Despite accessing consultations under SHA, many Kenyan patients still leave primary healthcare facilities without medicines, forcing them to spend out-of-pocket at private pharmacies even after seeking care at publicly funded facilities.
Just days after the government unveiled a Ksh177.2 billion health budget for the 2026/27 financial year, including Ksh19.1 billion for primary healthcare services, the Social Health Authority (SHA) is set to enforce sweeping accountability measures targeting health facilities that prescribe medicines but fail to provide them to patients.
The directive, announced by SHA Chief Executive Officer, Dr Mercy Mwangangi, could see facilities lose part of their reimbursements if patients leave consultations without receiving prescribed medicines, despite facilities already receiving public funding for those services.
The move strikes at one of the most persistent complaints surrounding Kenya’s healthcare system: patients visiting health centres and dispensaries, receiving diagnoses and prescriptions, only to be told to purchase medicines elsewhere.
For a government that has made primary healthcare the centrepiece of its Universal Health Coverage (UHC) agenda, the practice undermines both public confidence and the value of billions of shillings being invested in frontline healthcare services.
Speaking during an interview with Willow Health Media on June 3, 2026, on her first anniversary at the helm of SHA, Dr Mwangangi said the authority would begin enforcing stricter accountability measures on facilities accredited under the Primary Health Care (PHC) Fund.
“We have the budget and we are paying providers. In fact, I made my last PHC disbursement about five days ago, about Ksh2 billion was paid out,” Dr Mwangangi said. “What we want to do now is act as a strategic purchaser and compel facilities to actually provide medicines. Coming into the next payment cycle, we shall make deductions when medicine is not dispensed by a provider.”
The announcement reflects a broader shift in SHA’s approach as it moves from establishing systems and financing mechanisms to scrutinising how healthcare facilities deliver services.
The increased investment is evident in the latest budget, which proposes to allocate Ksh19.1 billion to primary healthcare services
Over the past year, SHA has prioritised expanding access to primary healthcare through a financing model that directs resources to dispensaries, health centres and community-level facilities, where the majority of Kenyans seek care.
According to Dr Mwangangi, approximately 70 per cent of Kenyans access healthcare through Level 2 and Level 3 facilities. Yet these facilities have historically remained underfunded despite carrying the largest patient burden.
“70 per cent of Kenyans access healthcare through dispensaries and health centres. If there is anything Kenyans should celebrate government for, it is that somebody was brave enough to decide to invest in primary healthcare services,” she said.
The increased investment is evident in the latest budget, which proposes to allocate Ksh19.1 billion to primary healthcare services, reinforcing the government’s decision to shift healthcare financing away from an overwhelming focus on hospitals and specialised treatment towards prevention, early intervention and community-based care.
Primary healthcare services financed through the PHC Fund include treatment of common illnesses, maternal and child health services, immunisation, family planning, health promotion and management of chronic diseases.
However, SHA’s own data suggests that financing alone is not enough. According to Dr Mwangangi, six months of data collected through SHA’s digital tracking system has revealed a troubling pattern across many facilities. While healthcare workers routinely prescribe medicines, many facilities fail to dispense them to patients.
“Our facilities, particularly public facilities, are prescribing medicines but not dispensing enough of them,” she said.
The findings expose a critical loophole in Kenya’s primary healthcare system. Patients may successfully access consultations under SHA, but many still incur out-of-pocket expenses because medicines are unavailable, inaccessible or not provided. In some cases, patients are forced to seek treatment from private pharmacies despite attending publicly funded facilities. The result is a disconnect between healthcare financing and healthcare delivery.
Patients will receive SMS prompts asking them to confirm whether they obtained prescribed medicines during their visit
To close that gap, SHA plans to use electronic prescription and dispensing records to verify whether patients actually receive medicines prescribed during consultations. Under the new system, facilities that fail to dispense medicines will no longer receive reimbursement for that component of care.
Instead, SHA will deduct the medication portion of the claim and redirect the funds to contracted pharmacies where patients can obtain the medicines without additional charges. The reforms represent one of the clearest examples of SHA’s role as a strategic purchaser of healthcare rather than simply a payer of claims.
The authority is also introducing a patient verification mechanism designed to strengthen oversight and reduce opportunities for abuse. Patients will receive text message (SMS) prompts asking them to confirm whether they obtained prescribed medicines during their visit. Their responses will be linked directly to claims processing.
The information could trigger audits, investigations and sanctions against facilities found to be repeatedly violating dispensing requirements.
“The customer is the Kenyan,” she said. “If providers are not delivering services as required, SHA has the power to sanction or decontract them.”
The approach reflects growing recognition that achieving Universal Health Coverage requires more than increasing budgets. Healthcare systems often struggle with what experts describe as the “last-mile problem”, which is the gap between policy intentions and what patients experience when they walk into a health facility.
In Kenya’s case, medicine availability remains one of the most visible indicators of whether healthcare reforms are working. A patient who receives a consultation but leaves without medication is unlikely to perceive the encounter as successful, regardless of how much funding has been allocated to the system.
Between July 2025 and January 2026 alone, 7,282 facilities received Ksh12.6 billion in PHC reimbursements
That reality helps explain why public trust remains fragile despite significant progress in expanding healthcare financing under SHA. Latest data shows 31.2 million Kenyans have enrolled in the new health insurance system, while more than eight million have already accessed primary healthcare services.
The authority is currently transacting with 10,277 healthcare facilities nationwide, including county government, faith-based and private facilities. Between July 2025 and January 2026 alone, 7,282 facilities received Ksh12.6 billion in PHC reimbursements.
County government facilities received the largest share at Ksh8.4 billion, while private facilities received Ksh3.6 billion. More than 80 per cent of the funding went to Level 2 and Level 3 facilities, underscoring the government’s emphasis on frontline care.
Yet medicine shortages continue to generate public frustration and raise questions about whether resources are reaching patients in the form intended. For Dr Mwangangi, the next phase of SHA’s reforms must focus on converting financing into measurable service delivery.
With health receiving its largest allocation in recent years and primary healthcare emerging as a central pillar of government policy, attention is increasingly shifting from how much money is being spent to whether patients are receiving value from those investments.
The SMS verification system is set to effectively transform citizens into participants in healthcare oversight, providing SHA with real-time feedback on what happens inside facilities after claims are submitted. If successful, the model could help identify gaps in medicine supply chains, expose facilities that routinely fail to dispense medicines and strengthen confidence in primary healthcare services.
