Kenya’s path to Universal Health Coverage: Insights from policy and practice

Abstract

Background

Universal health coverage (UHC) is a globally endorsed commitment aimed at ensuring equitable access to affordable healthcare services. Kenya's journey toward UHC has been marked by significant reforms, including the 2018 pilot phase and ongoing implementation phase (2020–2030). Using qualitative insights from policymakers and practitioners, this study explored Kenya’s progress, challenges, and opportunities to achieve UHC.

Methods

Key informant interviews were conducted with 44 stakeholders across seven counties in Kenya. Data were collected in English using a semi-structured interview guide, audio-recorded with consent, and transcribed verbatim. Thematic analysis, guided by the WHO health system framework, identified achievements, challenges, and areas for improvement across six health system building blocks.

Results

The pilot phase improved healthcare access for vulnerable populations by eliminating user fees in public health facilities but faced challenges such as staff shortages, inadequate supplies, financial constraints, and limited stakeholder engagement. The implementation phase introduced structural reforms, including Primary Care Networks (PCNs) to strengthen primary healthcare, mandatory social health insurance for financial protection, and legal frameworks to support service delivery and facility autonomy. Despite these advancements, challenges remain, including workforce shortages, financial barriers, and limited stakeholder participation. Sustaining UHC requires strengthened health systems, reduced out-of-pocket costs, and inclusive stakeholder engagement, with political commitment as a key enabler.

Conclusion

Achieving equitable, efficient, and sustainable UHC in Kenya demands more than political commitment. It requires strengthened workforce capacity, equitable financing, efficient supply chains, stakeholder engagement, reduced out-of-pocket costs, and strategic private sector involvement within inclusive policies.