In December 2017, President Uhuru Kenyatta committed his administration to the realisation of UHC. Following a pilot phase, the government announced it would deliver UHC primarily through a nationwide expansion of insurance through the pro-private sector NHIF.

This represented a major departure from the pilot phase, which had eliminated fees at public facilities in four counties with considerable success. This would instead transform the state from a provider of health services to a purchaser. While the NHIF is a public entity, it enrolls both private and public facilities and has overseen a significant shift in spending toward the private sector. Private providers have long been in the driver’s seat and receive higher reimbursements for the same services.

New data on NHIF expenditure shows how payment to the private sector has skyrocketed. Between 2010 and 2021, NHIF payouts to the for-profit private healthcare sector rose more than 30-fold, vastly outstripping increases for public facilities (8.8 times). In 2011, 32 per cent of total NHIF spending on benefits went to public facilities and 30 per cent to private for-profits. Just 10 years later, payouts to for-profits had soared to 64 per cent, while just 20 per cent went to public facilities.