Healthcare crisis: The high costs that crush Kenyan families

Baby Arianna needed just one thing to live: a bone marrow transplant. Her mother had faithfully contributed to Kenya’s health insurance for a decade, first under the National Health Insurance Fund (NHIF), then seamlessly transitioning to the new Social Health Authority (SHA) when it launched with great fanfare 260 days ago. When the bill came due—Sh1.6 million for the life-saving procedure—SHA covered Sh23,600. Baby Arianna died on February 23.

Her story, first broken by Nation, encapsulates the harsh reality facing Kenyans today. Despite promises of Universal Health Coverage and assurances that the new system would make healthcare accessible without forcing families to “dig deep in their pockets or ask for help from well-wishers,” the gaps that “touch the core of humanity” persist.

The Social Health Authority replaced the 57-year-old NHIF with much ceremony—offices re-painted, vehicles rebranded, and ambitious targets set. SHA has indeed enrolled more people than its predecessor, and on paper, promises Sh500,000 annually for overseas treatment for registered members. But when life hangs in the balance, is that enough? Online fundraising platforms like M-Changa tell the real story: medical fundraisers consistently attract some of the highest contributions as desperate Kenyans scramble to bridge the gap be-tween what the system promises and what it delivers.

Also read: Baby Arianna Wairimu dies, SHIF pays only Sh23,600 of Sh1.6m medical bill

Behind these statistics are human faces—parents watching their children suffer, young people whose dreams have been deferred by illness, families bankrupted by medical bills.

 Healthy Nation spoke to two such individuals: a father whose son is fighting a brain tumour abroad, and a young man whose rare bone disease has stolen eight years of his life whilst he waits for a health system that truly works.

Fredrick Ochieng’, filmmaker and photographer

“My son Bradley is 13 years old. He should be in Form One this year, but instead, he’s missed most of 2024 because he’s been in hospital. It began innocuously enough—I noticed he was struggling with light sensitivity. His eye seemed a bit itchy, so I took him to an eye specialist for what I thought would be a routine check-up. He received treatment, and I assumed that was the end of it. But then I started noticing other things. Balance issues. He couldn’t chew properly. His hands would tremble, causing anything he held to fall involuntarily. Initially, I thought he simply needed new glasses, but it wasn’t that simple.

We went to a different hospital where he underwent a brain MRI. The results were devastating: Bradley had a brain tumour. The hospital referred us elsewhere, but we faced an immediate challenge—the tumour’s position made it inoperable.

I wasn’t willing to accept this without exploring every option. We visited all the major hospitals in Kenya, seeking second, third, and fourth opinions. Only one provided what I considered a comprehensive medical report. The reality became clear: either we don’t have skilled doctors, or if we do, they’re inaccessible because they’re expensive and few in number. We’ve exported our best doctors, who’ve left seeking better remuneration abroad.

Also read: Patients denied treatment as SHA demands full payment

I refused to gamble with my son’s life, which is why I methodically visited every hospital. It wasn’t cheap—consultations with specialists cost at least Sh8,000 each, all paid out of pocket. Across different hospitals, consultations alone cost me Sh100,000.

Simultaneously, I sent his samples to India. As a parent, you conduct your own research because you want the absolute best for your child.

After a month of research whilst his health remained in limbo, the Indian doctors provided a comprehensive treatment plan. Kenyan hospitals were taking too long, and by the time I received results locally, I’d already made arrangements to travel to India as his symptoms were rapidly worsening.

As a filmmaker and photographer, I had equipment that could be converted to cash. I realised there’s nothing more expensive than life itself. I put my car up for sale, sold my cameras, and liquidated anything of value to ensure he received the treatment he needed. Before we departed for India, Bradley had lost his ability to speak. He couldn’t eat or chew properly, and even smiling had become a struggle.

I raised approximately Sh490,000 from selling equipment, supplemented by our savings. It wasn’t nearly enough. A friend suggested online fundraising, which has reached about 38 per cent of our target—USD40,000 (approximately Sh5 million).

I took him to India, where his mother and our younger daughter accompanied him. I joined them briefly but had to return to work because my financial resources were depleting, and I needed to replenish them to continue funding his treatment.

The journey itself cost USD1,800 (Sh232,000). Despite informing the airline in advance about our situation, they insisted on departure day that we lacked proper clearance, forcing us to rebook. I paid an additional Sh155,000.

