Kenya's 47 governors are on a collision course with the National Treasury over the future of healthcare, demanding that Treasury Cabinet Secretary John Mbadi make good on a pact with President William Ruto to ensure the survival of the new Social Health Authority (SHA). The county heads have urged the Treasury to release all funds for county wages and deductions by the third of every month, a critical move for the SHA's success.

This standoff is more than a bureaucratic squabble; it's a direct threat to the health of millions of Kenyans. The timely disbursement of these funds is the financial lifeblood for county health facilities, which are already buckling under the strain of delayed payments from the SHA. The failure to remit funds cripples the procurement of essential medicines and supplies, leaving patients vulnerable and undermining the government's ambitious Universal Health Coverage (UHC) agenda.

Hospitals in Financial Crisis

The transition from the National Health Insurance Fund (NHIF) to the Social Health Authority has been fraught with challenges, described by some stakeholders as chaotic. County governments report that billions of shillings in medical claims remain unpaid, forcing hospitals to redirect development funds to sustain basic services. In October, senators were told that the SHA owed Nyeri County alone KES 230 million, with a further KES 289 million in arrears from the defunct NHIF, leading to what Governor Mutahi Kahiga termed "double jeopardy" for employees who face deductions for a service they can't access.

The financial strain is not limited to public facilities. Private hospitals have also warned of imminent collapse, with some associations claiming their members are owed over KES 80 billion by the government, creating a nationwide healthcare crisis. The Council of Governors has previously threatened to shut down county operations entirely over funding impasses, highlighting the severity of the situation.

A Presidential Pledge vs. Economic Reality

The governors' demand stems from a resolution made at the 12th National and County Governments Coordinating Summit, chaired by President Ruto. The summit resolved that to support devolution and the new health scheme, the Treasury would disburse personnel emolument funds to counties by the third of each month, effective January 2026. This was intended to ensure counties could, in turn, make their statutory payments, including SHA contributions, by the ninth of the month.

However, the Treasury has painted a grim picture of the country's finances. While CS John Mbadi has noted allocations have been made to support the SHA, he has also been candid about the struggling economy, stating in November that the country could not sustain increased financial demands from counties. This sets the stage for a potential impasse between the President's directive and the fiscal realities managed by his treasury.

• The Agreement: Treasury to release county salary and deduction funds by the 3rd of each month.
• The Problem: Billions in delayed SHA reimbursements are crippling county health services.
• The Impact: Shortages of essential drugs, postponement of procedures, and threats of hospital shutdowns.
• The Context: President Ruto has championed the SHA as the key to UHC, promising to cover costs for 1.5 million vulnerable Kenyans.

As this financial tug-of-war unfolds, the critical question remains whether the SHA, the cornerstone of President Ruto's healthcare reform, will receive the timely funding needed to function. For the average Kenyan, the outcome will determine whether a hospital visit brings relief or a confrontation with a system starved of the resources it needs to save lives.