Insufficient infrastructure, an inadequate workforce, persistent industrial action by workers and underfunding of Community Health Promoters are the major threats to the success of Universal Health Coverage (UHC).
According to a report by the Parliamentary Budget Office (PBO), a think tank that offers fiscal advice to Members of Parliament, these factors, if not urgently addressed, pose a major risk to the success of the government’s ambitious health programme.
The UHC, which is one of the five pillars under the national government’s Bottom-Up Economic Transformation Agenda, seeks to ensure that all Kenyans have access to essential, quality health services without suffering financial hardship.
Additionally, the government seeks to cushion the poor and other vulnerable groups from financial risk through various mechanisms, including sponsoring vulnerable groups.
“Persistent industrial action by healthcare workers is a stress point that threatens progress towards the primary healthcare pillar of Universal Health Coverage,” reads the report.
This year alone, Kiambu, Nairobi and Machakos counties experienced industrial action of varying degrees by healthcare workers, including doctors, clinical officers and nurses.
Kiambu County, in particular, endured a five-month doctors’ strike that was called off in October, leaving a trail of deaths, especially among children.
This allocation follows a return-to-work formula agreement signed in March 2024 between the national government and the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU).
On the human resource challenge, the latest 2025 report on devolution by the budget team pointed out that the persistent uneven staff distribution leaves rural areas and informal settlements underserved, even as urban centres attract more health workers.
“Rationalising deployment is therefore key to equity. Beyond numbers, other challenges pertain to health worker motivation and responsiveness, which must be enhanced through timely and adequate remuneration, clear job descriptions, fair schemes of service, professional development, supportive supervision and safe work environments,” reads the report.
The report also noted that while Community Health Promoters play an integral role in the success of UHC, underfunding and lack of adequate equipment threaten to jeopardise their contribution.
“The Community Health Promoters project is severely underfunded by both sponsors, with only Sh786 million disbursed out of the Sh3 billion allocated to the project in the 2024/25 financial year,” reads the report.
However, the report notes that the latest report by the Controller of Budget indicates that only four counties—Bomet, Kwale, Tharaka-Nithi and Uasin Gishu—received the national government contribution for Community Health Promoters in FY 2024/25.
With respect to county governments’ contributions, the report notes that only 14 counties have contributed and spent on Community Health Promoters stipends, and payments are, therefore, not up to date.
“This affects the working morale of the CHPs, who are expected to form a crucial basis for the achievement of UHC,” reads the report.
“The CHPs need to be equipped with work kits and reagents, as well as training, which is the responsibility of the national government, especially in instances of palliative care for cancer patients and chronic diseases such as diabetes,” the report adds.
Community Health Promoters provide the first layer of healthcare service provision and act as a link between households and the formal health system. However, the budget team now warns that failure to adequately resource them jeopardises the ‘leave no one behind’ principle of UHC.
The PBO report on President William Ruto’s ambitious health agenda follows another report released last month by the National Assembly Committee on Health, which also pointed out policy gaps that threaten the successful implementation of the Social Health Authority (SHA).
According to the report, the challenges threatening the success of President Ruto’s core health pillar transcend health facilities offering services and are largely driven by policy gaps.
It pointed out that recurrent systemic challenges, operational and policy gaps, coupled with weaknesses in financial management, are among the core threats to the successful implementation of SHA.
