In recent years, Kenya has made ambitious commitments toward achieving Universal Health Coverage (UHC), a global goal designed to ensure that all individuals have access to essential health services without suffering financial hardship. Launched in 2018 as a pilot programme and expanded nationwide in 2022, UHC was seen as a beacon of hope for millions of Kenyans grappling with high medical costs and limited healthcare access. Central to the UHC promise were principles of affordability, equity, and quality care. However, the lived experiences of many citizens suggest that these promises remain far from realized.
Despite UHC’s noble intentions, countless Kenyans continue to face significant obstacles when seeking medical care. The shift from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) was intended to enhance access and streamline services, yet it has brought confusion and skepticism instead. Many people, especially those in rural areas, are unaware of how the new system works or whether they qualify for coverage. For individuals like Collins Mulo, the transition to SHIF has been bewildering. Without adequate information or visible improvements in healthcare services, he and others question the effectiveness of the new system. Mulo often resorts to buying medication out-of-pocket or relying on traditional remedies, reflecting a growing mistrust in the public healthcare infrastructure.
Financial constraints have also intensified under SHIF, which requires a mandatory 2.75% premium from salaried individuals. This has become a burden for many households already struggling with the high cost of living. Moreover, citizens in the informal sector, who make up a significant portion of the workforce, often opt out of the scheme due to affordability concerns or confusion about how it operates. As a result, access to healthcare remains deeply unequal, undermining the UHC objective of leaving no one behind. Only 3.3 million Kenyans have completed the means-testing required to access care under SHIF, leaving over 15 million members in limbo and forced to pay out of pocket.
Public hospitals, which should be the bedrock of UHC, face chronic shortages of essential drugs and equipment, further straining the system. This has forced patients to seek care in private facilities at exorbitant costs or travel to distant counties in search of affordable services. Joseph Kimani, a father and husband, has found himself in this predicament, sometimes traveling to Kiambu County where some support exists for indigent patients. He notes with dismay that services like free maternal care, once accessible under NHIF, now seem out of reach unless SHIF premiums are paid—an alarming development that affects vulnerable families most.
The government’s emphasis on SHIF as a key vehicle for UHC has drawn criticism from various quarters, including lawmakers like Senator Okiya Omtatah. He questions how healthcare can be considered truly universal if access hinges on premium payments, arguing that the current approach contradicts the very principle of inclusivity. The Ministry of Health maintains that reforms are underway to improve the system, but the reality on the ground suggests that progress is slow and uneven.
Healthcare workers continue to protest unpaid salaries, job insecurity, and poor working conditions, leading to frequent strikes and disruptions in service delivery. These issues, coupled with unresolved collective bargaining agreements, paint a grim picture of a healthcare system in crisis. The mismatch between policy promises and practical outcomes is leaving ordinary Kenyans stranded, with many forgoing care altogether due to cost or lack of access.
In a country where economic challenges persist and foreign aid is dwindling, the dream of equitable healthcare for all seems increasingly elusive. Unless urgent and sustained action is taken to address the gaps in healthcare financing, service delivery, and public awareness, Kenya’s pursuit of UHC may remain a promise unfulfilled—one that continues to leave millions without the healthcare they desperately need.
