Kenya's public health system is built to fail the poor

If you live in Kenya, you will have seen it countless times. A message in a family or church WhatsApp group. Someone is sick, the diagnosis is serious, and the hospital wants money before treatment. An M-Pesa till number is accompanied by an appeal: Please send what you can. In your busyness, you quickly send something. You don't dwell on it, because if you did, you would ask a question none of us want to answer: Is this how we'll keep each other alive? Mchanga, Kenya's largest crowdfunding platform, has recorded over 134,000 fundraisers since its founding - 40 per cent of them medical. In 2024 alone, up to 16,000 families used the platform to raise money for healthcare. And these are only the ones we can count - many more move through non-systemised channels, leaving no record at all. What Kenyans have built, out of necessity, is a parallel health financing system, constructed in the absence of a functioning public one. We call it harambee, the communal spirit that makes Kenya special. But generosity is no substitute for a functioning public health system. All of this is happening in a country where the right to health is guaranteed in the national constitution. The Ministry of Health recently revealed that 93 per cent of Kenya's public health facilities cannot provide basic outpatient care. A recent study has also shown that every year, roughly 1.5 million Kenyans are pushed into abject poverty by the cost of medical care. More than 80 per cent of Kenyans who fall sick pay out of pocket, meaning a single hospitalisation can erase a family's lifetime savings. Behind the policy failures is a hard structural reality. In recent years, Kenya has spent more on debt repayment than social services. In the 2025/2026 national budget, health received approximately Sh132 billion, less than 4 per cent of total government spending. At the same time, Kenya directs nearly 67 per cent of its government revenue to debt repayment - resources that could otherwise fund hospitals. Research across sub-Saharan Africa shows that underspending on health is one of the most powerful and least discussed drivers of poverty. In Kenya, the combination of high out-of-pocket costs, unreliable insurance, and a weak public system means that the health system is deepening inequality. Kenya has been promising universal health coverage for decades. The National Hospital Insurance Fund (NHIF), established in 1966, was the flagship vehicle for that promise. But in practice, the system excluded millions in the informal sector and offered unreliable coverage for enrolled members. Flat rate contributions burdened low-income earners, while weak oversight drained resources. In 2024, the government dissolved NHIF and replaced it with the Social Health Authority (SHA), a new scheme promising broader coverage, income-based contributions, and government subsidies for those who could not contribute. But on March 20, 2026, the Departmental Committee on Health of the National Assembly declared SHA unsustainable. With the scheme now struggling to meet its obligations, SHA's future looks bleak. If the programme is fully dismantled, millions will have to brace for tough times as they will be forced to shoulder a heavier burden of out-of-pocket healthcare costs. In contrast, MPs receive annual medical cover worth Shh10.65 million with maternity, dental, and optical benefits extending to their immediate families. This cover is entirely funded by the taxpayer. A motion proposing that all State officers be required to use public hospitals and enroll in SHA, like the people they represent, was tabled in 2025 but never brought to the floor for debate. Kenya must fund its public health system at a level that reflects the promises its leaders keep making, and as enshrined in the constitution. SHA must work in practice, with legacy debts resolved, facilities properly integrated, and a card in every citizen's pocket that actually covers the full range of quality medical care. Kenya must stop treating healthcare as a luxury and start treating it as the foundation of a functioning state. The M-Pesa till number is not a health system; it is evidence of one missing.

Kenya's public health system is built to fail the poor

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