Health Summit: The sector's sick reality buried in lofty speeches

President William Ruto during the presidential town hall at the KICC in Nairobi on August 18, 2026. [PCS]

For a moment, everything seemed to work smoothly in a Health docket that has been plagued by challenges.

This was the picture portrayed during the Health Summit, which culminated in a presidential town hall at the Kenyatta International Convention Centre (KICC) in Nairobi on August 18, 2026.

The engagement was meant to give Kenyans an opportunity to share their experiences, concerns and expectations, while accounting for reforms delivered and collectively shaping the next phase of the Universal Health Coverage (UHC) journey.

But as the engagement unfolded, health workers, government officials and hospitals largely praised the health sector, narrowing the discussion to the Social Health Authority (SHA) and maintaining that it was working smoothly.

The glowing assessment has left experts, healthcare providers, patients and Kenyans at large asking: Why are there complaints from across the country if SHA and the healthcare system are operating smoothly?

Questions have also emerged over whether Kenya has truly attained UHC — and, if not, who is fooling whom?

The praise for the health sector came even as Kenya confronts the reality of patients struggling to access care amid persistent health workers’ strikes, medicine shortages, including contraceptives, delayed treatment and gaps in the provision of essential services.

Hospitals, ranging from private to faith-based facilities, have also complained of SHA inefficiencies, including delays in treatment authorisation and reimbursement of claims.

National referral facilities have similarly raised concerns over delayed reimbursement, which they say is affecting service delivery.

Yet these concerns remained largely silent during the event presided over by President William Ruto.

SHA praised by hospitals

A number of top private and faith-based facilities, among them Tenwek, The Karen Hospital and Mater, praised SHA.

For Tenwek, SHA has been a saviour in providing access to quality care.

“Under the defunct NHIF, the hospital used to have a store of title deeds, but things have changed,” noted the hospital representative.

A representative of Mater said SHA is working, and that the management has engaged SHA on several occasions for smooth operation.

Though the services are smooth, she asked SHA management to ensure claims are paid continuously and on time.

Top management from dispensaries, health centres, Level Four facilities and Kenyatta National Hospital (KNH) all gave positive testimonials.

KNH Chief Executive Officer Richard Lesiyampe also praised the social health scheme.

The town hall engagement kicked off with a presentation of some stories that had been published in print media and aired on television about SHA inefficiencies and procurement of the Authority’s digital superhighway.

Uasin Gishu Senator Jackson Mandago, who is also the chairperson of the Senate Health Committee, also joined the praise of SHA, instead of playing an oversight role.

“I can confirm SHA is working. SHA is working and there is evidence it is working,” said Mandago.

Mandago’s praise came despite MPs poking holes in SHA’s operations, including delayed payment of hospital claims by the Authority and procurement of its digital superhighway.

MPs have also raised concerns over some health services not provided under SHA, including downtime witnessed in the past two years since it replaced NHIF.

During the engagement, Nairobi Woman Representative Esther Passaris said that although SHA is working, there is a need for the Ministry of Health to sensitise Kenyans more on registration, services provided and benefit tariffs.

Passaris proposed the establishment of a customer centre that would share finer details on SHA’s operations with Kenyans when needed.

She narrated how she received a phone call from a patient who had been admitted to hospital for two weeks and did not have her bill cleared.

The patient, however, had not registered for the scheme or paid premiums.

“We need to educate Kenyans more. Hospitals also need to be educated, with effective advertising done. Social media is cheap. Ministry of Health needs to do more education on premiums and how to onboard. Ministry is letting you [President] down,” said the Woman Representative.

In a quick rejoinder, SHA CEO Mercy Mwangangi reminded Kenyans that to access SHIF, individuals must register and contribute before they are admitted to hospital.

She said there is also a customer care number, including SHA branch officers, where Kenyans can seek information on SHA.

At the same time, Passaris shared the alleged frustrations of private hospitals over delays in the remittance of SHA claims.

The Nairobi Woman Representative mentioned a top Level Six hospital in Nairobi, claiming to have been in communication with its CEO, who complained about payment of SHA claims.

This attracted the attention of President Ruto, who took the mobile phone number of the said CEO and directly called him during the engagement.

