When health becomes a gamble: How corruption risks the lives of ordinary Kenyans

In the pre-dawn darkness of Kitui, Ruth Mwende laboured quietly, hoping to deliver safely under the new Social Health Authority (SHA) system.

But when she presented her cover at a nearby clinic, she was turned away and told that the facility had not been paid.

With no cash in hand, Ruth delivered at home, aided only by a neighbour. Hours later, complications threatened both her life and the newborn.

Ruth’s story echoes across Kenya: citizens who once had hope in a reformed health insurance system now find that promise slipping, as corruption and mismanagement hollow it out at the edges.

A breakdown in trust in health systems has deadly consequences. The 2022 Kenya Demographic and Health Survey (KDHS) reports maternal mortality at 345–355 deaths per 100,000 live births, which is well above the United Nations target of 70.

Although skilled birth attendance is 94%, nearly 39% of deliveries still occur outside healthcare facilities, leaving women vulnerable.

Access is especially limited in marginalized areas—arid and semi-arid lands (ASALs), rural communities, and informal settlements—where services are scarce.

When trust falters, women in these high-risk areas bear the brunt, and preventable maternal deaths remain common.

Vaccine coverage tells a similarly worrying story.

The 2022 KDHS shows that 80% of Kenyan children aged 12–23 months are fully immunized with the basic recommended vaccines, including BCG, DTP-HepB-Hib, OPV, measles, and pneumococcal vaccines.

While this is a significant achievement, it still leaves one in every five children unprotected against preventable diseases.

The gaps are greatest in arid and semi-arid lands (ASALs), rural areas, and informal settlements where access to health services is limited.

Any further breakdown in healthcare delivery could reverse decades of hard-won progress in child survival, with the most vulnerable bearing the heaviest burden.

When SHA was launched, it carried the promise of reform.

Twaweza’s Sauti za Wananchi survey findings based on a national representative sample of 3,603 respondents carried out in January and February 2024, reveals that a big number of citizens had NHIF coverage although a huge proportion did not.

Among NHIF users, 71% said the fund provided quality and affordable services, and 34% called it affordable for most Kenyans.

However, the findings also indicated that citizens complained: 49% said not all ailments were covered, 36% felt restricted to specific hospitals, 35% lost access when late with payments, and 1% cited corruption.

Additionally, citizens see lack of medicine at health facilities as the number one challenge (46%), followed by cost of healthcare (23%).

Clearly, citizens hoped SHA would fix these issues but today, many say the same problems are worse.

Meanwhile, counties like Kiambu, Kakamega and Nakuru have been building new Level 3 and 4 hospitals.

But when small private clinics receive payments comparable to or exceeding those channelled to public hospitals, the new infrastructure risks becoming ghost towns.

Facilities free in name only; equipment gathering dust. Crucially, when families are forced to self-medicate because they can't trust the system or afford it, mortality rises. This is not theory but a lived reality.

Kenya has made notable progress in reducing maternal and child mortality over the past two decades.

The World Bank and Ministry of Health data show progress: Kenya’s maternal mortality has fallen from 1,375 per 100,000 in 2000 to 149 in 2023, and under-five mortality has dropped from 52 to 41 per 1,000 live births, while infant mortality fell from 39 to 32 per 1,000.

But these fragile gains can unravel quickly if the social insurance system fails the poor. Sauti za Wananchi reports that 31% of Kenyans did not seek care the last time they were ill or injured due to lack of funds.

That grim figure points to a growing refusal to seek care—a silent retreat from the health system.

Taxpayers especially the poor ones are bearing the cost of a system meant to serve them. Out-of-pocket expenditures remain high, and yet self-medication is on the rise for many.

The Sauti za Wananchi numbers speak where more than half of citizens lack insurance, almost a third skip health facilities due to cost, and 46% blame medicine shortages—indicators of a system disintegrating from within.

First, SHA must act urgently to streamline the list of accredited facilities.

Accreditation must be merit-based and tied to capacity and not to political connections.

Public hospitals that manage complex cases and serve most citizens must be prioritized in reimbursements.

Second, payments must be transparent and equitable. Funds should follow patient volumes, not privilege.

SHA must introduce a digital claims-tracking system and publicly disclose disbursements to curb fraud and build trust.

Third, the voices of citizens expressed through surveys such as Sauti za Wananchi, must inform reform.

The survey findings clearly indicate that Kenyans want is clear: affordability, broader coverage, wider networks, and timely access.

SHA must deliver on those expectations, or risk erasing public confidence.

Kenya has precedents to draw on. For instance, Ghana’s health insurance woes were tamed through biometric patient registration and tougher auditing.

Rwanda’s community-based insurance systems, with strong accountability and emphasis on primary care, maintain trust even amid tight budgets.

Every misdirected shilling in SHA is not just financial loss but a life at risk.

When clinics demand cash at the door or medicines are unavailable, mortality rises and not because of biology, but because of broken policy.

Every child unvaccinated, every mother treated without dignity, every chronically ill patient forced to skip their medicine is a failure of governance.

As Kenya stands at this crossroads, the choice is stark: repair the system or abandon its people. Health must not become a gamble.

From Moyale to Msambweni, from slum mothers to rural farmers, the stakes are real—and they demand real solutions, now.

Dr. James Ciera is Senior Statistician and Kenys Country Lead, Twaweza East Africa. jciera@twaweza.org.