Growing concerns on Kenya's preparedness amid pandemic fears

As new pandemics continue to emerge across the globe, Kenyans are increasingly questioning whether the country is prepared for another health crisis.

Years of mismanagement, corruption, and financial instability have left the healthcare system fragile hospitals remain underfunded, patients struggle to access care, and medical workers are overwhelmed. Now, with the transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA), many are wondering whether the system has truly improved or if it remains just as vulnerable.

Veronika Wambui has been battling cervical cancer since last year, a journey that has tested both her strength and financial resilience. Despite the government's promise of equity under the Social Health Authority (SHA) and universal health coverage (UHC), she has found herself going from one fundraiser to another, pleading for help to cover medical tests and treatments.

The financial burden has been overwhelming. On top of the cost of care, Veronika is required to pay her insurance premium upfront, a condition that continues to strain her already struggling family. “I thought healthcare was supposed to be accessible to everyone, but here I am, forced to beg just to get tests done,” she says.

For many like Veronika, the transition to SHA has yet to translate into real change. While the government touts universal coverage, patients battling chronic illnesses still face significant barriers—from delayed approvals to out-of-pocket costs that push them into debt.

As she prepares for another round of tests, Veronika remains hopeful but frustrated. “I just want to focus on fighting cancer, not fighting for treatment,” she sighs. But until meaningful reforms take effect, equity in healthcare remains a promise unfulfilled for many Kenyans like her.

Samwel Onyango knows firsthand the devastating impact of an unprepared healthcare system. When COVID-19 struck, his father fell seriously ill in their rural village, where medical facilities were scarce and ill-equipped to handle the crisis. The hospital closest to them lacked essential supplies—most critically, oxygen. In a desperate attempt to save his father, Samwel’s family was forced to transfer him to a distant facility, an ordeal that came at an overwhelming financial cost.

“The expenses were unbearable, and even after the transfer, we struggled to find the care he needed,” Samwel recalls. “Many hospitals were overwhelmed, and the isolation policies only added to our pain. Families like mine were left helpless, unable to be by our loved ones’ sides in their final moments.”

Country's preparedness

Ultimately, his father succumbed to COVID-19, a tragedy worsened by underlying conditions that had gone undiagnosed due to limited access to healthcare. The experience left Samwel questioning the country's preparedness for future health emergencies.

Now, with the transition to SHA and the confusion surrounding its implementation, Samwel fears what would happen if another outbreak—whether a resurgence of COVID-19 or a crisis like Ebola—were to strike. “If our healthcare system was that fragile during COVID, how will it handle another devastating outbreak with all these new policy glitches?” he asks.

For Samwel, the painful loss of his father serves as a reminder of the urgent need for a healthcare system that is not only well-funded but also truly accessible to all, especially those in rural and underserved areas.

During the COVID-19 pandemic, glaring weaknesses in Kenya’s healthcare system were exposed. Access to healthcare was far from equal, with people in informal settlements and rural areas bearing the brunt of the crisis. Public hospitals were stretched beyond capacity, while private hospitals—often the only well-equipped facilities—were simply too expensive for most Kenyans. NHIF’s coverage was inadequate, benefiting only a fraction of the population and leaving many to fend for themselves.

Unprepared

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The country’s health infrastructure was unprepared for the surge in cases, with a severe shortage of ICU beds, ventilators, and personal protective equipment (PPE). Doctors and nurses went on strike, citing unpaid salaries and unsafe working conditions. Meanwhile, many Kenyans who fell sick had no choice but to pay out-of-pocket for treatment, as NHIF failed to fully cover COVID-19-related expenses. The absence of a universal health insurance system meant that millions faced financial ruin just to afford care.

Routine healthcare services were also severely disrupted. Lockdowns and curfews limited access to essential services such as maternal care, childhood immunizations, and chronic disease management. Many people avoided hospitals altogether, fearing exposure to the virus. At the same time, the economic devastation caused by the pandemic made matters worse—millions of Kenyans lost their jobs, leaving them unable to afford healthcare at a time when they needed it most. Informal sector workers, who were already excluded from health insurance benefits, found themselves without any safety net.

The Social Health Authority (SHA) was introduced to bridge healthcare gaps, but the high cost of premiums and systemic confusion have already marred its rollout. Payslips are becoming thinner as Kenyans struggle to keep up with deductions, yet access to quality care remains a challenge.

Many patients have lost their lives due to delays and inefficiencies, while millions remain hesitant to enrol. Although the government has registered nearly 18 million Kenyans, only 3.3 million have completed the means testing, raising concerns about the programme’s accessibility and effectiveness—especially in the event of another pandemic.

Under SHA, several hospitals have expressed frustration, with some—such as the Rural Private Hospitals Association (RUPHA)—even suspending services. Many cite the outstanding NHIF debt, which had reportedly accumulated to Sh30 billion, as a major obstacle to operations.

Appearing before the Senate on Wednesday, Health Cabinet Secretary Deborah Barasa revealed that as of September 30, 2024, NHIF accounts held Sh1.4 billion. She stated that SHA is currently in the process of closing all NHIF accounts, except for one designated to collect NHIF ledger contributions from employers and government institutions to clear outstanding debts.

The transition to SHA has also sparked concerns among lawmakers. Senator Okiya Omtatah (Busia) questioned the logic behind funding universal healthcare through premiums, arguing that no country in the world implements UHC in such a manner.

“Universal health coverage (UHC) means no one is left behind, but paying premiums means only those who can afford it get access. How is it universal if people have to pay to receive care? No country in the world funds UHC through premiums—it is supported by taxes to ensure everyone gets healthcare. So, when did Kenya move from the Abuja Declaration, which focused on government-funded healthcare, to a system where people must pay to access services under SHA?” said Senator Omtatah.

African leaders in the wake and post-COVID voiced concerns over the lack of equity in global healthcare systems during the COVID-19 pandemic, highlighting how developing nations were left behind in access to vaccines, medical supplies, and financial support.

“The pandemic exposed deep inequalities between the Global North and the Global South,” said South African President Cyril Ramaphosa, adding that Africa was forced to wait in line for vaccines while wealthier nations secured doses for their populations first.

Kenyan President William Ruto echoed similar concerns, stating, “We witnessed firsthand how Africa was sidelined in the global COVID-19 response. Access to life-saving medical supplies should not be determined by a country’s wealth.”

Former Ghanaian President Nana Akufo-Addo also emphasized the need for Africa to strengthen its own health systems: “If we do not invest in our healthcare infrastructure, we will always be at the mercy of others in times of crisis.”

As Kenya moves forward with SHA, the question remains: Is the country truly prepared for another pandemic? The high unemployment rate has pushed many Kenyans into the indigent category, yet the government insists that everyone above 25 years old must pay SHA premiums. Without a clear path to equity, millions remain vulnerable to the next health crisis.