As Kenya steps into 2026, its healthcare sector is still grappling with a widening gap between ambitious policy goals and on-the-ground implementation.
Despite comprehensive frameworks aimed at achieving Universal Health Coverage (UHC), the healthcare system in 2025 exposed deep challenges in funding, staffing and service delivery that continue to undermine progress.
The commemoration of last year’s Universal Health Coverage (UHC) Day offered a reality check on the country’s reform journey, particularly on funding and human resources.
In the 2025/26 budget, the health sector received Sh138.1 billion, an 8.74 percent increase from Sh127 billion the previous year. While this marked the largest health budget allocation in Kenya’s history, it told only part of the story.
The allocation amounted to just 3.3 percent of the total government budget, well below the Abuja Declaration target, which requires African nations to allocate at least 15 percent of their national budgets to health.
“The Abuja Declaration also includes a commitment by the government leaders to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilised. The governments further pledged to devote 15 percent of their budgets to improving the health sector,” reads a section of the declaration.
Chronic underfunding
More concerning were cuts to critical programmes. Funding for UHC, one of the government’s flagship initiatives, was reduced sharply from Sh42 billion in 2024/25 to Sh6.2 billion.
Similarly, the allocation for medical cover for orphans, the elderly and persons with severe disabilities was cut from Sh861.5 million to Sh430 million.
Dr Robert Pukose, former chairperson of the Health Committee, said chronic underfunding could have direct consequences for households.
"One of the biggest challenges is still the persistent high cost of healthcare experienced by households, which is majorly driven by the high cost of pharmaceutical products," he said, adding that "for every Sh100 spent in healthcare in Kenya, Sh30 is out of pocket."
Beyond financing, Kenya faces a severe human resource crisis. The country has about 30 doctors, nurses and clinical officers per 10,000 people, far below the World Health Organisation (WHO) recommendation of 45 per 10,000. The doctor-to-patient ratio stands at one doctor for every 5,263 people, compared with the WHO benchmark of one for every 1,000.
A recent WHO assessment warns that the shortage could exceed 114,000 health workers by 2030 and reach 170,000 by 2035 without urgent intervention.
The situation is worsened by the continued emigration of trained medical professionals seeking better opportunities abroad, while those who remain often contend with delayed salaries and poor working conditions.
Shortages are most acute in rural and underserved areas, where some facilities operate at less than half their required staffing levels.
Tom Coleman, Portfolio Director for Informa Markets, warned that the workforce gap threatens Kenya’s healthcare ambitions.
"Without enough doctors, nurses, and laboratory professionals, Kenya's health system cannot scale up to meet the growing demand for care," he said.
Demand for healthcare is also rising faster than workforce growth, with the sector expanding at 3.4 percent annually while patient needs are increasing at 4.7 percent, according to WHO.
Despite these pressures, Desta Lakew, Group Director of Partnerships and External Affairs at Amref Health Africa, expressed cautious optimism.
"The five transformative health laws passed in 2023 have laid a robust foundation, ensuring equitable access to services, sustainable financing, interoperable digital systems, and a people-centred, data-driven health system. I hope that these structures will attract greater political goodwill and innovation toward scalable, people-first solutions that can be replicated across Africa," he said.
SHA launch
One of the most significant reforms was the launch of the Social Health Authority (SHA) in October 2024, Kenya’s most ambitious healthcare financing overhaul to date.
By November, about 27 million Kenyans had registered under SHA. However, implementation challenges have threatened to undermine its promise.
By September, only about 860,000 contributors were from the informal sector, alongside 4.3 million salaried contributors. This meant that just 4.3 million people were paying into the contributory fund out of 27 million registrations, creating a significant funding gap that has strained healthcare providers.
“The SHA financing base appears weak as it is heavily dependent on contributions from the formal sector or salaried employees who are a minority in the workforce,” the Parliamentary Budget Office (PBO) noted in its analysis.
Despite reforms to healthcare financing, financial protection remains limited. The PBO estimates that Kenyans spend about Sh150 billion annually on out-of-pocket healthcare, with only one in four people covered by any form of health insurance.
The Kenya National Bureau of Statistics Consumer Price Indices and Inflation Rates 2025 Report shows healthcare costs rose by 3.3 percent over the year, increasing the burden on vulnerable households.
"The rise in healthcare costs will make it more difficult for people to afford healthcare services and also expose them to the risk of becoming poor due to high out-of-pocket healthcare payments," said Christine Akinyi, an advocate of the High Court and programme officer at the International Commission of Jurists–Kenyan Section.
Community health units
On technology, the Community Health Strategy envisioned full household registration and digitised service delivery through the Electronic Community Health Information System (eCHIS) by 2025. However, implementation has reached only about 70–75 percent household coverage, with just 60 percent of Community Health Units fully operational.
Many community health promoters still record data offline, often using personal funds to buy internet access for monthly reporting. As a result, about 40 percent of reports miss synchronisation deadlines, creating data gaps that hinder planning and resource allocation.
Primary Care Networks (PCNs), designed to coordinate care across community, clinic and hospital levels, also remain unevenly implemented. Only 25–30 counties have functional networks, with wide variations in quality.
While some counties have reduced unnecessary hospital referrals through better integration, arid and semi-arid regions record implementation rates below 10 percent. This has been attributed to differing county interpretations of the model, fragmented funding and coordination challenges in resource-constrained settings.
