Putting People First: The Youth Café and Civil Society’s Call for a Sustainable, Equitable, and Accountable Health System in Kenya
Introduction
Kenya stands at a defining moment in its health reform journey. The transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA), the enactment of the Primary Health Care Act and the Facility Improvement Financing Act, the expansion of Primary Care Networks (PCNs), and the deployment of more than 107,000 Community Health Promoters (CHPs) represent genuine progress. Yet, as the country prepares for the Kenya Health Summit 2026, the central question is not whether reforms exist on paper, but whether they can be financed, implemented, governed, and sustained in a fiscal environment marked by debt distress.
For civil society, including The Youth Café, this moment is about ensuring reforms translate into delivery—reaching households, protecting the poorest, and building a health system that is equitable, accountable, and sustainable. This blog explores the consolidated civil society position, highlighting the commitments proposed for the Joint Health Compact, and situates The Youth Café’s role in advancing youth‑centered, community‑driven health transformation.
Kenya’s Reform Journey: Progress and Promise
Civil society acknowledges the scale of reform already underway. The deployment of CHPs signals a shift toward preventive and promotive health, positioning community health as central to Universal Health Coverage (UHC). SHA has expanded registration, contracted facilities, and begun processing claims at scale, with reports of a 90‑day payment timeline and a 74% settlement rate.
Kenya is also entering a new financing environment, with Government‑to‑Government (G2G) arrangements—such as the Kenya‑US health cooperation framework—structured around investment in primary health care, disease programs, and maternal and newborn health. These are important steps. But reforms must be matched with predictable financing, effective implementation, accountable institutions, and meaningful citizen participation.
The Fiscal Context: Financing Health in an Era of Debt Distress
Kenya’s 2026 Budget Policy Statement recognizes fiscal consolidation, constrained revenues, and elevated debt‑service pressures. Currently, combined national and county health financing stands at 6.9% of the national budget, far below the 15% Abuja Declaration commitment. This financing gap of nearly Ksh 388 billion manifests in workforce contractions, SHA claim backlogs, and commodity stock‑outs.
Civil society proposes a “protect, prioritise, and account” approach. Essential services and high‑impact PHC interventions must be protected from disproportionate cuts. Resources should be prioritized toward interventions with the greatest impact on mortality, morbidity, equity, and household financial protection. Every financing stream must be accounted for transparently, enabling Parliament, county assemblies, civil society, and citizens to monitor outcomes.
Transforming Reform into Delivery
Reforms risk becoming hollow if fiscal pressures lead to over‑investment in visible hospital infrastructure while under‑financing prevention, community health, and health promotion. This would be a false economy. When prevention is neglected, treatment costs rise. When commodities are unavailable, households pay out of pocket. When providers are not paid, service continuity suffers.
Civil society insists that financing must follow population health needs, not institutional structures. The Compact must encode this logic, ensuring that Level 1 community health is protected and resourced.
Primary Health Care as the Foundation of UHC
Civil society emphasizes that primary health care must move beyond aspiration and become the financed bedrock of Universal Health Coverage. Kenya’s most important health system asset is the network that prevents people from becoming seriously ill, identifies risk early, and connects households to appropriate care. This begins at Level 1, with the Community Health Promoter platform.
To make this foundation strong, a clearly defined and protected financing envelope for community health must be established within Kenya’s PHC framework. A costed, multi‑year national financing plan should be jointly implemented by national and county governments, covering stipends, training, supervision, commodities, digital tools, referral support, data management, and community engagement. Prevention and health promotion must be recognized as outputs of the health system, not just clinical encounters, and community health indicators should be integrated into national financing and performance frameworks. Every national and county health plan should demonstrate how financing reaches Level 1.
SHA Must Become a Source of Confidence
Civil society acknowledges the progress made by the Social Health Authority, including expanded registration, facility contracting, and claims payments. However, public confidence will ultimately depend on what citizens and providers experience. Delayed claims, unclear processing procedures, tariff uncertainty, provider cash‑flow challenges, and unauthorized out‑of‑pocket payments remain pressing concerns.
