Universal healthcare: Kenya's health sector at a turning point

Former Health Cabinet Secretary Deborah Barasa during a visit to the maternity ward at Kenyatta National Hospital in Nairobi, on January 16, 2025. [File, Standard] Over the past decade, Kenya's health sector has undergone significant policy evolution, shaped by two major national development frameworks - the Big Four Agenda (2017-2022) and the current Bottom-Up Economic Transformation Agenda (BETA). Health has been prioritised under both frameworks as a social and economic pillar. It was initially framed around Universal Health Coverage (UHC) under the Big Four and is now integrated as a foundational enabler of inclusive economic growth under BETA. We are now at an inflection point, where structural policy ambitions must translate into system-wide resilience and long-term health gains. As Minister for Medical Services, Prof Anyang' Nyong'o (now governor of Kisumu) helped prepare the Kenya National e-Health Strategy 2011-2017, which laid the foundation for the sector's ongoing transformation. The strategy aimed to leverage ICT to accelerate reforms toward universal health coverage. It called for the creation of a secure, interoperable, and citizen-centric health information system that would decentralise services, empower communities and reduce inequalities in access. The strategy also highlighted the importance of participatory governance, enterprise architecture and capacity building-elements that continue to shape health policy today. As he noted, transforming the health sector involves more than infrastructure. It requires sensitivity to the lived realities of citizens and deliberate inclusive reforms that put people at the centre of healthcare systems. The strategy highlighted five pillars of focus - telemedicine, health information systems, m-Health, eLearning, and information for citizens. It emphasized the creation of a secure, citizen-centric, and interoperable health information system to bridge service delivery gaps, decentralize access, and empower communities. It also advocated for the development of enterprise architecture and national governance frameworks to support data security, interoperability, and institutional coordination. The strategy called for trust, transparency and inclusion in health system design, setting the tone for today's reforms. Although significant implementation gaps remained, this strategy provided Kenya with a coherent digital health blueprint, laying the intellectual and strategic foundation upon which later initiatives such as the Big Four Agenda and BETA would build. Under the Big Four Agenda, UHC was positioned as a core national priority and Kenya piloted UHC implementation in four counties - Isiolo, Kisumu, Nyeri, and Machakos - in 2018. The initiative focused on reducing out-of-pocket expenditures, expanding access to essential services, and reforming the National Health Insurance Fund (NHIF). The government invested in hospital infrastructure, human resources and a push for digitisation in health records and supply chains. However, several structural constraints limited the scale and sustainability of these reforms. First, the financing model remained heavily dependent on general taxation and donor support, without robust domestic resource mobilisation mechanisms. Second, NHIF's governance and benefit design challenges restricted its effectiveness as a universal health insurance provider. Third, intergovernmental coordination between the national and county governments posed implementation challenges, especially regarding budgeting and resource alignment. Despite these setbacks, the Big Four Agenda succeeded in placing health at the centre of national policy discourse and laid foundational investments that BETA can now build upon. BETA introduces a more grounded approach to development, focusing on ordinary citizens, particularly those engaged in agriculture, informal enterprises, and low-income urban settlements. It extends the reach for broad coverage so that no citizen of Kenya at any given point is left out. Within this framing, health is no longer viewed only as a social right but as a productive sector that underpins labour productivity, household income stability, and social protection for the estimated 50 million Kenyans, which includes aliens, visitors, and refugees within the boundaries of Kenya. Central to this approach is the emphasis on primary healthcare, community health systems, and preventive services. The recruitment of 100,000 community health promoters in 2023 signals a strong political will to decentralise health delivery and address service access barriers at the grassroots. These promoters - trained, digitally enabled, and equipped with essential kits - represent a paradigm shift towards a more people-centred, preventative model of care. Furthermore, BETA integrates health with adjacent policy domains such as agriculture (through nutrition and food safety), climate (through clean energy and water), and digital transformation (through e-health innovations). This intersectional design offers opportunities for multisectoral synergies and financing models that were previously absent. Building on the foundational Kenya National eHealth Strategy 2011-2017, Kenya is now entering a new phase of health system digitisation, with implementation by the Safaricom-led consortium in partnership with the Ministry of Health. This strategy reflects a bold and practical shift toward building a fully integrated national health information system that will connect public health facilities, digitise medical records, and establish a national health data exchange to support decision-making, financing, and service delivery. At the heart of this strategy is the development of a unique digital health ID for every citizen, integrated with mobile-based platforms that can link patients, health workers, payers (such as the Social Health Authority (SHA), and suppliers across the care continuum. Claims processing The system also envisions digitised outpatient and inpatient records, real-time stock visibility in pharmacies, referral tracking, and automated insurance claims processing. Safaricom's infrastructure, customer reach and ecosystem thinking - alongside its partnerships with m-Health providers, cloud platforms, and local innovators - enable the rollout of a scalable and user-friendly solution. The project draws on lessons from successful digital platforms in Kenya, such as M-Pesa, showing the potential of homegrown innovation to transform national systems. This rollout reflects the implementation of the long-envisioned national digital health backbone - moving Kenya closer to interoperability, portability of records, and predictive care. If effectively scaled and governed, the system could be a breakthrough in realising UHC, supply chain transparency, citizen-owned health data and data-driven policymaking across counties. Other countries have successfully handled system transformation. The United Kingdom's National Health Service (NHS) offers a long-standing model for integrated care delivery with strong public sector foundations. Its digital innovations, like the NHS App and patient-owned health records, highlight the potential of putting health data directly