NICHOLAS OKUMU
Africa-Press – Kenya. Rwanda has 14 million people and 83 per cent health insurance coverage. Kenya has 55 million people, a brand new Social Health Authority and a claims settlement rate of 27 per cent for the private facilities it is counting on to deliver universal health coverage. That gap is not a resource problem. It is a policy choice. And the greatest tragedy is not that we lack the talent to close it. It is that our systems are designed to bury that talent before it can bloom.
I know this from both sides. As a clinician, I watch patients referred to facilities quietly struggling to stay open, not for lack of skill, but for lack of oxygen. As someone who has built healthcare businesses in Kenya, I know what that suffocation looks like in a set of accounts.
When we registered our latest clinic, the process took a full year. Not a year of earning while working toward compliance, a year of meeting every requirement, satisfying every inspector, paying every fee, before we were permitted to see a single patient. Full cost. Zero revenue. In any functioning market, we call this investment. Here, it is the entry fee into a system that does not guarantee you will survive long enough to recover it.
That is not a metaphor. A healthcare business I previously built became insolvent holding a substantial portfolio of unpaid NHIF and private insurance claims. The services had been delivered. The patients had been treated. The money simply did not come.
There was no liquidity buffer because the reimbursements that should have provided it were indefinitely queued. The business and everything built into it was gone. Today, 92 per cent of Kenya’s healthcare facilities report financial distress and SHA has inherited Sh30 billion in unpaid NHIF legacy bills. My story is not exceptional. It is the pattern.
Potential is not the problem. Permission is. And three countries have shown what happens when a government decides to grant it.
Rwanda removes every excuse. It passed a dedicated PPP law enabling long-term government contracts with private digital health providers, then signed a 10-year purchasing agreement with Babyl, a platform that at its peak delivered over 4,000 virtual consultations daily via SMS and basic feature phones, registering 2.5 million users before its UK parent’s bankruptcy closed it in 2023.
Even in failure, the Rwanda story is instructive: the framework was right, the government commitment was real, and Rwanda is now rebuilding with stronger continuity protections. Kenya wrote a Digital Health Act and proposed licence fees that its own stakeholders say will suppress the innovation the Act was meant to create. Same ambition. Opposite architecture.
India built an open interoperability framework allowing free to access for any provider, from a teaching hospital to a single-room pharmacy and making every private practitioner a full participant in the national health system with no licensing cost at the door.
Singapore introduced regulatory sandboxes: innovators operate under temporary clearance while completing compliance, earning as they build rather than building in a void. Its medical technology sector generates over S$19 billion (Sh1.9 trillion) annually. The principle is simple and it is not complicated to understand. Regulation should reduce the cost of doing good healthcare, not increase it.
None of these countries abandoned oversight. They abandoned the assumption that the private sector is a problem to be managed rather than a potential to be released. That assumption runs through Kenya’s healthcare regulatory environment like a fault line. It shows up in nine regulatory bodies governing the same facility. In claims timelines that exist in policy but not in practice. In a one-year registration process that demands full compliance before the first patient enters. In the NHIF arrears that closed businesses that had already delivered the care.
Kenya does not have a talent deficit; in fact, we have more than 4,000 unemployed doctors. We do not have a vision deficit. Ushahidi, the crisis mapping platform the world now depends on, was built here. We have a permission deficit and it is entirely self-imposed.
The day our government decides that the people building this country’s healthcare system are partners worthy of protection, not sources of revenue to be extracted, will be the day our potential is finally set free.
Rwanda made that decision. India made it. Singapore made it. Every day Kenya delays, the cost is not paid in policy documents. It is paid in closed clinics, collapsed businesses and patients turned away from facilities that should still be standing. Quietly, systematically, one at a time.
Source: The Star
