traffic accidents, and Isiolo with maternal deaths.
While Isiolo and Machakos managed to implement parts of the pilot, Kisumu stumbled at the start and Nyeri dropped out halfway through due to financial constraints. The pilot showed potential but lacked the momentum to become the national solution that many had hoped for.
Today, Kenya has made significant progress towards UHC. In 2020, the government developed a comprehensive package of health services, covering both curative and preventive care, with the aim of making basic health care accessible to all citizens.
In 2023, new health laws were enacted to further expand access to public health care. The Social Health Insurance Act established the Social Health Authority (SHA) to replace the defunct National Health Insurance Fund (NHIF) and streamline health financing.
Similarly, Community Health Promoters (CHPs) have been particularly successful in promoting preventive care, especially in rural areas and among vulnerable groups such as the elderly.
Despite these successes, the transition has not been smooth. Confusion over the fate of former NHIF staff, unclear leadership roles, and operational hiccups have left the SHA struggling to deliver on its promises.
In its latest SHA transition scorecard report, the Rural-Urban and Private Hospitals Association of Kenya (Rupha) found that three out of 10 hospitals are struggling to access the SHA system, with some being locked out or having approved credentials that don’t work, resulting in an overall transition score of 46 percent, which it described as below average.
“The findings reveal stagnation in the SHA transition, with ongoing technical and financial challenges crippling the ability of healthcare facilities to operate effectively. Challenges such as frequent portal downtime, delayed payments, and inadequate training on the system are hindering providers and patients and require urgent intervention,” the report said.
Primary health care, which is fundamental to UHC, has not received adequate attention. While the SHA has developed a harmonised package of health services, community-level services, such as those provided by CHPs, remain underfunded and poorly integrated into the wider system.
Preventive care, an essential aspect of primary health care, continues to be overshadowed by curative services, creating a gap in efforts to address the root causes of disease.
Brian Lishenga, chairman of Rupha, noted that one of the biggest problems is money - or the lack of it. He says funding for primary health care and community health initiatives is inadequate.
“Hospitals face rising costs, and doctors and nurses have to juggle multiple licences just to keep facilities running. In addition, the Kenya Medical Supplies Authority (Kemsa), which is responsible for distributing medical supplies, is financially unstable, leading to shortages of critical drugs and equipment,” said Dr Lishenga.
For ordinary Kenyans, this means that access to healthcare is unequal. While urban areas may have decent hospitals and clinics, rural areas are often left behind. And healthcare isn’t just about hospitals - it’s also about tackling the root causes of disease, such as poor housing, lack of clean water, and limited education. These social issues, which have a huge impact on health outcomes, are often overlooked.
One group that feels left out of the UHC conversation is older people. According to Tasneem Yamani, a geriatrician at Hamat Healthcare, CHPs are doing great work to support seniors, but there’s no national plan tailored to their specific needs.
“Many older Kenyans find it difficult to navigate digital health platforms without proper training or support. Worse still, the focus of our health system remains on treating disease rather than preventing it,” she says, adding that this approach misses opportunities to stop diseases such as diabetes, hypertension, and cancer before they become life-threatening.
Dr Lishenga says that while the SHA recognises its importance, implementing gender equality is another critical area where UHC has fallen short. For example, teenage mothers and other vulnerable groups face barriers to accessing essential services.
Programmes such as cervical cancer screening, which could save thousands of lives, are still not fully operational, despite Kenya’s commitment to meet global targets by 2030.
So what needs to change?
“First, we need more funding. Primary health care and community health initiatives should get the financial support they deserve. Kemsa needs to be fixed to ensure that hospitals always have the supplies they need. Simplifying licensing for healthcare providers will reduce the burden on them and allow them to focus on what matters - treating patients,” he says.
“Governance also needs to be reviewed. The SHA needs to define clear roles for its managers, appoint permanent staff, and fix its disorganised digital system to make services accessible and efficient. We need to address inequalities in access to healthcare and ensure that rural areas and vulnerable populations are not left behind,” said Dr Lishenga.
Dr Tasneem emphasised the need to focus on prevention. This means educating Kenyans about healthy lifestyles, regular screening, and early detection of diseases.
“For older Kenyans, we need specialised training for health workers and policies that prioritise their specific needs. Programmes to support adolescent mothers and expand reproductive health services will also help close the gender gap in health care,” she said.
“The vision of UHC is within reach, but it will take bold action, smart investment, and a relentless focus on equity. Kenyans deserve a health system that works for everyone, not just the privileged few. Let’s make UHC more than a policy - it should be a reality that ensures no one is left behind. Together, we can create a healthier, more inclusive Kenya,” said Dr Lishenga.
