NAIROBI, Kenya — The pharmacy at the mission hospital in Nyeri, in Kenya’s central highlands, has a new sign on its window: “Insurance cards accepted for emergencies only. Cash for everything else.” Dr. Wanjiru Kamau, the hospital’s chief executive, put it up in August, when the arrears owed to her by the national health insurance fund passed 210 million shillings, about $1.6 million, and her suppliers stopped delivering insulin.
“We believed in this scheme. We registered our patients ourselves,” she said. “But I cannot pay nurses with a promise from Nairobi.”
Kenya’s universal health insurance program, launched a year ago to replace a national fund notorious for fraud and politically connected claims, has registered 22 million of the country’s 55 million people, the health ministry said last week. But only 9 million are making the monthly contributions, set at 2.75 percent of income for those in formal employment and a means-tested flat rate for everyone else, and a survey by the association of faith-based hospitals, which provide about a third of Kenya’s care, found that members owed a combined 38 billion shillings for claims submitted since March.
The gap is structural. Most Kenyans work in the informal economy, where contributions must be collected one phone payment at a time, and a rule that members must pay for a full year before claiming for chronic illness has led many to register and then stop. The government had pledged to pay contributions for the poorest 1.5 million households, but the treasury has released only about 40 percent of that money, officials acknowledge.
James Otieno, a spokesman for the health ministry, said the arrears were being cleared “in order of submission” and that 11 billion shillings had been paid in September. He said the scheme had already covered 3.4 million hospital admissions and 600,000 cases of cancer, dialysis or surgery that under the old fund would have ruined families. “The old system paid quickly and paid fraudsters,” he said. “This one verifies every claim. Verification takes time. We will fix the time.”
At the county hospital in Kisumu, on Lake Victoria, the delays have a face. Grace Achieng, 46, a market trader with kidney failure, was told in September that her thrice-weekly dialysis, which the scheme had been covering, would continue only if she paid 9,500 shillings per session, about $73, until the hospital was reimbursed. She has sold her stock and is dialyzing twice a week. “They said the card would be my protection,” she said. “The card is in my bag. The protection is somewhere in an office.”
Health economists say the scheme’s design is sound but that its launch was rushed ahead of a political deadline, with claims software that was not fully tested and a contribution base that was always going to lag enrollment. “Every country that has done this, Thailand, Rwanda, Ghana, hit a cash crisis in year two,” said Dr. Peter Mwangi, who studies health financing at the University of Nairobi. “The ones that survived had a treasury willing to bridge it. Kenya’s treasury is also paying for the debt crisis.”
In Nyeri, Dr. Kamau said she had received a payment of 31 million shillings on Friday, the first since June. She has not taken the sign down. “When it is three months, not nine, I will,” she said.
A version of this article appears in print on Oct. 12, 2026, Section A, Page 9 of the European edition with the headline: A Year Into Kenya’s New Health Insurance, Hospitals Say the Government Owes Them Billions.
