Makueni healthcare crisis: The collapse of free insurance scheme amid mounting medical bills
Mary Mutiti during the interview in Muusini Village, Makueni County on May 10, 2025. The ailing granny is among thousands of Makueni County residents who are grappling with catastrophic health expenditure after Governor Mutula Kilonzo Junior abolished Makueni Care.
What you need to know:
- Under the insurance scheme dubbed ‘Kivutha Card’, a nuclear family enjoyed free healthcare services for a year after paying only Sh500.
- Those enrolled in the scheme, which was launched in 2016, enjoyed 10 days of free mortuary services.
- Facing intense public backlash amid hitches in the roll out of SHA, Governor Kilonzo has now announced plans to revive ‘Kivutha Card’.
Until a year ago, Mary Mutiti’s compound in Muusini Village, Makueni County was alive with countless chicken at any given moment. Feeding, watering and protecting the birds from predators kept the 88-year-old ailing grandmother engaged. But not anymore.
The peasant farmer’s life has taken a dramatic turn after selling all her birds to pay mounting medical bills.
“I had at least 300 mature chickens, but they have all been wiped out by medical expenses,” she tells Healthy Nation.
Ms Mutiti has battled high blood pressure and other age-related complications for years. She is among thousands of Makueni County residents struggling with unaffordable medical bills after Makueni Governor Mutula Kilonzo Jnr abolished Makueni Care, a pioneering health insurance scheme launched by his predecessor Kivutha Kibwana.
Under the insurance scheme dubbed ‘Kivutha Card’, a nuclear family enjoyed free healthcare services for a year after paying only Sh500. Those enrolled in the scheme, which was launched in 2016, enjoyed 10 days of free mortuary services.
According to the World Health Organization (WHO), more than 90 per cent of the approximately 1,000,000 Makueni residents were under Makueni Care in 2018. This, according to WHO, was a significant universal health coverage milestone considering that a paltry 8.8 per cent of the Makueni population had health insurance at the advent of devolution.
But during the 2022 general election campaigns, Mr Kilonzo Jnr denounced Makueni Care. “Kibwana, your medical care scheme has failed. We cannot entrust you with our relatives,” he once teared into Prof Kibwana in the presence of the then Deputy President William Ruto during the funeral of a relative who had died while receiving treatment at Machakos County Referral Hospital.
When he took office after winning the election, Mr Kilonzo Jnr announced a plan to build a robust healthcare system, abolishing Makueni Care. However, this move ushered in what residents describe as a period of rampant medicine shortages, soaring healthcare costs, deteriorating health outcomes and widespread public outcry.
For vulnerable residents like Ms Mutiti, the cancellation of Makueni Care had immediate and severe consequences. She recalls creating a scene at Makindu Sub-county Hospital when asked to pay for services that were previously free. "That is the last time I went to that hospital," she laments, joining many elderly residents pleading for the return of the ‘Kivutha Card’.
The Ministry of Health has revealed that two out of every three Makueni residents are exposed to catastrophic health expenditure. “We are deeply concerned because only 32 per cent of the Makueni population is registered in the Social Health Insurance Authority (SHA),” President William Ruto said when he hosted a section of Ukambani leaders at State House last week.
Facing intense public backlash amid hitches in the roll out of SHA, Governor Kilonzo has now announced plans to revive the ‘Kivutha Card’.
“SHA has failed. The system has become unreliable at the pre-authorisation stage. We have agreed with the county assembly that we cannot continue this way. We need our own healthcare scheme,” Mr Kilonzo Jnr said a month ago at the start of the 2025/2026 budget making public participation forums. He called on residents to endorse an affordable medical plan proposal.
Clandestine arrangement
The announcement signaled an end to a clandestine arrangement that has placed MCAs at the heart of the county’s healthcare system. Under the arrangement, the county government has allocated Sh500,000 per ward for waiving hospital bills for patients who are deemed unable to afford healthcare services. The county’s 30 elected MCAs control the budget and are in charge of determining who qualifies for the waivers. An MCA also dictates how much waiver a patient deserves.
Mr Kilonzo Jnr had introduced the hospital bills waiver scheme after abolishing ‘Kivutha Card’.
However, the system is operated with little transparency. A spot-check by Healthy Nation has shown that only one in 10 residents is aware of the waiver arrangement.
A first-term MCA, who requested anonymity due to the sensitivity of the matter, revealed the opaque process: "When a patient is admitted...the family should have my telephone number...My office does background check before writing to the hospital to waive the bill. This financial year I have set aside Sh1.4 million for waiving the bills."
Some wards like Makindu are allocated up to Sh2 million for waivers, yet many deserving cases like Ms Mutiti remain unaware of the programme.
“We are forced to sell our properties to foot hospital bills. Alternatively, we fundraise and borrow money from friends and relatives whenever a loved one is hospitalised,” Abdallah Wambua told Healthy Nation.
Governor Kilonzo Jnr faces an uphill battle to restore what his predecessor built. For Ms Mutiti and thousands like her, the hope is that quality, affordable healthcare won't remain a casualty of political rivalry much longer.
In the meantime, Makueni Health Executive Paul Musila believes SHA is a panacea to the county's health woes. He has enlisted community health volunteers to popularise SHA. “The best you can do as we wait for anything else is to register yourself and your loved ones into SHA. We will soon provide a solution for those who are not able to pay the SHA premiums as provided for in the law,” Dr Musila said a day after Mr Kilonzo Jnr announced the plan to revert to Makueni Care.