To build trust, SHA transparency must become a standing Compact commitment. This means quarterly, county‑disaggregated publication of contributions, claims, approvals, rejections, and processing times. It also requires publication of the basis for tariff and benefit‑package decisions, independent actuarial reviews, and grievance‑redress mechanisms. Structured civil society participation in reviewing the benefits package and financing reforms will ensure accountability and responsiveness.
Health Debt and Provider Arrears
Health‑sector debt is not just an accounting issue; it directly affects service delivery. When providers are owed money, commodities are not replenished, suppliers restrict deliveries, facilities accumulate liabilities, and patients ultimately bear the cost. The Government’s decision to begin settling verified claims inherited from the defunct NHIF is an important step toward restoring provider confidence.
The Compact should build on this by requiring verification and publication of health‑sector arrears, establishing a time‑bound settlement plan, and putting mechanisms in place to prevent new arrears from accumulating.
Civil Society’s Role in Kenya’s Financing Architecture
Kenya’s shift toward greater domestic financing and Government‑to‑Government arrangements presents an opportunity to strengthen national ownership and align resources with priorities. Civil society supports government leadership but insists that ownership must be accompanied by accountability.
Civil society organizations bring comparative strengths that government systems alone cannot provide. They help ensure national investments are understood by communities and translated into locally responsive services. They monitor whether resources, commodities, and services reach intended beneficiaries. They provide social accountability through community scorecards, audits, and citizen feedback. They reach underserved populations such as informal settlements, arid counties, mobile communities, adolescents, and persons with disabilities. They generate evidence by identifying bottlenecks not visible through routine systems. They aggregate community evidence into national policy processes. Finally, they track Compact implementation and publicly report progress.
To institutionalize this role, civil society proposes the establishment of a formal Health Accountability and Partnership Mechanism within the Ministry of Health’s coordination architecture.
Cross‑Cutting Priorities
Civil society highlights four cross‑cutting priorities that must be embedded in the Compact. Commodity security is essential, as a patient covered by SHA but unable to find medicines has not experienced financial protection. Financing for essential commodities must be ring‑fenced, forecasting and procurement must be transparent, and stock‑availability indicators must be published.
Human resources for health are equally critical. Community health workers and promoters must be treated as integral members of the workforce, with equitable distribution, retention, continuous professional development, and supportive supervision financed and implemented.
Digital health and data governance must strengthen, not replace, the human relationship between communities and the health system. Commitments should include interoperability across systems, strong data protection, assisted pathways for digitally excluded populations, and publication of anonymized, disaggregated data.
Finally, equity must be a standing test. Success cannot be measured by national averages alone. Every financing reform should undergo equity impact assessments, focusing on marginalized groups such as people living in poverty, informal‑sector workers, women and girls, persons with disabilities, older persons, and populations in arid and semi‑arid counties.
Proposed Commitments for the Joint Health Compact
Civil society envisions the Joint Health Compact as a social contract for health, defining not only government responsibilities but also partner contributions and performance measures.
Under the financing pillar, commitments should include establishing a protected PHC financing floor across national and county budgets, adopting a multi‑year community health financing framework, and publishing verified health‑sector arrears with settlement plans.
Under the delivery and quality pillar, commitments should include publishing quarterly SHA financing and claims data, ring‑fencing essential commodity financing, and formally recognizing CHPs as part of the health workforce with equitable distribution and professional development.
Under the accountability and partnership pillar, commitments should include ensuring G2G financing incorporates structured civil society participation, institutionalizing civil society engagement through a formal mechanism, and creating an annual public review of the Compact with measurable indicators, equity assessments, and citizen feedback.
Immediate Actions After the Summit
Civil society stresses that credibility will depend on what happens after the Summit. Within 90 days of adoption, government and civil society should jointly establish a Compact Implementation and Accountability Committee, agree on a results framework and indicators, and map existing health financing flows across all sources. They should develop the national community health financing framework, establish a public SHA accountability dashboard, agree on civil society participation in G2G financing, create mechanisms for community feedback, and publish the first progress report.
The Compact should then be reviewed annually at a high‑level accountability forum.
The Youth Café’s Contribution
For The Youth Café, this position paper is more than a technical input—it is a call to action. As a youth‑led organization, The Youth Café brings unique strengths: mobilizing young people, amplifying grassroots voices, and ensuring that reforms are not abstract policies but lived realities.