Lives of millions at risk over poor health system, say lobbies

If you lost your job or suffered a chronic illness, you risk losing your wealth and life due to corruption, under budgeting and a failed system, a report by civil society groups has shown.

The report compiled by the entities contributing to the UN’s peer review mechanism says up to 80 per cent of Kenyans have aggravated risk of getting economically gutted if a health crisis strikes.

This follows the government's consistent reduction of the health budget and the diminishing ratio of health workers to the population.

The current doctor-to-patient ratio in Kenya is still far below WHO recommendation of one doctor to 1,000 patients and 25 nurses per 10,000 patients.

The ratio of nurses is 42,487 nurses per 10,000 people and 5,559 general medical officers for every 10,000 people.

Recent protests by doctors and interns evidence a gap in financing, as the Ministry claimed an inability to post interns due to a lack of funding.

The lobbies also question the capacity of the social health insurance architecture to provide dependable cover for millions, given the teething challenges that have emerged in the implementation of SHA and inefficiencies in the defunct NHIF.

“Only 19.9 per cent of Kenyans were registered under the previous national social health insurance scheme, NHIF. This meant 80.1 per cent were unable to access healthcare and had to pay out of pocket for services,” the report says.

The Social Health Insurance Act, 2023, repealed the NHIF Act and as at October 1, last year the government transitioned to a new model administered by the Social Health Authority.

Heavy reliance on donor funding and public-private partnerships has also affected the priority setting for budgetary allocations for health, the lobbies say.

For example, domestic funding for HIV prevention increased from $31 million (Sh4 billion) in 2017 to $38.5 million (Sh4.9 billion) in 2022 while international funding over the same period increased.

“Overall HIV expenditure reduced from $254.1 million (Sh32.5 billion) to 111.8 million (15.2 million) in 2022. Budgetary allocation in 2022-23 was to the tune of Sh1.2 billion for the procurement of family planning and reproductive health commodities. However, in 2024-25, there was no allocation for family planning or related expenses,” it reads.

Still on the national health budget challenge, the lobbies say the allocations have consistently been on declined over the years, falling short of recommended WHO guidelines and Abuja Declaration recommendations of five and 15 per cent.

In the 2022-23 budget, the health sector at national level was allocated a total of Sh122.52 billion which was 3.69 per cent of total and 0.97 per cent of GDP.

Nominally, allocation increased by 1.18 per cent from Sh121.09 billion in 2018-19 to Sh122.52 billion in 2022-23 financial year.

“However, the share of the health sector to total budget reduced from 3.97 per cent in 2021-22 to 3.69 per cent in 2022-23 and as a share of GDP reduced from 1.08 per cent in 2021-22 to 0.97 per cent in 2022-23.”

Despite a significant increase in health sector allocations over the past five years–36 per cent increase from Sh90 billion to Sh122.52 billion–health sector allocations as a share of the total national budget have slightly reduced from 3.70 per cent to 3.69 per cent and 1.06 per cent to 0.97 per cent.

Moreover, corruption and accountability problems in the sector is enhancing the health risks for Kenyans as monies are embezzled, making donors to withdraw.

The lobbies say Kenya's health sector lacks accountability and transparency.

They cite the National Ethics and Corruption Survey, 2021, which ranked the health sector as the second most corrupt nationally.

Also, the Ethics and Anti-Corruption Commission in 2023 reported pervasive corruption in all phases of the health sector project management processes.

Scarce financial resources are further depleted owing to poor resource management and misappropriated funds, ultimately eroding public trust and undermining service delivery, it says.