The scam that is Kenya's healthcare system

Kenya’s health sector has always stood at the centre of public debate, and for good reason. Recently, it’s become the talk of town, with SHA becoming an acronym for corruption. It’s a conduit for siphoning money from public coffers into private hands.

We have heard of hospitals the size of a mama mboga kiosk getting hundreds of millions from the fund. We heard of huge sums paid to nabobs running SHA while patients cannot access aspirin. It’s a mess.

The transition from the National Hospital Insurance Fund to SHA was to solve old problems but is quickly proving to be just another costly avenue for theft. The NHIF, for all its faults, was at least familiar. Kenyans knew it, understood its bureaucracy, and despite inefficiencies, many people benefited. But in typical Kenyan fashion, the government declared the scheme broken, scrapped it and rolled out a new “social healthcare” framework.

The rollout came with much fanfare, new logos, new computer systems, and of course, new tender opportunities. Billions were sunk into this transformation. Yet today, the lived experience of ordinary Kenyans seeking care has has worsened. At the heart of the problem is not the structure of the scheme but the political economy of healthcare in Kenya. Every new programme becomes a cash cow for well-connected contractors, suppliers, and consultants. Funds earmarked for medical equipment, rural hospitals, and health worker support often vanish into the pockets of cartels and politically connected elites. By the time the dust settles, the patient in Busia, Garissa or Turkana still finds themselves begging.

The frustrations of frontline health workers tell the story best. I recently spoke with a doctor in a far-flung hospital. His words painted a grim but honest picture. “Even where there is some good equipment, it just doesn’t work,” he told me. They have to scrounge for the most basic items to do their work, including buying their own gloves.

It’s a common story. A simple blown fuse, a small electrical fault, or a minor mechanical hitch can render an entire machine useless for months. There are no biomedical engineers to fix them. The irony is the government spends billions importing shiny new machines, but once they break down, they gather dust because nobody has planned for spare parts, maintenance or technicians. This neglect speaks to a deeper problem — the obsession with politicising everything and viewing everything from the lens of greed. We should be focusing on ensuring our hospitals have a steady supply of drugs, that our doctors and nurses are paid on time and that equipment in hospitals work.

The transition to social healthcare was pitched as a bold step toward universal health coverage, one of the government’s flagship promises. But universal health coverage is not just about creating a new fund or demanding higher contributions from citizens. It is about access, equity, and sustainability. A mother in Samburu should be able to access the same quality of care as one in Nairobi. A child in Homa Bay should have working diagnostic machines just as one in Nakuru. Today, that is simply not the case. Instead, inequality deepens as those who can afford private healthcare flee the public system, while the majority are left to navigate a collapsing framework. The economic cost of this failure is staggering. Families are pushed into poverty by catastrophic health expenses when the so-called social health insurance refuses to pay or when services are unavailable. Hospitals turn away patients because they cannot claim reimbursements on time. Health workers, demoralised and overworked, strike for better pay and conditions. And the cycle continues.

What Kenya needs is not another cosmetic rebranding of healthcare schemes but a deep structural reset. First, accountability must be non-negotiable. Every shilling spent in the health sector must be tracked. The government must invest in human capital as much as it does in equipment. Maintenance and supply chains must be prioritised over flashy new procurements. A well-maintained X-ray machine is more valuable to a patient than a multimillion-shilling CT scanner that no longer works. Finally, community-based health systems need to be strengthened so that preventive care reduces the load on hospitals.

-Writer is a communications consultant