The success of Kenya’s health reforms will ultimately be judged at the hospital level, President William Ruto said, as he called for a closer look at whether patients are receiving affordable, reliable and dignified care.
Ruto said the government should not rely only on new laws, registration figures or other official records when assessing the changes made in the health sector. Instead, he said the views and experiences of Kenyans seeking treatment should guide the next stage of the reforms.
He spoke on Tuesday during the Ministry of Health’s first Kenya Health Summit, where government officials, county leaders, health workers and other stakeholders reviewed the progress and problems affecting the sector.
The meeting was held under the theme “Reforms Delivered, Health as a Right”.
Ruto said bringing back Universal Health Coverage (UHC) was among the priorities he set after taking office, noting that he considered the programme to have been on its deathbed at the time.
He said UHC was therefore placed among the five main pillars of the Bottom-Up Economic Transformation Agenda.
According to the President, improving the economy would have little meaning if illness continued to take away household savings or leave families struggling with poverty.
This was one of the reasons his administration moved to introduce four health laws in 2023, leading to the establishment of the Social Health Authority (SHA).
Ruto said 32.3 million Kenyans had registered with SHA, while more than eight million had already accessed treatment through the new system.
Among those who have benefited are about 1.2 million mothers who received support to give birth safely. The President also said more than 500,000 surgical procedures had been carried out since the system began.
He cited the figures while responding to criticism that his administration had moved away from the “hustler” agenda that helped define his campaign.
Ruto said the number of ordinary Kenyans using SHA was evidence that the reforms were reaching the people his government had promised to support.
“Reform is not an event. It is a continuous journey of closing the distance between the promise we made and the experience of every Kenyan who seeks care,” he said.
The President also called for the health sector to build on areas where reforms were delivering results while addressing weaknesses and closing gaps that continue to affect patients.
Council of Governors chairman Ahmed Abdullahi defended the record of devolved healthcare, saying the system had not collapsed despite the difficulties experienced since health functions were transferred to counties.
Abdullahi said 16 years after the Constitution introduced devolution in health, political divisions were among the main issues slowing progress in the sector.
He described toxic politics as a bigger problem than the structure of devolved healthcare.
However, health sector representatives attending the summit gave a different picture of the challenges still facing patients and workers.
Nelly Munyasia, executive director of Reproductive Health Network Kenya, said the country had recorded gains in reproductive health, particularly through the development of policies.
She said the bigger challenge was ensuring those policies translated into regular services for patients at health facilities.
“The key challenge now is moving from policy and programmes to consistent implementation at the point of care,” she said.
Munyasia said the sector needed steady funding, adequate supplies, improved infrastructure and enough skilled health workers.
She also called for stronger referral and data systems and better cooperation between communities and health facilities.
Patrick Oyaro, a project director at Liverpool VCT and Research Kenya, said SHA needed to cater for people living with HIV as the country adjusts to reduced dependence on donor funding.
He said HIV programmes had for many years relied on donors, creating a need for a new approach to funding and delivering these services under the country's health insurance system.
“For a long time, HIV has been donor funded. When the initial packages of SHA were made, we didn't have packages for HIV. We need to change that,” he said.
Oyaro said LVCT was assisting county governments to seek funding from private organisations as Kenya moves through the transition from donor-supported programmes.
He said the organisation was also training counties on how to make SHA claims to support HIV and tuberculosis programmes.
The summit took place as an industrial strike involving Universal Health Coverage workers and nurses continued, putting the working conditions of health professionals among the issues under discussion.
Peterson Wachira, chairman of the Kenya Union of Clinical Officers, said Kenya's healthcare system had failed to reach the ambitions set out under Vision 2030.
He said the long-term plan had targeted making Kenya Africa's medical tourism hub by 2030, but the country was still some distance from achieving that goal.
Wachira also criticised the level of government spending on healthcare, saying Kenya had not attained the Abuja Declaration commitment to allocate 15 per cent of the national budget to the sector.
He said the management of health workers under county governments had created several problems, including fragmented systems, nepotism and the exploitation of staff.
The union is calling for a centralised human resources system and the formation of a Health Service Commission to manage health workers.
Brown Ashira, secretary-general of the Kenya Environmental Health and Public Health Practitioners Union, said public health was another area facing serious financial and staffing challenges.
He said Kenya was yet to give enough attention to public health measures despite growing threats from pollution and climate change.
“There is still low absorption, recruitment, replacement and uptake of public health officers, specialists and technicians in this country. Food safety and disease surveillance across our borders remain the worst-hit areas,” he said.
Dr Dennis Miskella, deputy secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union, said shortages and poor management of health workers remained a major concern.
He cited the doctors' strike in Isiolo and salary delays affecting more than 40 counties as signs of the problems facing the workforce.
Miskella proposed a clearer division of responsibilities, with county governments managing primary healthcare and the national government taking charge of curative services.
The different views presented at the summit showed that while the government points to SHA registration and treatment figures as signs of progress, health workers and sector organisations continue to raise concerns about what happens at the point where patients seek care.
Ruto said the reforms should therefore remain an ongoing process, with the government listening to Kenyans, fixing weaknesses, protecting what is working and expanding successful programmes to more parts of the country.