Ruto's UHC promise check as 2027 polls nears

The Health Sector Caucus workers took to the streets to demand inclusion of UHC staff on permanent and pensionable terms, better working conditions, among other grievances, on July 22, 2026.[Benard Orwongo, Standard]

Access to quality healthcare for all Kenyans, regardless of their financial status, was a key agenda of the Kenya Kwanza administration when President William Ruto came to power.

This was to realise Universal Health Coverage (UHC), an ambition previous governments had pursued, but failed to achieve.

 To deliver on the plea, Ruto’s administration introduced radical reforms in the health sector, including a major shift in health financing from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA).

SHA, is financier of UHC.

But barely 12 months left before the next General Election, UHC remains a gray area, with experts questioning whether the ambitious reforms can deliver meaningful change within the remaining period.

Prof XN Iraki, an economist and lecturer at the University of Nairobi, says achieving UHC within a year would be a tall order.

“We cannot achieve UHC in one year. What will change?” poses Iraki.

In an interview with The Standard, Iraki observes that the country has already entered a political mood, with attention shifting towards the 2027 elections.

“We have to pay debts and the focus is now on the 2027 polls,” he says.

Prof Iraki acknowledges that the government has registered millions of Kenyans under SHA but says the major challenge remains making the system work effectively.

At least 32.2 million Kenyans have been onboarded to SHA, but barely 5 million are remitting their premiums..

“SHA has been a work in progress. We all long for the day it will stabilise,” says the economist.

“UHC is yet to be achieved. Universal health services, where every Kenyan would be covered and sleep in peace,” he adds.

Iraki also questions the cost of the new health financing system, noting that with contributions capped at 2.75 per cent of income, the benefits must commensurate with what Kenyans contribute.

Further, the economist says it is unfortunate for Kenyans to continue paying out of pocket, despite the high number of people enrolled in the new social health scheme.

“Why pay from the pocket with UHC?” poses Iraki. “This is a big question”.

According to the economist, achieving UHC requires more than changing the financing system, and that preventive healthcare must also be strengthened.

Prof Iraki's concerns are echoed by the Kenya National Union of Nurses and Midwives (KNUNM), which says the highly pronounced UHC agenda is yet to become a reality.

KNUNM Secretary General Seth Panyako says UHC did not begin with the Kenya Kwanza administration, noting that successive governments have pursued the goal under different names.

“UHC is not an agenda that started with this government. It started a long time ago. Only it comes with different names, just like how someone puts on different clothes,” says Panyako.

According to him, achieving UHC requires several key pillars, including adequate human resources and sustainable financing.

In an interview, Panyako argues that social services can only be sustainably financed through taxation, unlike current SHA model where the government relies on contributions formal workforce.

“You cannot finance a universal service when money is coming only from a few working people. This will definitely collapse. This is a hurdle that is yet to be dealt with,” says Panyako.

Panyako observes that even with changes in social healthcare, the majority of Kenyans only pay SHA premiums when they fall sick.

The model, according to the official is unsustainable and could be contributing to SHA's financial difficulties.

Contrary, with defunct NHIF model, members were required to have three months paid up premiums, before seeking care.

This ensured continuous contribution of premiums.

Further, he cites removal of packages like Edu Afya for students and Linda Mama, under SHA have limited access to care, more so among vulnerable population.

“We had Linda Mama. When they tell us every woman everywhere (EWENE), they should have had a better way of onboarding women, even if they did not like Linda Mama by name. Where are those vulnerable women from poor families who would register and NHIF would pay? This was also removed. Are we therefore expanding healthcare or reducing?” poses nurses official.

Nurses are asking for inclusion of all stakeholders to smoothly attain UHC.

“We are willing to help the government come up with a model that works for the government. There is no way SHA will succeed with this model,” observes Panyako.

Inefficiencies at SHA has affected smooth delivery of healthcare, with hospitals unable to procure essential drugs.

“If UHC is clinched on SHA, then it is bound to fail,” he says. “I am not seeing any light at the end of the tunnel,”

Cost of running SHA (Sh104.8 billion), he observes is also expensive.

Defunct NHIF required Sh700 million for advancing its digital system.

Panyako says the focus should not be on the names of institutions but on whether Kenyans are receiving services.

