Kenya’s Social Health Authority (SHA) has disbursed just over Ksh12.57 billion to 7,282 health facilities across 45 counties in what represents one of the most comprehensive datasets ever assembled on primary healthcare (PHC) funding in the country.  

The figures span facilities from Level 2 dispensaries to Level 4 county referral hospitals, with Nairobi leading all counties with Ksh1.34 billion disbursed across 347 facilities, followed by Kiambu at Ksh650 million and Mombasa at Ksh584 million. Tana River, on the other hand, received Ksh41.5 million across 48 facilities, while Samburu got Ksh49.6 million across 64.  

The disparity reflects the underlying registration and utilisation gap: urban counties with higher enrollment, greater health awareness, and denser populations generate more patient visits, which in turn drive higher capitation-based disbursements under a volume-driven funding model that rewards utilisation over population size alone. 

Kitui County Referral Hospital received Ksh57.9 million, the highest disbursement in the country. Kitui County as a whole received Ksh241 million across 211 facilities, meaning its average payment per facility stands at about Ksh1.14 million. The referral hospital received 50.6 times the county average, an outlier ratio.  

Referral hospitals carry a disproportionate patient burden, handle complex cases, and serve populations beyond their own county boundaries. But the sheer concentration of one facility means the surrounding Level 2 and Level 3 facilities, which form the backbone of primary care, may be systematically under-resourced.  

Similar concentration patterns emerge in Nandi, where Kapsabet County Referral Hospital received Ksh48.9 million, representing 24.2 times the county average, while in West Pokot, Kapenguria County Referral Hospital received 27.8 times its county average. 

Then there is Magongo MCM Dispensary in Mombasa, a Level 2 facility, meaning it’s a small community dispensary offering basic outpatient services. Yet it received Ksh32.7 million, ranking seventh nationally and comfortably outpacing Level 4 hospitals in multiple counties. Level 2 facilities collectively account for 43.5 per cent of total disbursements nationally, which reflects a deliberate PHC policy priority, but Magongo’s figures sit so far outside the Level 2 norm. 

This is because SHA only pays for documented care. Facilities with poor records get less funding, and the facilities with the worst records are invariably the poorest. 

The breakdown by ownership type reveals an important structural truth about Kenya’s health system. County government facilities account for 66.9 per cent of total disbursements and represent the dominant provider across the country. Private facilities, however, make up 31 per cent of all registered facilities yet receive only 28.5 per cent of total funds, a modest gap, but a consistent one.  

Faith-based organisations, which have historically been the backbone of rural healthcare delivery in Kenya, account for just 4.4 per cent of disbursements despite maintaining some of the country’s most trusted and high-volume facilities, particularly in remote counties such as Trans Nzoia, Bungoma, and Migori. 

That private facilities receive a slightly smaller share of funds than their numbers would suggest may seem unremarkable. But in counties where government infrastructure is thin and private providers fill the gap, even a modest funding shortfall carries real consequences for patients.  

Eagle Health and Clinic Services in Nairobi demonstrates what integration looks like when it works, Ksh40.7 million disbursed, ranking third in the country. 

Limuru Valley-Med Diagnostic Centre in Kiambu, a Level 3B facility whose “Jamii” (community) suffix signals a community-service mandate, is the only community-owned facility in the entire SHA dataset. One facility out of 7,282 received just Ksh407,710, the lowest total of any ownership category. 

One of the most troubling aspects of the dataset is the presence of 278 facilities that received less than Ksh10,000 each. In a handful of extreme cases, payments fall below Ksh1,000. 

Bestcare Hospital in Makueni received Ksh400.85. Arqam Medical Centre in Garissa received Ksh417.37. Across Turkana, Samburu, and Garissa, dispensaries received payments that would not cover the cost of a single consultation. The figures do not suggest that these facilities delivered no care. They suggest the care was most likely never recorded. 

That pattern scales up dramatically in Mandera and Wajir. Despite having 317 and 249 contracted facilities, respectively, figures that rival or exceed far better-funded counties, Mandera averaged just Ksh398,000 per facility and Wajir Ksh421,000, the two lowest county averages in the country. Facility count, it turns out, means very little when the claims never arrive. 

Generally, the PHC funding system is functioning at scale but unevenly, with a small number of high-volume urban and referral facilities capturing disproportionate shares of public funds, whilst hundreds of small rural facilities operate on sums that border on the symbolic. 

Data analytics and visualisation by Stanley Njihia & Text by Yvonne Kawira.