The CEO, however, did not pick up the phone call. Passaris laughed it off, saying that the CEO could have been performing surgery.

As the conversation about SHA continued, a top manager of the said facility contradicted her CEO’s statement on SHA inefficiencies.

In a shocking revelation, the manager said the information shared earlier was “incorrect”.

This was followed by SHA CEO’s presentation on the amount paid to the hospital in claims.

Mwangangi said SHA had rejected a total of Sh9.3 million in claims for the hospital and had told the facility to take action, while SHA held a total of Sh51 million in unpaid claims.

So far, the hospital has received a total of Sh209 million from SHA.

But Simon Kigondu, the immediate past president of the Kenya Medical Association (KMA), observed that the role of a health insurance system is to pay for healthcare while avoiding catastrophic health expenditure.

Kenya Kwanza, he observed, has increased catastrophic health expenditure.

This includes reducing disposable income through increased taxation, namely avoidable housing costs, and an unfair SHA tax based on the premise that those who earn more should pay more.

For SHA, he said the gazetted services have more exclusions than inclusions.

For instance, the DHA system, he said, is always collapsing and lacks outpatient cover, while out-of-pocket payments have increased.

“The more bad a system is, the more one needs to defend it by repeating that it is working when it has so many challenges,” said Dr Kigondu.

The practitioner added that legacy NHIF debts have not been paid, despite promises after promises.

“They say they are verifying claims. Facilities are being asked to take a haircut [discounts],” said the senior doctor.

“Non-payment of legacy debts has led to closure and downscaling of many facilities,” he added.

He noted that SHA-gazetted items have more exclusions than they cover.

Additionally, he took issue with DHA, saying it has been rejecting valid claims.

“People work and their claims are rejected on flimsy reasons. SHA mounting debts are high,” said Kigondu.

Parliament’s allocation to the Primary Health Care Fund and the Emergency, Chronic and Critical Illness Fund (ECCIF) is also grossly underfunded, he said.

In the current FY 2026/27, the Government allocated Sh19.1 billion for the PHC Fund and Sh4 billion for ECCIF.

All the hospitals praised SHA.

This is even despite some of them, including public facilities, having earlier complained to the media about delayed reimbursement of SHA claims.

For example, one Level Four hospital claimed services had improved under SHA, but last year, its management had complained that some services had been scaled down because of accumulated unpaid SHA claims.

The town hall engagement was attended by health workers, civil society organisations working in the health sector, government officials, scientists and other health stakeholders.

The engagement has been criticised, with a section of health workers reportedly leaving the presidential town hall engagement frustrated.

The workers felt they were not given an opportunity to raise issues affecting the health sector directly with President William Ruto.

Only doctors, through the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), were given an opportunity to speak during the session.

Brown Ashira, Secretary-General of the Public Health Officers Union, said health workers attended the engagement expecting to have a conversation with the President, which was not the case.

“We are not happy as healthcare workers. We are seeing in Kenya we only have one union, that is the doctors’ union. This country is actually praising one union. I am not happy,” said Ashira.

Ashira said he had attempted to catch the President’s attention several times but was not given an opportunity to speak.

“We have not had a conversation. I raised my hand like four times, but I was not given an opportunity to speak,” he said.

The engagement, he observed, should have addressed both the curative and preventive components of healthcare, noting that prevention and primary healthcare are central to the Government’s Universal Health Coverage (UHC) agenda.

“The President needed to hear what is actually ailing Kenyans, but we have not managed that,” said Ashira.

“The President has not gotten into the nitty-gritty,” he added.

The union representative also questioned the nature of some of the questions posed during the engagement, saying they appeared “directed and designed to elicit particular responses”.

“The questions that were posed during the conversation were seemingly directed, actually made to reflect a certain position,” he said.

“Health workers are not happy. We thought we were going to get much from this summit, but it is unfortunate.”

On SHA, Ashira said health workers had hoped to raise concerns about challenges affecting the scheme, including delays in the remittance of contributions and the impact of delayed payments to health facilities.

Public health officers, according to the representative, are affected by delayed clearance of SHA claims to hospitals.

Because of delayed SHA claims payments, employers are not able to remit SHA premiums on time.

As a result, their employees are not able to access services with SHA cover.

