The fundamental problem with many health and education projects in Kenya is not lack of ideas, lack of money, or even lack of infrastructure. The problem is leadership philosophy.
SERVANT LEADERSHIP
A government committed to servant leadership begins with one question:
“How do we improve the lives of citizens?”
But many of the systems created in Kenya today appear to begin with a different question:
“How do we position ourselves to benefit from the money allocated to health and education?”
That distinction changes everything.
Healthcare and education are not luxury commodities. They are basic rights and foundational public goods. Kenyans elect leaders and allocate taxes with the expectation that those resources will strengthen hospitals, improve schools, train personnel, expand access, and protect the vulnerable. Yet too often, what emerges are elaborate systems that create the appearance of reform while quietly redirecting public resources into politically connected structures.
The tragedy is that Kenya frequently already possesses the infrastructure needed to deliver services. What is often introduced is not a solution to a service gap, but a financial and political intermediary layer designed around extraction.
CIVIL SERVANTS SCHEME
Take the Civil Servants Medical Scheme of 2011.
All civil servants were awarded to private entities who were prepaid billion of KES to provide healthcare services to civil servants across the country. The justification was that these firms had nationwide healthcare access infrastructure. They did not.
But the irony was glaring: the Government of Kenya already had nationwide healthcare infrastructure. Public hospitals existed in every county and subcounty. These facilities already had doctors, nurses, laboratories, theatres, wards, pharmacies, and referral systems.
In Isiolo, for example, I was allocated to a small private clinic of one of the Tenderpreneurs operating in a dark room with minimal resources, while at the same time I was the Medical Superintendent and gynecologist of Isiolo District Hospital — a fully operational public institution capable of serving civil servants across the entire region and northern Kenya.
Instead of strengthening existing public hospitals, money was diverted into parallel structures with weaker capacity. That is not healthcare reform. It is resource relocation disguised as reform.
MEDICAL EQUIPMENT SCHEME (MES)
The same pattern emerged with the Medical Equipment Services (MES) programme.
The original concept had merit. A centralized national procurement system could leverage economies of scale to obtain specialized equipment affordably for counties. Combined with a properly structured Health Service Commission managing human resources, Kenya could have built an integrated and sustainable public healthcare system.
But the programme mutated from a public health strategy into a politically driven leasing model.
Instead of counties directly owning equipment after procurement, Kenya entered expensive lease arrangements where counties continued paying massive sums without eventually acquiring ownership. Equipment was “pushed” into facilities regardless of actual need, existing capacity, staffing, or infrastructure readiness.
Some counties received equipment they could neither optimally utilize nor maintain. In some places, similar equipment already existed. Yet the machinery was delivered anyway because the objective had shifted from solving health problems to sustaining procurement and leasing flows.
When leaders objected to this irrationality — as Governor Isaac Ruto correctly did regarding the MES programme — political consequences followed.
NATIONAL EQUIPMENT SCHEME PROGRAM (NESP)
Then comes the current vendor-driven approach under programmes such as NESP.
Under this arrangement, vendors supply equipment to public facilities while SHA pays the vendors directly. Yet the payment structures heavily favour the vendors despite the fact that the public facility provides the land, buildings, personnel, utilities, patient base, and operational ecosystem.
The public sector absorbs most of the operational burden while specifically chosen private actors disproportionately capture the financial flows. This is not health system strengthening. It is commercialization of public infrastructure under the language of reform.
SOCIAL HEALTH AUTHORITY (SHA)
The clearest example, however, is the Social Health Authority (SHA).
The architects of SHA appear to have prioritized revenue collection before system design.
A mandatory 2.75% levy on gross income was established to guarantee inflow of funds. Kenyans were assured that Primary Healthcare and the Emergency, Chronic and Critical Illness Fund would receive Exchequer support. Large figures were announced publicly to create confidence.
But beneath the promises was a troubling reality: the system appears heavily structured around system vendors, cost containment and payment minimization rather than patient care and provider sustainability.
The warning signs are now obvious:
• Failure to adequately onboard and sustain informal sector contributions
• Overburdening of the formal sector
• Massive claim rejections over technicalities
• Delayed reimbursements
• Mounting SHA debts
• Unpaid NHIF legacy debts
• Arbitrary empanelment barriers
• Increasing out-of-pocket expenditure for Kenyans
• Financial distress among healthcare providers
A genuinely patient-centred and provider-centred system would have been built slowly, transparently, consultatively, and with broad stakeholder participation. Instead, the laws were rushed through Parliament insufficiently incorporating feedback from engagement from healthcare professionals and implementers, instead prioritizing ‘health economist’ impractical views.
The result is a financing structure that increasingly appears designed to maximize collection while minimizing payout.
And that is the core governance crisis Kenya faces.
When leadership ceases to be service and becomes extraction, public systems begin to fail regardless of how sophisticated the language around them sounds.
SERVANT LEADERSHIP
Servant leadership is different.
Servant leadership asks:
• How do we strengthen public hospitals instead of bypassing them?
• How do we make healthcare affordable for citizens rather than profitable for intermediaries?
• How do we ensure sustainability instead of creating politically connected procurement chains?
• How do we empower doctors, nurses, teachers, and frontline workers rather than frustrate them?
• How do we leave behind stronger institutions instead of stronger cartels?
TRUST
Countries achieve Universal Health Coverage not merely through legislation or taxation, but through trust. Citizens must trust that public money is being directed towards the public good.
When people begin to believe that every reform is primarily designed to enrich a few individuals, confidence collapses. Compliance weakens. Health systems become adversarial. Providers become financially distressed. Patients pay more from their own pockets. Eventually, even well-intentioned programmes lose legitimacy.
Kenya does not lack brilliant professionals, capable hospitals, hardworking healthcare workers, or sufficient policy expertise.
What Kenya lacks is governance anchored on genuine servant leadership.
Leadership must return to first principles:
Public office is a responsibility, not a commercial opportunity.
The role of leaders is not to build systems around personal benefit hidden inside public necessity. The role of leaders is to steward public resources honestly for the greater good.
Until that philosophy changes, healthcare and education reforms will continue to generate headlines, structures, authorities, and acronyms — but ordinary Kenyans will continue struggling to access quality healthcare and quality education.
True national transformation will only occur when leadership stops asking:
“How do we benefit from the system?”
And starts asking:
“How does the system benefit the people?”
VOTING
We are entering campaign season. Many people will solicit for your votes. Do not ask them what they will do for you. Examine their leadership philosophy by their history, their writings and whether what they say matches with what they do. Determine if they possess the servant leadership traits listed above.
Dr Simon Kigondu is a Gynaecologist and Commentator on Health Policy