“Let us not do politics of saying SHA and NHIF. This is too shallow. Kenyans don't care about names, all they care about is services,”

For Timothy Wafula, a lawyer at the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN), the Ruto administration has made significant policy and legal changes towards UHC, although implementation remains a major challenge.

The Parliament enacted four major health laws in 2023 namely the Social Health Insurance Act, Primary Health Care Act, Digital Health Act and Facility Improvement Financing Act.

In a previous interview with The Standard, the former Health CS Susan Nakhumicha said previous governments failed to achieve UHC, because of lack of laws.

The laws were intended to establish a new framework for health financing, service delivery, digital health and management of health facilities.

Wafula also identifies the replacement of NHIF with SHA as a significant institutional reform aimed at addressing longstanding weaknesses in the former insurer, including inefficiencies in claims processing, governance concerns and inequitable access to healthcare.

The government has also sought to shift the health system from a predominantly curative model towards preventive and promotive healthcare by strengthening primary healthcare and expanding the role of community health promoters.

However, the ambitious policy direction has been undermined by implementation challenges, says Wafula.

According to Wafula, the reforms were introduced within a relatively short period and attracted criticism over public participation and stakeholder engagement, resulting in several court challenges and uncertainty during implementation.

SHA has also faced persistent operational difficulties, including system downtimes, delays in registration and verification, reimbursement bottlenecks and uncertainty over benefit packages.

“These challenges have undermined public confidence in the new scheme,” Wafula says.

The lawyer also points to concerns arising from the transition from Linda Mama to SHA, including reports of a regression in access to maternity care and women being detained after childbirth over unpaid hospital bills.

“Financing reforms alone cannot achieve UHC without corresponding investment in the wider health system,” says Wafula.

Persistent shortages of healthcare workers, industrial actions, inadequate medicines and supplies, and underfunded public health facilities continue to affect service delivery, particularly at county level.

“An insurance card or SHA registration is of limited value where hospitals lack medicines, health workers, diagnostic capacity, beds or functioning emergency services,” adds the lawyer.

He further raises concerns over transparency, procurement, accountability and financial management in the implementation of SHA.

However, President Ruto, maintains that his administration has made significant progress towards achieving UHC, pointing to reforms in health financing, emergency care, primary healthcare and digitisation.

Speaking during the launch of the SHA 922 Lifeline national emergency dispatch centre, Ruto said operationalisation of the Emergency, Critical and Chronic Illness Fund (ECCIF), would ensure patients in need of emergency care are evacuated without having to raise money first.

He said the emergency system was part of wider reforms intended to make UHC a reality by ensuring Kenyans could access care regardless of their ability to pay.

“No deposit, no guarantee, no negotiation, no relative running for money, everything shall be taken care of,” said Ruto.

Ruto further took credit in employment of 107,000 Community Health Promoters.

The CHPs, he said have been key in promoting primary healthcare, at household level.

On his part, Duale similarly defended the government's record, saying all three funds established under the SHA framework, namely Primary Healthcare Fund, Social Health Insurance Fund and ECCIF, were now operational.

Additionally, Duale said there is improvements in the supply of medicines and medical commodities, noting that KEMSA had strengthened its ability to fulfil orders from health facilities.

“Today I can confirm, every item ordered in Kenya, out of 10, KEMSA can deliver nine,” said the CS.

On human workforce, the union official applauds the Kenya Kwanza administration of allocating a budget towards recruitment of more healthcare providers.

At least 8,000 health workers under UHC have also been placed under permanent and pensionable terms.

The Health Cabinet Secretary Aden Duale has also promised to hire more staff employed to handle an acute shortage of human resource.

But Panyako says availability of healthcare workers means little when facilities lack medicine.

“The problem is lack of medicine. Health workers cannot turn themselves into medicine to give patients,” says the official.

Further, he raises concerns over specialised training for health workers, saying some are unable to operate new equipment procured by the national government, because county governments do not allow them to pursue specialised education.

“It is becoming hard for health workers to operate on new equipment simply because they are not being allowed by counties to enrol for specialised education to gain knowledge on their use,” he says.

On whether the Kenya Kwanza administration can deliver UHC within the remaining months,  Panyako says the success of the reforms will ultimately depend on political will and a change in mindset.

“UHC is a change of mentality. Something that can take 10 years can be implemented in one year, and something that can take one year can take us 100 years until you get the right people in office,” he says.

He adds: “Currently, a lot of people are suffering in terms of healthcare services”.