“For salaried individuals and those in the civil service, SHA is tied to salaries, and if they do not pay on time, they are disconnected from services immediately,” he said.

Ashira said union members had complained of being unable to access healthcare because employers had failed to remit premiums on time.

Under the SHA contribution structure, he said, remittances for individuals in formal employment are expected to be made by the ninth of every month, with failure to remit potentially affecting access to services.

“We wanted to tell the President some of the areas in SHA that should be addressed for smooth operations. But just how?” maintained Ashira.

Ashira said health workers had also expected the ongoing strike to be addressed during the engagement.

However, the industrial action was not addressed.

Earlier, CoG CEO had told the media last week that by the time the Health Summit was being conducted, the issue of the striking workforce would have been solved.

The striking workforce includes nurses, clinical officers, public health officers and laboratory technicians, among others.

Only doctors are working, but through their union, KMPDU, they admitted healthcare is paralysed as doctors cannot work in isolation.

Further, the issue of UHC also remained unresolved.

Ashira said the workers are yet to be employed on permanent and pensionable terms despite the Ministry of Health signing an agreement to regularise their employment.

During the town hall, President Ruto acknowledged the concerns surrounding UHC workers and said the Government would work with governors to resolve the dispute.

The President said he was in discussions with the Council of Governors to find a solution.

According to the President, if the matter is not resolved at the county level, the national Government would consider employing the workers.

“The missed opportunity at the town hall left health workers without the chance to put their concerns directly to the President,” regretted the union official.

On their part, clinical officers under the umbrella of the Kenya Union of Clinical Officers (KUCO) were also disappointed with the engagement.

KUCO chairperson Peterson Wachira dismissed the town hall meeting as a “choreographed talk show.”

Wachira told The Standard that healthcare has fallen short of target in relation to Vision 2030, which expected Kenya to be a medical tourism hub for Africa by the year 2030.

Health financing and leadership and governance, he observed, have also been the worst hit, with the Abuja Declaration remaining a mirage.

“The country has never budgeted more than six per cent to health since Kenya became a signatory,” said Wachira.

In the current budget allocation, at least Sh175 billion was allocated to the sector, the highest ever.

This, however, represents only four per cent of the national budget.

Amid donor cuts, there was no focus on domestic local financing.

Initially, the country heavily depended on donor funding, a weakness that was experienced during the stop-work order by President Donald Trump, which saw the majority of health programmes, including malaria, HIV, TB and research, highly affected.

With this, there had also been shortages of drugs and health commodities.

For instance, people living with HIV are not able to test viral loads, which are limited to pregnant and breastfeeding mothers. This is because of shortages of HIV viral load testing.

Kenya has also experienced shortages of drugs. There is also a delay in the delivery of TAF/3TC/DTG, an ARV regimen that had been introduced by NASCOP to people above 69 years to protect their kidneys and bones.

Supply of this, according to an earlier presentation by NASCOP, is because of the transition by the United States Government (USG).

The union official adds that leadership and governance is highly segmented and many county governments do not follow legal and policy imperatives, especially in human resource management.

“Nepotism has been normalised. Many health workers are exploited by corrupt officials to either secure employment or promotion,” alleged the union official.

“We are far from achieving adequate HRH staffing. Workers suffer fatigue, burnout and work-related stress, with some descending into depression and suicide,” he added.

He maintains that fragmented HRH management under county governments must be reviewed.

Clinical officers are currently proposing either centralised HRH management under an authority formed under Article 189 of the Constitution or a Health Service Commission.

At the moment, clinical officers across the country are on strike.

On SHA, Wachira notes that some areas are working, whereas others report challenges that should have been shared for a solution.

“How do you tell people whose nearest hospital is closed that SHA is working?” posed the union representative.

Civil society left out

Civil society organisations invited to the presidential event, which have been working closely with communities and the Government to boost healthcare in the country, also felt left out.

During the conversation, none of the civil society organisations in attendance shared their take on the state of health and areas for improvement.

Some who spoke to The Standard on anonymity said they were ignored.

One of the civil society organisations that requested to remain anonymous because of fear of victimisation said the summit did not address the issues in health and the gaps therein.

“Why should we be talking about what’s working? How does that help anyone?” posed the individual. “We should be discussing what’s not working so that it can be rectified.”

