Kenya’s public health system is built to fail the poor
Quality healthcare is reserved for the wealthy, despite being a right enshrined in the constitution for all citizens
By Brenda Osoro*
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% 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% 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 percent 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 Ksh132 billion, less than 4% of total government spending. At the same time, Kenya directs nearly 67% 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, Members of Parliament receive annual medical cover worth Ksh10.65 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 enrol in SHA, like the people they represent, was tabled in 2025 but never brought to the floor for debate.
Kenyans are fed up with this, and they’re organising. Fight Inequality Alliance Kenya has been training communities on budget literacy and how to engage county governments. This enables ordinary people to analyse the budget, identify the gaps, and advocate for what they actually need, including with respect to health.
We’re starting to see real impacts. In 2025, FIA-trained citizens successfully fought for an increase of over Ksh.15 million in Vihiga County's proposed health allocation. In 2026, public health will remain a central pillar of our work across the country.
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.
The illegitimate debt suffocating the economy must be scrapped, because a country that spends more on interest payments than on keeping its people alive has its priorities backwards.But above all, 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.
Brenda Osoro is the National Coordinator for Fight Inequality Alliance Kenya