Health sector under pressure as donor shift, funding gaps and labour dispute converge
Supply chain transition, Sh116 billion SHA shortfall and union concerns raise questions over service delivery
By Chemtai Kirui | Nairobi
The health sector is facing pressure from a shift in donor-funded supply chains, domestic funding gaps and a growing dispute over medical cover.
A five-year health cooperation framework between the government and the United States is set to reshape the procurement and delivery of essential medical commodities, including those for HIV, tuberculosis and malaria, although implementation remains subject to a High Court conservatory order pending the constitutional petition.
The shift is taking place under existing transition planning frameworks, including the Global Fund Kenya Health Sector Transition Roadmap and PEPFAR country-led procurement approach, which are designed to move programmes toward domestically financed systems.
Health officials and sector stakeholders have raised concerns about the pace of the transition, warning that gaps in local procurement and distribution capacity could affect the availability of key commodities if not addressed.
At the same time, the Social Health Authority (SHA) is operating with a funding gap. Analysis by the Institute of Economic Affairs estimates a collective shortfall of Sh116.1 billion across SHA’s funds, including primary healthcare, emergency, chronic and critical illness, and social health insurance. The gap has coincided with delays in reimbursements and increased pressure on higher-level hospitals as patients bypass under-resourced primary facilities.
The authority recently announced the disbursement of Sh11.1 billion to healthcare providers to settle approved claims. However, providers and unions say access to services remains uneven.
Teachers’ unions, including the Kenya National Union of Teachers (KNUT) and the Kenya Union of Post Primary Education Teachers (KUPPET), have raised concerns over access to care under the scheme and signalled the possibility of industrial action. KUPPET has said it could take industrial action at the end of April if the issues are not resolved, while KNUT has threatened to withdraw from the SHA medical scheme and warned of a nationwide strike.
On the supply side, the Kenya Medical Supplies Authority has set a target of a 90 per cent order fill rate for the 2025/26 financial year and aims to reduce delivery times to seven days for public hospitals under a new performance contract with the Ministry of Health.
Budget constraints remain a key pressure point. The Ministry of Health told Parliament it required Sh426.8 billion for the 2025/26 financial year to sustain programmes, including the rollout of social health insurance, but current budget estimates are significantly lower.
The combination of supply chain changes, funding constraints and labour concerns is placing pressure on service delivery across the system.
