The prognosis for President William Ruto’s flagship healthcare overhaul is grim. Three years into the administration’s ambitious attempt to re-engineer Kenya’s medical infrastructure, a scathing report by the Parliamentary Budget Office (PBO) has declared the patient—the Social Health Authority (SHA)—to be in critical condition.

Released this morning, the fiscal analysis does not mince words. It warns that the transition from the National Health Insurance Fund (NHIF) to the SHA is being suffocated by a toxic cocktail of underfunding, technological failure, and a disillusioned workforce. For the average Kenyan, this bureaucratic diagnosis confirms a painful reality: the promise of "Afya Bora" is becoming an expensive mirage.

The 'Glitch' That Became a Feature

The government has repeatedly dismissed service interruptions as mere "teething problems." However, the PBO report suggests these issues are structural, not temporary. The system, procured at a staggering cost of KES 104 billion, is reportedly failing up to four times a month. These outages are not just inconveniences; they are life-and-death delays.

Auditor General Nancy Gathungu has previously raised alarms that the government neither owns nor fully controls this critical digital infrastructure, which is managed by private entities. This lack of sovereignty over patient data and payment systems has created a black box where accountability goes to die.

• The Registration Mirage: While 19.3 million Kenyans are registered, only 3.3 million are actively contributing. The math simply does not add up.
• The Debt Trap: The SHA inherited a debilitating KES 30.9 billion debt from the defunct NHIF, crippling its ability to pay hospitals on time.
• The Settlement Crisis: Private facilities report a claims settlement rate of just 27-34%, forcing many to demand cash upfront from desperate patients.

A Workforce on the Brink

No hospital can function without healers, yet the human resource crisis is deepening. The report highlights a shortfall of 70,000 health workers as of January 2025. Worse still, the morale of the existing workforce is in the gutter. Persistent industrial actions in counties like Kiambu, Nairobi, and Machakos have turned public hospitals into ghost towns for months at a time.

The plight of Community Health Promoters (CHPs)—the celebrated foot soldiers of this revolution—is particularly telling. Promised as the backbone of preventive care, they have been left high and dry. The PBO notes that out of KES 3 billion allocated for CHPs, only KES 786 million has been disbursed. In the 2024/25 financial year, only four counties received the national government’s matching funds.

The Human Cost of Policy Gaps

Behind the billions and the acronyms are real Kenyans facing impossible choices. Cancer patients, previously covered up to KES 600,000 per individual under NHIF, are now navigating a confusing system where benefits are capped at KES 400,000 per household. For a family with two patients, this is a death sentence.

Former Deputy President Rigathi Gachagua has seized on these failures, describing the transition as "pure theft" and arguing that the old NHIF could have been reformed for a fraction of the cost—KES 800 million versus the SHA’s KES 104 billion price tag. While his critique carries political weight, the PBO’s non-partisan data validates the core concern: the cure is proving more painful than the disease.

As the government scrambles to plug these leaks, the PBO warns that without an urgent injection of funds and a complete overhaul of the governance structure, the entire system risks collapse. For a President who bet his legacy on Universal Health Coverage, the window to save the patient is closing fast.