NAIROBI, KENYA – In a significant policy shift aimed at eradicating chronic medicine shortages in public health facilities, President William Ruto on Sunday, November 16, 2025, directed the Kenya Medical Supplies Authority (KEMSA) to deliver drugs and medical equipment directly to hospitals and dispensaries across the country. The directive, issued during an event in Marsabit County, effectively bypasses the long-standing model where supplies were first delivered to county government depots for last-mile distribution.

"We don't want to hear stories of a lack of drugs in our health facilities," President Ruto stated, emphasizing that the national government has provided KEMSA with the necessary funding to ensure an uninterrupted supply chain. This move is a core component of broader government reforms intended to transform KEMSA into a more efficient and transparent agency, crucial for the success of the country's Universal Health Coverage (UHC) agenda.

A System Plagued by Shortages

The President's order confronts a persistent crisis that has severely hampered healthcare delivery in Kenya. For years, patients in public facilities have faced the grim reality of "hakuna dawa" (no medicine), forcing them to either purchase essential drugs from private chemists or forgo treatment altogether. A January 2025 report highlighted severe shortages of critical supplies, including HIV medicines, testing kits, and even basic BCG vaccines for newborns, threatening to reverse years of public health gains.

The previous distribution model, a feature of the devolved system of governance established by the 2010 Constitution, designated County Governments as the primary recipients of KEMSA supplies. However, this system has been fraught with challenges, including logistical delays, alleged mismanagement at the county level, and crippling debts owed to KEMSA by county governments. As of May 2024, at least 27 counties owed the agency a total of Sh2.88 billion, severely hampering KEMSA's ability to procure and restock essential medicines.

The New Direct-to-Facility Model

The new directive mandates KEMSA, which serves over 10,000 health facilities, to leverage its logistical network for direct, door-step delivery. This policy is intertwined with other major health financing reforms, particularly the operationalization of the Social Health Authority (SHA), which replaced the National Hospital Insurance Fund (NHIF) in October 2024. Under the new framework, public hospitals will receive direct payments from the SHA and, in turn, pay KEMSA directly for supplies, delinking the process from county treasury systems.

Health Cabinet Secretary Aden Duale stated in May 2025 that this direct payment model is designed to eliminate bureaucratic delays and improve order fulfilment rates, which have languished below 50%. KEMSA has since launched a 100-Day Rapid Results Initiative (RRI) and a 2025–2030 Strategic Plan focused on full digitization, supply chain reform, and financial sustainability to support this enhanced role. The authority is targeting a 100% order fill rate to eliminate delays.

Implications for Devolution and Stakeholder Reaction

While the directive is widely seen as a necessary intervention to fix a broken supply chain, it raises fundamental questions about the role of county governments in managing healthcare, a constitutionally devolved function. The Council of Governors (CoG) has previously advocated for urgent reforms at KEMSA but has also maintained that the institution should be structured as a joint entity accountable to both national and county governments. The move to centralize distribution could be perceived as undermining the autonomy of counties in health service delivery.

Medical practitioners have long decried the impact of drug shortages on their ability to provide care. The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has repeatedly highlighted supply chain failures as a critical issue during industrial action negotiations. While the union may welcome a solution to stock-outs, concerns remain over the logistical capacity of KEMSA to consistently reach thousands of remote and rural health facilities without significant investment in its distribution infrastructure.

Ultimately, the success of this centralized distribution model will depend on KEMSA's ability to execute its expanded mandate efficiently and the national government's capacity to manage the delicate political balance with the 47 county governments. For millions of Kenyans reliant on public healthcare, the hope is that this directive finally marks the end of the chronic medicine shortages that have defined their experience for far too long.