Kenya's national conversation on universal healthcare must ultimately move beyond legislation, registration figures and institutional structures to one fundamental question: can every Kenyan obtain quality healthcare without being pushed into poverty?
Universal healthcare is realised not when a card is issued, but when a mother delivers safely, a child receives treatment without delay, medicines are available, healthcare workers are adequately supported and no family sells its property to pay a hospital bill.
Mombasa's experience demonstrates that this ambition is achievable, but only when national policy is matched by strong county delivery systems.
Counties operate the facilities, employ most frontline workers and respond directly to patients. National institutions provide policy leadership, insurance financing and specialised support. Neither level can deliver universal healthcare alone.
In Mombasa, we have treated healthcare as an interconnected system founded on accessibility, adequate personnel, modern infrastructure, prevention and financial protection. The results have positioned our county as an important case study in Kenya's transition towards universal healthcare.
Although Mombasa has more private than public health facilities, county government facilities attend to more than 80 per cent of patients seeking treatment. Coast General Teaching and Referral Hospital also serves patients from all six coastal counties and beyond.
This demonstrates the confidence residents have in public healthcare, but it also illustrates the disproportionate burden carried by referral hospitals in host counties.
Our first priority has been rebuilding the workforce. Mombasa had 2,239 healthcare workers in 2022. That number has grown to 3,749 – a 67 per cent increase. We have recruited nurses, doctors, clinical officers, specialists and other essential cadres while transitioning hundreds of workers from casual to contractual employment.
A workload analysis guided by World Health Organisation standards indicates that Mombasa requires about 5,600 healthcare workers. Our journey is therefore not complete.
We must continue closing this gap while confronting a wider national challenge: counties cannot sustainably expand their health workforces when financing is uncertain and intergovernmental transfers are delayed.
The recent national resolution to convert universal health coverage staff to permanent and pensionable terms was therefore welcome. However, this commitment must be backed by predictable financing, adequate provision in the Division of Revenue and County Governments Additional Allocations frameworks, and timely reimbursement by the Ministry of Health. Universal healthcare cannot be delivered through an insecure workforce.
Staff welfare is equally important. Our promotion of 70 doctors, pursuant to the collective bargaining agreement between the Council of Governors and KMPDU, was an investment in service quality. Of those promoted, 42 were women, while the beneficiaries represented 13 communities and several specialties.
A health system that respects diversity, recognises merit and provides professional growth is better equipped to care for a diverse population.
The transition to the Social Health Authority is another critical component of Kenya's universal healthcare reforms. By July, Mombasa had registered more than one million residents - about 83.5 per cent of our population, compared with a national rate of 67.7 per cent.
This achievement was driven by community mobilisation, cooperation with the national government, our healthcare workers, community health promoters and serikali mtaani administrators. It demonstrates that national programmes succeed when they are translated into trusted, local engagement.
Registration, however, is only the beginning. Coverage must lead to accessible services and the timely settlement of claims. Hospitals must have the medicines, personnel and equipment required to treat the people registered under SHA.
The national conversation must therefore measure success not merely by enrolment, but by active coverage, utilisation, quality of care and protection from catastrophic expenditure.
Through Executive Order No. 6 of 2026, I directed county health facilities to use facility improvement funds to pay annual SHA premiums for qualifying indigent patients.
No person presenting at our facilities should be denied registration, consultation, admission or treatment because they cannot afford the premium.
This is the principle behind MombasaCare: healthcare is a constitutional right, not a privilege determined by income. We have carried the same principle into our free treatment programme for children under five.
Visits increased from 462,167 in the 2023-24 financial year to more than 800,000 by the middle of the following financial year. When financial barriers are removed, families seek treatment earlier and avoid preventable complications.
We have also waived mortuary charges for the first seven days at Coast General and established the 1599 hotline and MombasaCare desks, supported by 69 agents. Universal healthcare must be simple to navigate. Citizens should not be defeated by paperwork, unclear procedures or fragmented information.
Infrastructure is equally central to our model. We are redeveloping Likoni Level 4 Hospital through a Sh400 million partnership with the Dawoodi Bohra community.
The Likoni Mother and Child facility is expanding maternal, neonatal and theatre services. The Raila Odinga Kongowea Level 4 Hospital will bring comprehensive care closer to residents of Nyali and adjoining areas, while our wider programme includes facilities in Port Reitz, Mikindani, Mjambere and Bofu.
At Coast General, we have commissioned a second linear accelerator, doubling radiotherapy capacity to approximately 120 to 140 patients daily.
This investment is especially important as the hospital's oncology workload has grown from approximately 6,000 to 13,000 patients within three years. The Faraja Cancer Wellness Centre, supported through a Sh63.2 million M-Pesa Foundation grant, will complement treatment with psychosocial and wellness support.
Our proposed 1,000-bed level 6 hospital in Jomvu represents the next frontier. Planned on 30 acres, it will expand advanced referral care, training and research for Mombasa, the Coast region and Kenya.
Through the Technical University of Mombasa medical programme, we are also training doctors who can serve within this expanding system.
Mombasa's experience offers Kenya five clear lessons. Universal healthcare requires a motivated workforce; reliable financing; strong primary and community healthcare; modern, well-equipped facilities; and genuine cooperation between the national and county governments.
As governor, chairperson of the Council of Governors Health Committee and ODM’s deputy leader, I believe this is also a question of social justice.
The test of our politics is whether government protects citizens at their most vulnerable. A nation cannot claim progress while illness continues to condemn families to poverty.
The future of universal healthcare will not be secured through competition between institutions or political formations. It will be built through cooperation, accountability and the recognition that counties are not peripheral participants - they are the principal delivery platforms.
Mombasa has not solved every challenge. We still need more personnel, stronger financing, greater digitisation, dependable medicine supplies and sustained investment in prevention. Nevertheless, our direction is clear and our progress measurable.
The national promise of universal healthcare can become a lived reality. Mombasa's journey shows that when political commitment, community participation and intergovernmental cooperation come together, every Kenyan can receive care with dignity, regardless of income or place of residence.
