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