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Kenya’s debt is collapsing health and failing schools

Tuesday, July 29, 2025

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The entrance to the Accident and Emergency unit at Kenyatta National Hospital in Nairobi.

Photo credit: Wilfred Nyangaresi | Nation Media Group

By Stellah Bosire

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There is no justification in a national budget that values debt repayment over saving lives.

The 2025/206 budget for the Burns and Paediatrics Centre at Kenya’s largest referral hospital was cut by half.

Several counties are operating beyond their capacities. Global Fund-supported services are quietly being phased out. Patients with cancer and kidney disease, along with sickle cell anaemia, cannot access care unless they can pay for the services.

Kenya continues to face a debt crisis that restricts its healthcare and educational systems along with the potential for achieving societal equity. As of May 2025, Kenya’s public debt had reached Sh11.5 trillion, an increase of 10.3 per cent from the previous year. External lenders hold debts that make up almost half of Kenya’s total financial obligations.

And the main problem is the cost of servicing that debt. Between July 2024 and May this year, the government spent Sh1.448 trillion on debt servicing, nearly 70 per cent of the total revenue. This is not just an economic problem, but a public health crisis.

Under the guise of “fiscal discipline”, Kenya has introduced austerity measures that are undermining public service. Introduction of punitive taxes on fuel, bread, and salaries, through the 2024 Finance Bill, sparked nationwide protests. The government bowed to pressure and withdrew the Bill. However, this was after many protesters had been killed, others maimed, and Parliament breached.

Significant discrepancies

The government spends most of its budget on debt repayment obligations. Government representatives praise minor improvements that raise total health spending to Sh138 billion, while actual conditions demonstrate significant discrepancies.

In the 2025/2026 budget, the government has allocated Sh138.1 billion to health, an increase of 8.7 per cent from last year. But this is only 3.3 per cent of the national budget, a far cry from the 15 per cent target enshrined in the Abuja Declaration.

It is a mockery of the increasing cost of care, the burden of chronic disease, and Kenya’s own commitment to Universal Health Coverage (UHC). It’s almost as if more money is being spent on the management of health policy than on caring for actual patients.

The management and coordination of the UHC is allocated Sh6.2 billion, an increase from last year’s Sh4.2 billion. Meanwhile, the Emergency, Chronic, and Critical Illness Fund (ECCIF) – the fund meant to take care of patients with expensive conditions such as cancer, renal failure, sickle cell anaemia, and more – has increased to Sh8 billion, but this is a paltry sum in the grand scheme of things.

In a country where most patients depend on public hospitals for dialysis, chemotherapy, and long-term care, this should not be happening. Patients are being turned away. Families are fundraising on social media. And the state is paying interest to foreign creditors as of this is normal. Women and girls bear the greatest financial burden. Cuts to public healthcare are passed on as out-of-pocket costs, forcing mothers to give birth at home. Kenyans are denied lifesaving cancer screenings or are forced to buy expired medicine off the counter to self-medicate.

Most of Kenya’s healthcare workers are women. They face overwhelming patient demands while struggling with inadequate equipment and staff shortages. Education is also in crisis.

When government educational funding for girls is cut, it starts a dangerous chain reaction that immediately threatens their health, safety and future prospects. Schools act as the sole barrier protecting girls from early marriage, sexual violence, and poverty. Education helps delay child marriage, reduces the likelihood of adolescent pregnancy, empowers girls with sexual and reproductive health knowledge and enables them to seek help in case they are abused.

Kenya is slowly extinguishing its educational lifeline due to delayed capitation and reduction of per-student funding, from Sh22,244 to Sh16,900. Girls who drop out of school due to lack of tuition fees or overcrowded classrooms face a higher risk of early marriage and sexual exploitation, or transactional sex as a means of survival.

These girls face the risk of gender-based violence as well as HIV, unsafe abortions and maternal death.

And because educated mothers are more likely to have healthy, educated daughters, the ripple effects of this crisis will haunt us for generations to come.

Freeze public wages

It’s what economists call an austerity–debt–inequality trap. Kenya borrows to pay its debt. As a condition of IMF-supported programmes, it agrees to freeze public wages, hire fewer civil servants, and slash spending on health and education. These cuts degrade service delivery, damage social outcomes and slow growth, forcing Kenya to borrow even more. The cycle repeats as the lenders get rich. The people get poorer. And women pay the price.

Women shoulder the unpaid care burden, sacrifice their health for their children’s, and navigate a health system buckling under fiscal injustice. Numbers on a page tell one story. In the hallways of hospitals and classrooms, austerity looks like suffering.

Reset of both fiscal policy and political priorities must begin immediately. Kenya must move past its current approach, which places debt repayment above human life in its spending priorities.

Sacrificing lives to pay debt isn’t right. The government should push for the restructuring or cancellation of loans which no longer offer public benefit.

It should jettison the IMF conditions that turn essential services into commodities. We must have a more progressive tax system—one that taxes wealth and corporate profits, not bread and salt.

Let’s also ring-fence funding for health, education and social protection in law. Kenyans should demand accountability from their leaders and lenders. While ordinary Kenyans did not create the crisis, they are forced to pay for it through their lives. Beyond being unethical, it is also unsustainable. In law, we call it unjust enrichment, where one party benefits at the expense of another without just cause.

In medicine, we call it neglect when a patient gets worse while under the care of a responsible person. What is happening in Kenya today is both. Development cannot be financed through perpetual borrowing while forcing citizens into poverty and denying them health and potential.

A nation cannot be built through interest payments and spreadsheet calculations. True development should reflect the quality of life instead of debt-to-GDP ratios. Let’s choose the people, not the lenders.

Dr Bosire is a medical doctor and lawyer. [email protected]

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