“The town hall seemed to be choreographed,” added the official.

According to the organisation, bringing managers of hospitals to give an account of how things are working was not the objective of the meeting.

“The meeting, instead, was for Kenyans to engage the President on what they feel is not working for him to improve,” said the source.

The SHA presentation by a section of the hospitals was criticised as not being a real picture of the situation across the country.

“The hospitals did not present the real picture. The real picture cannot be painted by handpicked managers,” observed the official. “We needed to hear from random hospitals.”

The conversation, added the source, should have also given patients a chance to give their testimonials.

During the engagement, a mother shared her experience with SHA, noting how it had assisted her teenage daughter access care.

In another incident, a vitiligo patient shared her frustration over how SHA was not able to provide her with sunscreen to protect her skin despite being a registered SHA member.

In response, SHA CEO said the services would be included in benefit tariffs by October 31, 2026.

The benefit tariffs are currently under review, ahead of gazettement.

“For patients of vitiligo, they are affected by sun. In our current benefit package, it is not there,” said Mwangangi. “We currently liaise with KEMSA to procure sunscreen at an affordable rate.”

The vitiligo patient was the only person who questioned the functionality of SHA during the entire conversation.

The patient was in the company of other individuals with the same condition, including people with albinism.

“We also need to hear from patients for whom SHA has not worked,” said the civil society official.

Ruto defends digitalisation

The town hall engagement was, to some extent, moderated by President Ruto.

The President pinpointed individuals for testimonials about SHA.

He accused individuals who criticised SHA of doing so despite testimonials showing that SHA is working effectively.

This, he said, was the right direction towards attaining UHC for the country and guaranteeing quality care to all Kenyans.

President Ruto pegged the achievement in health to digitalisation.

Digitalisation, he said, has made work more efficient, averted fraud and reduced workload.

Under the defunct NHIF, he said, there were multiple cases of illegal and fake surgeries.

Some facilities were doing more surgeries than KNH.

Quacks were also conducting surgeries and stealing Kenyan money.

“We have individuals taken through several leg amputations, and you could question how many legs a person has.”

At the moment, all surgeries are authorised by SHA, with doctors conducting them also licensed.

At the moment, no facility is allowed to provide services that have not been licensed under the SHA benefit package.

Medicines are also tracked from the manufacturer to the health facility to the patient to ensure that the dispensed drugs are those licensed.

Ruto added that digitalisation has also reduced human error and the workforce.

For instance, SHA has an establishment of 815 people, against 1,700 under NHIF.

Individuals who left SHA because of its human resource, said the President, are currently serving in other government dockets.

Digital Health Agency (DHA) CEO Anthony Lenaiyara further expounded on the digital operationalisation, saying it has centralised all services.

For example, there is no paperwork and patients no longer have to walk with notebooks containing their health history.

SHA, he noted, has at least 43 systems that not only support SHA but also improve operational efficiency.

“We are able to do telemedicine because of digitalisation. At the moment, we are able to read patterns of fraud,” he said.

SHA recovered at least Sh300 million from fraudulent claims, with at least 15 cases under investigation.

At the same time, the President dismissed reports that the SHA digital highway was purchased at Sh104 billion.

“There is no Sh104 billion contract,” he said.

He further said the Government asked companies to invest in their digital systems, with the services offered being paid for.

The operation, he said, is like the NESP programme that has supplied MRI, CT scan and theatre machines that cost billions of shillings.

“We have told manufacturers to invest. They bring machines, we invest. It is their business to make sure machines are working and operational. Ours is to provide service,” said President Ruto.

He added: “We asked companies to invest their money in health digital platforms. We took this to Parliament and the public and agreed on rates.”

The Head of State further said: “We agreed we were not going to spend more than five per cent of resources collected. The management of five per cent included payment of digital platform.”

So far, SHA has only paid Sh500 million to digital system service providers, with a deduction of Sh25 for only active SHA members annually.

The President noted that in his manifesto, he promised to hire 21,000 health workers to assist in the transition to UHC.

So far, he said, more health workers have been employed by both the national and county governments, to a tune of 40,000.

In the town hall engagement, the President further committed to hiring 5,000 health workers.