Бюджет на здравоохранение Кении: увеличение финансирования без фискальной дисциплины неэффективно

More Revenue For Health Will Not Be Enough Without Budget Credibility By FaithAnn Kinyanjui, a Kenyan public finance and inclusive governance specialist focused on advancing equitable and accountable public financial management. Kenya’s 2026/27 financial year opened with an encouraging headline: Parliament has allocated KSh175.5 billion to health, including KSh19.1 billion for the primary healthcare fund and KSh4.0 billion for the emergency, chronic and critical illness fund. Those figures matter. But for the average Kenyan waiting for medicine at a dispensary, the nurse working without essential supplies, or the family asked to pay out of pocket for a service that should be covered, an allocation alone does not yet translate to healthcare services on the ground. The real test is what happens next. It is evident that Kenya needs more resources for health, but that is not the key question. In a constrained fiscal space, what we need to interrogate more closely is how the government earns the legitimacy to mobilise those resources and deploy them efficiently. For too long, public debate has treated the size of the health budget as the key measure of government commitment. We note that Parliament approves and then move on. The harder and more consequential questions often remain unaddressed. Were the funds released on time? Did they get to the intended programme or facility? Were they spent as approved? What service did the funds buy? Can citizens see the results? The concept of budget credibility is all about whether government raises and spends public money in line with its approved plans and budgets. In our healthcare system, budget credibility determines whether a clinic has medicines, whether providers are reimbursed and whether patients receive timely medical care before a manageable condition becomes an emergency. Budget credibility is also central to Kenya’s debate about what we refer to as domestic resource mobilisation, or DRM. Too often, DRM is reduced to ‘collecting more tax’. That framing is incomplete and, after the public outcry provoked by the 2024 Finance Bill, politically tone-deaf. Kenyans cannot continually be asked to contribute more while the government struggles to demonstrate how existing resources become reliable services. Raising more revenue will not, by itself, produce better health outcomes. Revenue mobilisation and expenditure credibility must be treated as one reform agenda. Otherwise, we risk pouring more money into a system whose weaknesses steadily erode public confidence. The fiscal challenge is nevertheless real. Research commissioned by development advisory firm AfriCatalyst estimates that Kenya forgoes between US$5.5 billion and US$7.5 billion in tax revenue each year through a combination of policy choices and failures to collect what is already legally due. The larger opportunity lies in compliance. Digital systems such as eTIMS, combined with other approaches such as tax education, can improve reported turnover without simply increasing rates for already-compliant taxpayers. Meanwhile, Kenyan households are still paying roughly a quarter of their total health spending directly from their pockets. That means that every execution failure has a human price, whether through treatment delayed, savings depleted, assets sold, or care abandoned altogether. The Social Health Authority (“SHA”) makes this urgency concrete. Its ambition to extend affordable healthcare to every Kenyan, is essential. In January, the Ministry of Health informed Parliament that 29 million Kenyans had registered and KSh93.4 billion disbursed to facilities. Yet registration and disbursement totals do not tell us whether informal workers can contribute fairly, whether legitimate claims are settled promptly, or whether people receive the care promised to them. In other words, Kenya now needs a visible compact between revenue and results. That compact begins with transparency. Health budget reporting should follow the money all the way from the approved allocation to the service delivered. National and county budget reports should show, in accessible language, releases, actual expenditure, outstanding obligations and outputs such as medicines supplied, claims paid, facilities supported and patients served. According to the county budget transparency survey 2025, counties are barely publishing budget implementation reports within the stipulated timelines and only five counties published citizen budgets on time. For accountability and not just compliance’s sake, these reports should be published in a timely manner and contain comprehensive and usable information. Transparency only matters if the duty bearers can answer to what is revealed. The National Treasury, the Ministry of Health, counties and SHA should publish and act on clear explanations for material underspending, delayed transfers and payment backlogs. Responsibility is shared across institutions, but shared responsibility must not become blurred accountability. Furthermore, additional revenue for health should come first from fairer, smarter collection that involves removing unjustified exemptions and improving compliance among those able to pay. Protection for low-income households must also be designed into these measures, not added as an afterthought. And finally, budget credibility does not need to remain in the sphere of the hypothetical, we should identify counties and facilities where public money is translating into dependable care, understand why, and scale what works. Reform becomes credible when citizens can see practical examples, not only national promises. The government must collect fairly, spend as promised and show the results.