Kenya Kwanza's sweet health promise suffers funding pains

Beatrice Kairu, a Health economist during with the Standard on 8th April 2025. (Collins Oduor, Standard) Last month, Alfred Nyandege received a distress call. His 16-year-old daughter had suddenly fallen ill. The Kangemi resident rushed home and immediately took his daughter to Mbagathi Hospital. At the facility, he presented his Social Health Insurance (SHA) details, confident they would cover the treatment. But he was in for a rude shock. "I was told SHA doesn't cover outpatient services," Nyandege recounts. Frustrated and confused, he dug into his pocket, paying Sh200 for consultation and Sh1,100 for lab tests, which confirmed his daughter had ulcers. It didn't end there. Nyandege was then asked to buy medicine at a private chemist, costing him an additional Sh3,000. "I don't understand why I had to pay out of pocket in a public hospital when I am an active SHA contributor. I feel completely let down by the system," he says. "National Health Insurance Fund (NHIF) covered admissions and outpatients but SHA picks and chooses what to cover," he added. But in Kitale, Nancy* tells a different story. The 32-year-old was rushed to St John's Mission Hospital after suffering severe abdominal pain, vomiting and convulsions. She had an ectopic pregnancy, with all tests and treatment catered for by SHA," she says. "The process was smooth-much better than what I experienced under NHIF." Her emergency care was handled seamlessly, in stark contrast to Nyandege's frustrating experience. The two sharply contrasting encounters paint a grim picture of inequality in Kenya's healthcare system. This is despite President William Ruto's promise that no Kenyan would be denied care under his flagship Universal Health Coverage (UHC) programme. As SHA, which repealed NHIF, now finances UHC, millions of Kenyans are asking whether access to health care is being realised or remains elusive despite growing demand for services. In his Kenya Kwanza health manifesto, President Ruto affirmed his commitment to realising UHC-the constitutional right to health - within the shortest time possible. The manifesto outlined several pillars to enhance UHC, including fully publicly financed primary healthcare -preventive, promotive, outpatient, and basic diagnostic services. It positioned NHIF as the primary health cover, with private insurance as secondary, and contributions made at the household level. Each household was to pay between Sh300 and Sh3,000 monthly, aiming to raise Sh200 billion annually, against Kenya's total health expenditure of Sh550 billion. This translated to an average of Sh4,000 per person or Sh16,000 per household to support secondary and tertiary care. However, two and a half years later, the government scrapped NHIF in favour of the SHA, introducing a new payment model capped at 2.75 per cent of income. Declared earnings Salaried Kenyans are now automatically deducted, while informal sector contributors must pay based on declared earnings. Previously, NHIF contributions ranged from Sh500 to Sh1,700 regardless of income, and various specialised schemes under it have since been dissolved. According to Ruto's 2025 mid-term scorecard, SHA registration surged by 146.25 per cent compared to NHIF, growing from eight million to 19.7 million members, including 4.2 million transitioned from NHIF. The government sees this growth as a milestone in expanding health coverage. SHA is supported by four new health laws: the Social Health Insurance Act, Primary Health Care Act, Facility Improvement Financing Act, and the Digital Health Act, all passed in 2023. These laws were intended to ensure a smooth transition, though President Ruto acknowledges the system is still facing early-stage challenges. The government has also promised enhanced benefits under the new Social Health Insurance Fund, including access to primary care, emergency services, and chronic and critical illness funds-all intended to ease financial pressure on households. Yet, despite these assurances, implementation has been rocky. Many Kenyans, like Nyandege, continue to struggle with access to basic healthcare, highlighting the gap between policy and practice. Health economist and policy expert Beatrice Wangui Kairu notes that the manifesto initially gave Kenyans hope for a healthcare system that would finally meet their needs. However, over time, the government's failure to commit adequate funding has hindered progress. While the plan aimed to raise Sh200 billion annually, health allocations have decreased - from Sh141 billion in 2022/23, to Sh127 billion in 2023/24, and Sh118 billion in 2024/25. A projected increase to Sh204 billion in 2025/26 remains uncertain. "On paper, the plan was sound and aligned with Kenyans' desire for UHC," says Kairu. "But the budget remains only three per cent of the national expenditure - far below the 15 per cent Abuja Declaration benchmark." Kairu argues that rather than reforming NHIF, the government opted for a complete overhaul, introducing Social Health Insurance Fund, Primary Healthcare Fund, and Emergency Fund. Informal sector The new model requires contributions from all income groups, but many informal sector workers find the proxy means testing system flawed and unaffordable. While the government hoped to raise Sh133 billion through this model, confusion and poor communication have led to frustration. Only a fraction of the 19.7 million registered SHA members are actively contributing, casting doubt on the sustainability of the programme. The health economist explains that even with adoption of the new medical scheme, there is a disconnect between registration and contribution. The then acting SHA Chief Executive Robert Ingasira recently told the National Assembly Departmental Committee that only four million of the registered Kenyans are paying SHA deductions. "Registration is easy. Paying is another matter. The government can't make people contribute if they don't see value for their money. The government proudly announced that 18 million Kenyans had registered for the new health scheme, but the real issue lies in the low contribution rate." Kairu notes that currently only seven per cent of SHA holders are remitting deductions, compared to 44 per cent under NHIF. "Without clear benefits and a trustworthy system, people are reluctant to pay. This mismatch between registration and contribution means that the system is financially unsustainable," she observes. As part of health reforms, NHIF required Sh700 million to upgrade its system to include more benefit tariffs and coverage, having previously had only 44 per cent of its membership actively remitting. The health economists, Kairu revealed, also recommended income-based contributions: those earning more than Sh500,000 to pay Sh5,000 monthly; incomes above Sh100,000 to be deducted Sh2,000; and anyone earning below that to pay Sh1,000 or Sh500, depending on their bracket. This advice was ignored. "When Kenya Kwanza took power, it dumped the good plan only to overhaul the entire system, undoing 60 years of work done by NHIF. We threw away a vehicle that was moving slowly, only to start from scratch," she says. Kairu maintains that the goal of UHC remains a distant dream-a challenge even developed countries continue to grapple with. "Despite promises to equip county hospitals and improve health care access, the reality is that after two and a half years, nothing significant has changed. In the 2024/25 budget, only Sh3.5 billion was allocated for medical equipment-barely enough to meet the health sector's needs," says Kairu. Even as Kenya Kwanza highlights its achievements, Kenya Medical Practitioners and Dentists Union Secretary-General, Dr Davji Atellah, rates the administration's performance as below par. "To be honest, when you look at the Kenya Kwanza regime from August 2022 to April 2025, I would definitely say their performance is below par. We have had struggles that were unimaginable based on the manifesto they sold us.

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