into citizens' hands to improve self-care and system responsiveness. In Qatar, the implementation of a national electronic health record system - Cerner- across public hospitals has significantly improved care coordination, health data integration, and resource planning. The Qatari model demonstrates the importance of centralised digital infrastructure supported by strategic leadership. In Abu Dhabi, the Malaffi platform provides a health information exchange that connects over 2,000 healthcare providers, enhancing clinical decision-making and reducing duplications. Its success lies in private sector inclusion, regulatory enforcement and citizen trust. Kenya must adopt and adapt these models by investing in a national digital health backbone, a unified digital health identity, and interoperable systems across counties and sectors. Kenya's progress in digitising health systems has been uneven. The Kenya Health Information System (KHIS) forms a basic layer of digital reporting, but it lacks full integration with patient-level clinical systems, pharmaceutical inventories, insurance databases, and civil registration systems. Building a secure, citizen-centric digital health ID system is critical. It would enable patients to move seamlessly across providers, ensure better tracking of service utilisation, and reduce fraud in health financing schemes. More importantly, it can democratise access to data, empowering patients with their own health information and enabling predictive, personalised care. Health data must also be used more robustly for research and innovation. With the right data governance frameworks, Kenya can enable local research institutions and innovators to access anonymised datasets for developing AI tools, improving disease surveillance, and designing targeted interventions that could be localised to be more relevant to specific diseases and treatment practices. This will require investment in data protection, ethical review boards, and health informatics training. The transformation of the health sector cannot happen without the involvement of healthcare professionals. A significant gap in Kenya is in having formal representation structures, professional development pathways, and transparent regulatory processes. Drawing from the UK and Scandinavian models, Kenya could consider institutionalising professional advisory councils at the national and county levels. In parallel, improved working conditions, adequate staffing and continuous professional education are needed to retain health workers and raise system-wide productivity. The integrated health system will also help in dealing with the issues prevalent in the pharmaceutical sector, which is highly fragmented, with procurement inefficiencies and inconsistent quality assurance. Kenya must move towards a national medicines tracking system, enabling end-to-end visibility of essential drugs from manufacturer to patient. Digitised inventory management systems, integrated with procurement platforms and regulatory databases, can improve forecasting, reduce stockouts, and curb pilferage. There is also a need to expand local pharmaceutical manufacturing, aligned with national demand forecasting and quality assurance frameworks. Lessons from India's pharmaceutical scale-up and Rwanda's supply chain digitisation (through platforms like Zipline) offer valuable insights. There is also more to be done by counties, which handle most of the healthcare provision under devolution. While devolution brought services to communities, some counties have done better than others. BETA must prioritise capacity building for county health departments in strategic planning, financial management and health infrastructure optimisation. Digital tools Counties should adopt data-driven health planning, utilise digital tools to track productivity, and implement facility-level dashboards linked to health worker incentives. Shared services across neighbouring counties-for procurement, specialist care, and referral systems-can also enhance efficiency. National government must support counties through conditional grants, capacity support, and policy alignment mechanisms, ensuring a coordinated approach to national health goals. Kenya's initial phase of transformation under the Big Four Agenda was anchored in visible infrastructure development-roads, energy access, housing, and industrialisation. These interventions were necessary and catalytic. However, the next frontier-transforming the social sector-is inherently more complex, sensitive and emotional. Unlike physical infrastructure, social sector reforms in health, education, and social protection engage directly with the lived realities of citizens. Health, in particular, involves not just systems and policies, but also people's bodies, trust, emotions and livelihoods. It requires careful balancing between technocratic reform and social legitimacy. Improving health outcomes demands changing behaviours, addressing deep-rooted inequities, reallocating public resources, and restructuring how services are delivered and accessed. Leaders must approach these reforms with empathy, political awareness, and sustained communication, ensuring citizens, health workers, and communities are not only consulted but co-own the transformation. The success of BETA's health goals will hinge not only on systems and financing but on how inclusively and humanely the transformation is managed. Social sector reform must therefore be treated as a long-term, participatory process-anchored in justice, dignity, and shared responsibility. Consequently, policy leaders must empathise with Kenyans seeking care in hospitals and being turned away due to the system's inefficiencies in SHA. Such concerns must be viewed with empathy and policy, and the heads and senior management of facilities should make an exception to support citizens during the system's transition. Leaders must not turn a deaf ear to the plight of citizens. They must listen and act. Kenya's health sector is now at an inflexion point - poised between policy aspiration and systemic transformation. BETA presents a renewed window to address the structural limitations of past reforms while embedding health more deeply into Kenya's socio-economic development narrative. To realise a truly transformative agenda, Kenya must prioritise long-term health financing reform, county-driven primary care systems, integrated policy and programme design across sectors, pharmaceutical alignment and local manufacturing, digitisation and citizen-centred data systems, and professional empowerment and facility-level productivity. Only then can health serve not only as a right but as a strategic enabler of Kenya's development vision. The country must move from fragmented reforms to system-level coherence, from paper-based operations to digital-first governance, and from short-term gains to sustained, inclusive impact. Kenya's decade ahead in health must be driven by a new compact between citizens, providers, policymakers, and investors. The time for coordinated, technology-enabled, citizen-centred health transformation is now. - The writer is the managing director of Oxygene Marketing Communications, Nick.Wachira@oxygene.co.ke

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