Serious weaknesses in Kenya’s healthcare system are putting the government’s Universal Health Coverage plan under strain, with a parliamentary report warning that long-standing problems could stall progress if they are not urgently fixed.
The report by the Parliamentary Budget Office highlights limited health facilities, staff shortages, frequent strikes by healthcare workers and delayed funding for Community Health Promoters as key obstacles to the success of Universal Health Coverage.
The office, which provides budget advice to Members of Parliament, says these issues threaten one of the core programmes under the Bottom-Up Economic Transformation Agenda.
Universal Health Coverage aims to make sure all Kenyans can access quality healthcare services without being pushed into poverty by medical costs. It also seeks to protect poor and vulnerable households through government support.
However, the report notes that gaps in service delivery continue to undermine this goal, especially at county level where health services are delivered.
Industrial action by healthcare workers emerges as a major concern in the report, with repeated strikes disrupting essential services in several parts of the country. According to the findings, these stoppages are weakening primary healthcare, which is central to the Universal Health Coverage plan.
“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.
During the year, counties such as Nairobi, Kiambu and Machakos were affected by strikes involving doctors, nurses and clinical officers. Kiambu County was hit hardest, with doctors downing tools for five months before resuming work in October.
The prolonged strike left many patients without care and resulted in deaths, especially among children.
To address disputes over pay, the national government allocated Sh1.8 billion in the 2024/25 financial year to clear salary arrears owed to county health workers.
The funds are to be sent to counties through the County Government Additional Allocations Act, 2025. This followed a return-to-work agreement reached in March 2024 between the national government and the Kenya Medical Practitioners, Pharmacists and Dentists Union.
The report also draws attention to deeper workforce problems that go beyond strikes. It notes that health workers are unevenly spread across the country, with rural areas and informal settlements facing the greatest shortages.
At the same time, urban centres continue to attract more health personnel, widening the gap in access to care.
According to the 2025 devolution report by the budget office, addressing these imbalances is critical to achieving fairness in healthcare delivery.
The report says equal access cannot be achieved without proper deployment of staff and better working conditions.
“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.
Community Health Promoters, who form the backbone of health services at the grassroots, are also facing major setbacks due to poor funding and lack of basic equipment.
The report warns that delays in paying stipends and providing tools could weaken their ability to support Universal Health Coverage.
“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.
The report estimates the number of Community Health Promoters at 10,831, with their stipends jointly funded by the national and county governments on an equal basis. However, funding has not flowed as planned, leaving many promoters unpaid.
Figures from the Controller of Budget show that in the 2024/25 financial year, only four counties—Bomet, Kwale, Tharaka-Nithi and Uasin Gishu—received the national government’s contribution for Community Health Promoters.
On the county side, only 14 counties have set aside funds and paid stipends, meaning payments remain irregular and incomplete.
The Parliamentary Budget Office warns that unless funding, staffing and labour issues are resolved, the country risks weakening the foundation of Universal Health Coverage and limiting access to basic healthcare services for millions of Kenyans.
