Health reforms: Hits and misses under Kenya Kwanza

Social Health Authority (SHA) headquaters. [File, Standard]

Kenya has recorded its highest-ever registration into a social health scheme since independence, with 32.2 million people now registered under the Social Health Authority (SHA), in the government’s latest push to achieve Universal Health Coverage (UHC)

The milestone is among the major gains in the health sector under the Kenya Kwanza administration.

The administration has also enacted four major health laws, expanded primary healthcare, recruited more than 107,000 Community Health Promoters (CHPs), equipped hundreds of public hospitals with modern medical equipment and established a national emergency ambulance dispatch centre.

The health docket additionally has a significant jump of Sh37 billion, the biggest ever in Kenya’s history, bringing the total budget to Sh175.5 billion.

Health is a key pillar of Kenya Kwanza’s Bottom-Up Economic Transformation Agenda (BETA), with President William Ruto tasked with delivering the government’s health agenda.

As Kenya prepares for the Health Summit to kick off today, the experts raise fundamental concern on whether the reforms have brought the country closer to UHC, or are persistent gaps in the health system threatening to undermine the gains.

The Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) says enactment of laws is among the administration’s achievements

“Kenya can take pride in establishing a stronger legal and institutional foundation for universal health coverage,” KELIN says.

The Social Health Insurance Act, Primary Health Care Act, Digital Health Act and Facility Improvement Financing Act established a new framework for financing and delivering healthcare at national and county levels.

The Social Health Insurance Act also established the Social Health Authority (SHA), replacing the National Health Insurance Fund (NHIF).

Under SHA, the government established the Primary Healthcare Fund, Social Health Insurance Fund and Emergency, Chronic and Critical Illness Fund.

The reforms were intended to shift healthcare away from a system where access depends on the ability to pay.

KELIN also points to the operationalisation of the Digital Health Agency as an important development, saying an integrated digital health system can improve continuity of care, accountability and efficiency.

At county level, the organisation cites Nyeri as an example of progress in implementing the Facility Improvement Financing Act, which allows revenue generated at health facilities to support health services.

But KELIN says the real test is whether the legal, financing and digital reforms translate into tangible improvements in the quality, affordability and accessibility of care.

And it is here that some of the biggest concerns emerge.

The transition from NHIF to SHA has been one of the most visible reforms, but has also faced significant challenges.

Kenya Union of Clinical Officers Secretary General George Gibore says the transition has gaps that were not adequately anticipated, including the settlement of billions of shillings in NHIF liabilities.

The Treasury allocated Sh4 billion in the 2026/27 budget to settle pending NHIF bills.

“Transition from NHIF to SHA has so many gaps, despite the scheme having had great intentions of sealing corruption and onboarding more Kenyans,” says Gibore.

So far, 32.2 million Kenyans are registered under SHA.

But experts note that the registration has not necessarily translated into consistent contributions or seamless access to care.

Of the registered people, 22 are principal members, 10 dependents, with 5 million of principal members remitting premiums.

Health and public policy expert Beatrice Kairu says the government needs to rethink how contributions are determined, particularly for people in the informal sector.

“To have many Kenyans pay SHA contributions, there is need to redesign how payment is done. SHA uses Artificial Intelligence (AI) algorithms with a lot of mistakes that locks out the majority of Kenyans,” she says.

She proposes a simpler contribution structure based on income levels.

SHA has also come under scrutiny over fraud, despite being established partly to address weaknesses associated with NHIF.

SHA Chief Executive Officer Dr Mercy Mwangangi recently said the authority had recovered close to Sh300 million from fraudulent claims.

About 15 cases are before the courts, while others are being investigated by the Directorate of Criminal Investigations (DCI) and the Office of the Director of Public Prosecutions (ODPP).

Maternal healthcare is another area where stakeholders fear gains could be reversed.

The transition from NHIF to SHA saw the scrapping of Linda Mama, which provided free maternity services to women who could not afford delivery costs.

Under SHA, pregnant women are expected to be paid-up members to access care.

The scheme provides Sh10,000 for normal deliveries and Sh30,000 for Caesarean sections.

But Kairu questions the practicality of providing deliveries at Level 2 and 3 facilities, noting that many lack theatres and other capacity needed for Caesarean sections.

“The government needs to put in more funds, so that a mother can be able to access these services across Level 2, 3 and 6 without having to pay for the services,” she says.

“I would prioritise maternal healthcare services from Level 2 to 6, to ensure gains are not reversed.”

The concern comes against a backdrop of high maternal and newborn deaths, with at least 15 mothers and 92 newborns dying each day at birth.

The government has also invested heavily in equipping public hospitals.

Under the National Equipment Services Programme (NESP), at least 213 hospitals across 43 counties have been installed with modern equipment, including digital X-rays, ultrasound machines, CT scanners, laboratory systems and specialised operating theatres.

The programme, costing Sh7.3 billion, was adopted after the previous administration’s Managed Equipment Services (MES) initiative.

Under NESP, private-sector partners provide, maintain and replace equipment, while vendors are compensated based on actual use and services provided through SHA.

But Gibore says the success of the programme should be measured by whether the equipment is actually being used.

He recalls cases under MES where equipment was installed in hospitals without electricity or the technical personnel required to operate it.

“Supply of medical equipment is one of the corruption we are talking about. People sit somewhere, identify a gap, sit with a supplier and decide to make things work for them,” he says.

On his part, Prof Peter Anyang’ Nyong’o, the Governor of Kisumu and former Minister for Medical Services, says devolution has significantly expanded access to healthcare.

“Health services have increased in the country exponentially,” he says.

Nyong’o recalls that before devolution, some districts had only one health centre serving large populations, with facilities separated by vast distances.

He says dispensaries and health centres are particularly important in rural areas, where they handle most health problems.

“In many cases in the rural areas, dispensaries and health centres handle, I would say, 90 per cent of the health problems of the people,” he says.

But he warns that infrastructure must be matched with investment in health workers, equipment and medicines.

Asked where the Kenya Kwanza administration is getting it wrong, Nyong’o points to human resources.

“I think the problem has always been in human resources, the remuneration of health workers, because health workers are very important in our lives,” he says.

Gibore similarly says shortages have rendered some facilities non-functional, citing 11 hospitals in Meru that he says have no health workers and 22 non-functional facilities previously reported in Nairobi.

“We need realignment in budget to employ more health workers to meet WHO,” he says.

The 2026/27 budget allocated Sh8 billion for UHC health workers, but Gibore says more resources are needed to address staffing gaps.

The financing dispute extends to the relationship between national and county governments.

Nyong’o says the two levels of government should stop treating health financing as a contest for control of resources.

“There is really no need that we should pull strings; we should have a tug-of-war on how health is financed,” he says.

Instead, he wants the two levels to establish, using actual figures, what counties require to deliver healthcare and agree on who should meet the costs.

For example, the government has recruited at least 107,000 CHPs, paid a Sh5,000 monthly stipend jointly by the national and county governments.

But Nyong’o says counties should be given the resources to meet their obligations.

“If you want the counties to pay their remuneration, give the counties the money needed to pay CHPs. If you don’t, then pay it,” says Prof Nyong’o.

He also questions whether Kenya’s social health insurance financing model is sufficiently equitable.

According to him, greater financial capacity, including companies and the private sector, should contribute more, while the poorest should be protected from contributions they cannot afford.

“My feeling is that those with more money should pay more to the fund as compared to the peasants in the countryside,” observes the Governor.

As Kenya heads into the Health Summit, the health sector therefore presents two contrasting faces.

According to Nyong’o, achieving UHC will require adequate financing, investment in health workers and cooperation between the two levels of government.