Kenya’s ambitious push towards universal health coverage is being undermined by chronic weaknesses in medicine financing, fragmented county systems and heavy dependence on imported pharmaceuticals.
According to a new health supply chain report, poor coordination, weak policy implementation and inadequate investment in medicines and medical supplies are undermining major structural reforms in the sector.
The 2025 Kenya Annual Report by the Africa Resource Centre notes that despite increased government spending on healthcare under President William Ruto’s Bottom-Up Economic Transformation Agenda, counties still allocate only about 10 per cent of their health budgets to medicines and medical supplies.
“The extent to which the allocated budget met the demand forecast ranged between 21 per cent and 71 per cent, which presented limited fiscal space at the county level,” the report states.
The findings raise questions about the sustainability of Kenya’s universal healthcare agenda at a time when the government is rolling out the Social Health Insurance Fund and promising improved access to healthcare services.
The report notes that although Treasury allocated Sh138.1 billion to health in the 2025-26 financial year, procurement and supply chain financing remain sub-optimal, contributing to continued shortages and uneven access to essential medicines across counties.
It warns that weak systems at county level continue to undermine service delivery nearly 15 years after the introduction of devolution.
A baseline assessment conducted across 46 counties found that 51 per cent remained in the two lowest maturity levels for health supply chain systems.
Significant variation in HPTU maturity exists across counties, the report says, with only 49 per cent reaching the desired performance levels.
The report also found major weaknesses in policy formulation in the health sector itself.
According to the review of submissions made during the revision of the Kenya National Pharmaceutical Policy, “91 per cent of the policy actions proposed were found not to promote equity and fairness in access to health products and technologies … they were self-preserving.”
Further, only 38 per cent of policy submissions were backed by supportive evidence, while just six per cent had input from affected communities or relevant groups.
The findings suggest that many healthcare policy proposals are being developed without sufficient public participation or evidence-based analysis, raising broader governance and accountability concerns.
The report further highlights Kenya’s continued dependence on imported medicines despite repeated government promises to grow local pharmaceutical manufacturing.
A comprehensive manufacturing assessment found that only 20 per cent of formulations on the Kenya Essential Medicines List are produced locally.
Even more striking, the report says, very few medicines for maternal and neonatal care are manufactured in Kenya.
“Only Chlorhexidine 7.1 per cent gel, Salbutamol 500mcg injection and magnesium sulphate 500mg/mL injection were being produced locally for key maternal and newborn conditions, each by a single manufacturer.”
The findings come amid growing debate across Africa over pharmaceutical sovereignty and the continent’s vulnerability to global supply chain disruptions exposed during the Covid-19 pandemic.
The report argues that Kenya requires “a paradigm shift toward strategies that build long-term capacity, sustainability and local ownership rather than short-term project-based interventions”.
Among the key focus areas in the reforms is the Kenya Medical Supplies Authority, the state agency responsible for distributing medicines and medical supplies nationwide.
The Africa Resource Centre says it has been supporting Kemsa through projects aimed at reducing inefficiencies and lowering distribution costs through integrated delivery systems and strategic network optimisation.
The report projects that integrating vertical supply chains for HIV, malaria, family planning and essential medicines could reduce distribution costs by 15 per cent.
However, the reforms also come against the backdrop of long-standing public concerns over Kemsa’s governance, including procurement controversies and questions over operational efficiency.
In response to persistent access challenges, Kenya is increasingly turning to private-sector partnerships and community-based care models.
One of the most notable innovations highlighted in the report is the Community Pharmacy Model, which allows HIV patients to collect antiretroviral drugs from private pharmacies instead of hospitals.
More than 700 patients across four counties had enrolled in the programme by November 2025.
The model, according to the report, reduces transport costs and waiting times, while easing pressure on congested public health facilities.
“Medicines come near me as opposed to me-go-to medicine,” the report states in describing the philosophy behind the programme.
The initiative is also expected to expand to cover non-communicable diseases and family planning commodities.
Still, the report cautions that reforms alone may not be enough without stronger coordination between national government, counties, donors and private actors.
“Competing priorities for national teams and misalignment between partner missions and government priorities require ongoing attention and coordination,” it says.
