Kenya’s Healthcare Crossroads: Why we have to act now!

The recently released Kenya Population Situation Analysis (PSA) provides one of the clearest assessments of our national health trajectory — offering both encouragement and a timely warning.

Over the past three decades, Kenya has made meaningful progress. Life expectancy has risen from 59 years in the early 1990s to 66 today. Under‑five mortality has dropped from 115 to 41 per 1,000 live births, and maternal mortality has improved from 590 per 100,000 live births in 1998 to 355 in 2022. HIV prevalence has also fallen significantly, reflecting effective policy action and robust partnerships.

These gains matter. They represent long-term investment, committed frontline workers and sustained reforms.

But the PSA also shows that the landscape is changing quickly.

Non-communicable diseases (NCDs) now account for 40% of all deaths in Kenya — nearly double their share in the early 1990s. Cardiovascular diseases contribute 13% of total deaths, and hypertension affects 24% of adults, up from below 15% three decades ago. Kenya is now managing a dual burden: persistent infectious diseases and a sharp rise in chronic conditions. Both require strong financing, skilled health professionals and long-term systems planning.

Workforce Shortages: A Structural Constraint

Rising demand is colliding with limited supply. According to the PSA, Kenya has just 10 nurses per 10,000 people against an estimated requirement of 58.6, and only 1 doctor per 10,000 compared to the WHO benchmark of 7.7. Shortages are most acute in rural and underserved counties, where understaffing, limited specialisation and high attrition weaken service delivery. As the population grows, these gaps risk becoming a major barrier to achieving Universal Health Coverage (UHC).

Addressing this calls for coordinated national action: scaling training capacity, improving distribution of professionals and strengthening retention. Postgraduate education, specialist fellowships and continuous development must keep pace with Kenya's shifting disease burden.

At Aga Khan University (AKU) and Aga Khan University Hospital (AKUH), we are prioritising this need. Our internationally accredited undergraduate and postgraduate programmes use simulation-based learning and other innovations to prepare practice-ready graduates. We have expanded specialist fellowship training to 16 programmes, increasing the number of cardiologists, oncologists, neurologists and other critical specialists. We also provide continuous medical education to over 3,000 clinicians each year — many from the public sector. These healthcare workers take their training back to their communities, improving the quality of care. But even with these efforts, far more partners must join in to meet national needs.

Prevention: The Most Under‑Leveraged Intervention

The PSA underscores a critical truth: Kenya cannot treat its way out of the NCD epidemic. Prevention must move to the centre of national strategy.

Government efforts to strengthen primary healthcare, expand community health promoters, enhance vaccination, enforce tobacco control and roll out the Social Health Insurance Fund (SHIF) — which includes preventive services — provide a strong foundation.

But prevention requires a whole-of-society approach. The private sector can play a bigger role through workplace wellness programmes, health education and community outreach.

At AKUH, working with employers, religious institutions and other partners, we screen more than 100,000 people annually for hypertension, diabetes, cancers and other NCDs. These programmes help individuals lead healthier lives, support early detection and improve outcomes — while also supporting productivity.

With nearly one in four adults hypertensive, prevention is both a public health priority and an economic imperative.

Financing Reform Must Expand Access

The PSA also highlights persistent financing challenges. High out‑of‑pocket spending and declining donor funding threaten the continuity of essential programmes.

Sustainable healthcare requires predictable public financing and shared responsibility. SHIF offers an opportunity to stabilise the system — but its success will depend on timely reimbursements, adequate coverage of preventive care and strong protections for vulnerable populations.

Private insurers must also innovate, particularly by offering micro‑insurance products suited to informal workers and retirees, who often lack adequate coverage.

A Defining Decade

The PSA is more than a snapshot; it is a call to prepare for the future.

Kenya's population is growing, urbanising and ageing. Expectations will rise alongside demand for complex care. Fiscal pressures will increase.

If we invest now — in workforce expansion, preventive care, equitable financing, climate resilience and digital integration — Kenya can transform demographic growth into health and economic resilience.

If we wait, we risk widening inequities and pushing already strained facilities beyond capacity.

Kenya is at a crossroads. The decisions made in the next decade will determine whether our health gains accelerate — or stall.

By Rashid Khalani, CEO, Aga Khan University Hospital, Nairobi