At the hospital, we started the entire treatment process from scratch. Surgery was ruled out once again, leaving radiation as the best option. Bradley underwent 30 radiation therapy sessions, concluding on May 13.

Return to India

Whilst the treatment didn’t proceed exactly as planned, he’s experienced relief from several symptoms—he can speak somewhat and move his feet—but he remains generally unwell. His eyesight has actually deteriorated. He’s currently on a three-month break, after which we must return to India. I now need to hire a physiotherapist to help with his mobility—another mounting bill. Accommodation cost at least Sh5,000 nightly, excluding meals. I paid for all treatment out of pocket. To this day, I’m still waiting for SHA to respond to my claim. I’m an active contributor and even paid for an entire year upfront this year.

We’re in crisis. We simply don’t have a functional healthcare system. How is it that there’s money to distribute in churches, but none to help people access medical treatment?

The hidden costs of medical treatment are staggering. I’d already paid Bradley’s school fees for the entire year, had to purchase medications, and our daughter was also out of school. Everyone faces their own struggles, so I can’t forcefully demand help from others. Those who can assist have done so, and we continue hoping for the best.

If I could meet the President, I would remind him to invest properly in healthcare. We invoke God in our National Anthem and when our leaders take their oaths of office, but we don’t live up to those values in practice.”

Nicacius Mugambi, 24

“My medical odyssey began in 2017—a journey that feels like a horror film. I experienced pain in my ankles that gradually progressed to my knees. When I sought medical attention, I received only painkillers and no diagnosis.

By 2018, I was using crutches and was told I had arthritis. In 2019, the year I sat my KCSE examinations, my legs began deforming, and I knew my condition was becoming serious. I frequented clinics and underwent countless X-rays, but the more medical attention I sought, the worse my condition became. I could no longer stand independently. A year later, I began daily physiotherapy at a hospital in Kerugoya. Eventually, I reduced this to twice weekly.

I couldn’t enrol in any college because my family focused entirely on my healing journey. I briefly opened a barber shop in my home area but couldn’t sustain it because I tired easily. My deteriorating condition caused my mother to suffer a stroke—I’m her only son and last-born child. She used to sell groceries, but that income wasn’t sufficient to supplement what the defunct NHIF provided.

In 2022, I stayed home for an entire year without seeking medical treatment because we couldn’t afford it. I survived on painkillers that merely numbed the pain. 

Also read: Shame of patients neglected by health insurance system

In July 2023, friends contributed money and took me to Kenyatta National Hospital, where I remained until December. Finally, I received a diagnosis: hypophosphatemic osteomalacia. I required complete detoxification to flush out the medications I’d been taking over the years. My condition causes my bones to be excessively weak. The doctors explained that I’d actually damaged my bones by continuing physiotherapy without knowing the real problem.  I now depend entirely on a wheelchair and rely on others to move around. Each clinic visit to KNH costs at least Sh20,000.

I must use private transport, which costs approximately Sh10,000 to reach Nairobi. Once in Nairobi, I first visit Nairobi Hospital for tests, paying cash, before proceeding to KNH for review.

Since February, I haven’t managed to attend clinic because I can no longer afford it. My family has sold everything valuable we owned, including our cattle. It’s emotionally devastating—I take antidepressants when I contemplate my situation. I subscribed to SHA but couldn’t see its value because whenever I attended clinic, I paid out of pocket. I stopped contributing and chose to use that little money for clinic fees instead. I struggle to obtain medications because they’re available in only a few Nairobi hospitals and aren’t always in stock.

My friends have organised four fundraisers, raising approximately Sh270,000. This condition has cost more than Sh1 million, and I can no longer afford clinic visits.

If SHA is genuinely going to be a stepping stone towards Universal Health Coverage, it should support patients entirely, not require us to pay out of pocket. I’m nearly 25, but technically immobile.

I still hope that one day I’ll return to school.”

[email protected]

Why Kenyans pay more for treatment

By Beatrice Kairu

The two most profitable businesses are war and illness. The Kenyan health sector relies on several funding sources, which include government allocations at national and county level (52 per cent), donors (18 per cent), private bodies, implementing partners (six per cent) and households 24 per cent.

