Transforming Kenya’s Health Sector: Ruto’s Reforms Two Years On

Since President William Ruto assumed office on September 13, 2022, his administration has implemented significant reforms in Kenya’s health sector, targeting the longstanding barriers that prevent access to affordable and quality healthcare. A major component of this transformation is the establishment of the Social Health Authority (SHA), which is set to begin operations on October 1, replacing the 66-year-old National Hospital Insurance Fund (NHIF). This shift, along with other initiatives, marks a pivotal moment in Kenya’s journey towards achieving Universal Health Coverage (UHC).

Structural Changes and Infrastructure Development

One of the most notable changes under Ruto’s administration has been the replacement of NHIF with SHA. This new entity aims to provide enhanced services to all Kenyans, regardless of economic status. SHA Chairman Timothy Olweny has stated that these reforms will address the gaps that existed under the previous system, setting the stage for a more inclusive and effective healthcare provision model. To support this transition, four new laws have been enacted: the Primary Health Care Act, Digital Health Act, Social Health Insurance Act, and Facility Improvement Financing Act. These laws provide a solid legal framework that underpins the new system.

Infrastructure improvements have also been a focus, with a 1.7 percent increase in the number of Level 4 hospitals, rising from 357 in 2022 to 363 in 2024. Additionally, six specialized facilities have been established to cater to more complex health needs. The Kenya Medical Supplies Agency (KEMSA) has undergone a revamp, resulting in a three percent increase in the fill rate of essential drugs and health products—from 59 percent in 2022 to 62 percent in 2024. This improvement was made possible through a Sh500 million recapitalization effort aimed at bolstering the supply chain.

Primary Health Care as the Cornerstone of UHC

A central pillar of Ruto’s health sector reforms is the emphasis on primary healthcare. The administration has established 150 primary care networks (PCNs) with an additional 41 in progress, a remarkable increase from just seven in 2022. These networks, which are expected to expand to 315 across all 47 counties, consist of dispensaries, health centres, and at least one Level 4 hospital. Unlike NHIF, which restricted patients to a single facility for outpatient services, SHA allows access to all lower-level facilities within a PCN, thus improving flexibility and accessibility for patients.

Community Health Promoters (CHPs) play a vital role in the new system, with their numbers having increased from 29,000 in 2022 to 107,000. These CHPs are tasked with delivering promotive and preventive care at the community level, making healthcare more accessible by bringing services to the doorstep of every Kenyan. This approach not only alleviates the burden on hospitals but also emphasizes prevention over treatment, aligning with the administration’s goal of shifting from a curative to a preventive healthcare model.

Financial Support for Chronic and Critical Illnesses

In addressing the financial burden of chronic illnesses such as cancer, hypertension, and diabetes, the government has established the Emergency, Chronic, and Critical Illness Fund. This fund provides much-needed support for the long-term management of these conditions, reducing the strain on household incomes. It serves as a safety net, ensuring that even when allocations under the Social Health Insurance Fund (SHIF) are exhausted, patients can still access the care they need at no additional cost.

Towards a Fair and Equitable Healthcare System

The SHA seeks to make healthcare provision fair, equitable, and progressive. The system will be funded through a 2.75 percent deduction from the salaries of formally employed Kenyans, contributing to a more sustainable model for healthcare financing. As Kenya moves towards realizing UHC, these reforms are expected to have a lasting impact on the health and wellbeing of the nation, making quality healthcare accessible to all. President Ruto’s administration is not only addressing the current gaps but also laying the foundation for a healthier and more resilient future for Kenya.