Kenya’s president rushed through universal health reforms. How he did it and why this matters

For decades, Kenyans without health insurance have had one option when they fall sick, or a hospital bill arrives.

Reach out to friends and family to gather what they can for their healthcare.

By 2023, official figures showed only about a quarter of Kenyans had any health cover.

And most of these were people working in formal sector jobs.

For the remaining 75%, who had no cover, falling sick meant paying out of their own pockets at health facilities.

The few exceptions include maternity care and basic services in local clinics.

The World Health Organization estimates that half of all people worldwide impoverished by out-of-pocket health expenditures live in Africa.

In 2023, shortly after taking office, President William Ruto’s government pushed through a major health financing law, the Social Health Insurance Act .

This new law scrapped the National Hospital Insurance Fund, the state insurer since 1966.

The insurer had collected members’ contributions and paid their hospital bills, yet only managed to cover about a quarter of Kenyans.

The new law replaced it with a new body, the Social Health Authority.

Every Kenyan, formally employed or not, is now expected to register with the authority and contribute 2.75% of their income .

The law was immediately challenged in court .

Petitioners argued that it had been rushed through without adequate public participation; that the executive bypassed parliament; the burden of 2.75% contribution was too heavy; and that tying healthcare access to registration and contributions violated constitutional rights.