Healthcare is expensive, especially for Kenyans. There are a number of factors that contribute to that high cost, including wasteful systems, rising drug costs, medical professional salaries, profit-driven private sector health facilities, types of medical practices, health-related pricing, health infrastructure and the distance to health facilities, which affect supply and access to healthcare.

Most of the costs involved in Kenya’s healthcare system are dependent on market forces. This results in high, unregulated prescription drug costs and higher healthcare providers' salaries in contrast to other African nations. Government involvement in regulating prices is very minimal.

There has been persistently low government budget allocation to healthcare, further indicating that insufficient healthcare financing has been exacerbated by inadequate use of data-driven, evidence-based decision-making on domestic health financing.

Kenya’s budget allocation to health is below 15 per cent of the national budget, which also translates to below five per cent of the recommended share of the health budget to Gross Domestic Product (GDP). This is against the collective commitment made by Africa’s heads of state during the Abuja meeting in 2001, and subsequently the 2019 Africa Leadership Meeting, which also committed to increase health budget allocation and ensure efficient use of health resources.  Data and evidence are critical components that should inform how the health sector is resourced. Generation and use of data in domestic health financing in the country remains a major challenge despite the enormous benefits that result from using reliable data and evidence to guide resource allocation in the health sector.

Health spending is skewed toward secondary and tertiary curative care. This is evidenced by the government’s expenditure going towards Non-Communicable diseases. Curative care is more expensive in comparison to preventive care. Thus the government should focus its funds more on primary healthcare services and emergency care services.

 Health care costs can either increase the demand of a service or reduce it due to cost barriers. Healthcare pricing is therefore a key factor in the designing of the health insurance benefits packages, which incorporate various provider payment methods that incentivise healthcare providers to deliver quality care.

When it comes to the Social Health Authority, for instance, the package for dental services is Sh2,000 per household. This is not adequate in relation to the need for dental health per household. This will result in out-of-pocket expenditure to access adequate dental services for a household.

Underutilised production capacity and the lack of price control policies threaten the country’s ability to provide affordable, locally-produced medicines, which drives the cost of healthcare up since we rely majorly on imports. It increases the access gap and quality of healthcare provided. 

Due to Kenya's heavy dependence on imported Health Products and Technologies (HPTs), the healthcare system is susceptible to price fluctuations. Only about 30 per cent of HPT needs are being met by local manufacturing as acknowledged within the Health Products and Technologies Supply Chain Strategy 2020 – 2025.The industry is vulnerable to the fluctuations in the international market. As a result, healthcare providers and local pharmaceutical distributors are forced to adjust their prices, potentially affecting affordability for patients.

To address this challenge, the government should focus on increasing local HPT production. This could significantly improve availability and affordability of healthcare to patients and strengthen the entire healthcare sector. Local manufacturing would significantly reduce the prices as freight costs incurred on imported goods would not be incurred.

A recent report on the State of Kenya Healthcare market 2024 shows that there is no assessment done for the pricing of health services and products. This would ensure appropriate setting and regulation of prices. Most pricing of healthcare services done in public facilities is based on guess work.

More than 75 per cent of healthcare costs are due to chronic conditions such as heart disease, cancer, stroke, diabetes and arthritis. Research shows the costliest one per cent of patients account for 20 per cent of all health care spending in Kenya. Ten per cent of the population consumes 63 per cent of the total health care shillings in the country. People with three or more chronic disease conditions generally fall into that one per cent category.

Financial protection by SHA is quite weak since it only offers limited financial protection – with the poor, those over 60 years’ old and patients with chronic illnesses, having lowest access based on the amount the government allocated for Primary Health Care and Emergency and Chronic Illness funds in its 2024/2025 budget. Insured members still need to pay out of pocket fees for treatment and diagnosis.

If you look at the benefits package provided by SHA, it focuses more on inpatient services rather than the outpatient services, where the reimbursement amount per patient visit for level 2 and 3 facilities is Sh75. For those with chronic illness and emergencies, there is a limit beyond which the patient will be forced to pay out of pocket.

In instances where citizens prefer to use public health facilities, the situation of the facilities are discouraging. Most resources in public hospitals or meant for public hospitals are mismanaged and misappropriated for corrupt ends, with stories regularly surfacing about horrific malpractice.

Administrative costs are frequently cited as a cause for excess medical spending. According to statistics, healthcare costs in Kenya exceed those in other African nations, and these costs include those related to the administration of these systems.

The writer is a health economist