Healthcare crisis mounts as Ruto turns to public to police hospitals

President William Ruto has called for greater public oversight of hospital management in a bid to curb the misuse of healthcare funds, even as his administration grapples with a deepening crisis in the health sector marked by labour unrest, medicine shortages, service disruptions and growing criticism of the Social Health Authority (SHA).

The president’s push for accountability comes amid mounting concerns over SHA’s effectiveness in financing healthcare, delayed payments to facilities and persistent challenges in ensuring Kenyans access reliable and affordable medical services.

Ruto said greater community oversight is necessary to curb the misuse of funds and improve accountability in the country’s struggling healthcare system.

Speaking during a church service at ACK Kapsabet Church yesterday, October 18, 2026, the president said hospital management boards should bring together medical professionals, government representatives, county officials and members of the public, borrowing from the governance model used in public schools.

“Health centres must be supervised by doctors and members of the public, just as we supervise schools. Doctors, government officers, and county officers must also be represented,” Ruto said.

The president expressed concern that some health facilities were spending money received through SHA on infrastructure projects and other non-essential activities instead of purchasing medicines and medical commodities needed to sustain patient care.

“When money is sent to a dispensary, the first responsibility is to buy medicines. Some people, when we send SHA money, buy gates or install cabro,” he said.

Ruto said the direct disbursement of funds to individual hospitals placed a greater responsibility on their management boards to ensure resources were used for their intended purpose.

“Because we are now sending money directly to every hospital, the Boards of Management in every hospital must prioritise purchase of medicines and health commodities over infrastructural developments,” he added.

Under the Basic Education Act, public schools have boards of management incorporating parents, community representatives and other stakeholders alongside education officials.

Ruto wants a comparable arrangement in public health facilities to strengthen public participation in decisions on spending and service delivery.

His proposal also comes amid changes in hospital governance, including Nairobi County’s Health Services and Management Act, 2026, which granted Level Five county hospitals greater autonomy over their finances and operations while retaining oversight requirements and providing for management boards.

However, the proposed public oversight model faces the challenge of being implemented in a health system already under pressure from industrial action, funding concerns and operational difficulties associated with the transition to SHA.

Nurses and midwives have been involved in industrial disputes over the implementation of the 2025–2029 Collective Bargaining Agreement, with reported strike action disrupting services at major public hospitals, including Kenyatta National Hospital, and facilities in Embu, Kericho, Kisumu and Machakos.

Clinical officers have also maintained pressure over salary harmonisation, promotions and the conversion of long-serving contractual and casual employees into permanent and pensionable positions.

The disputes have threatened access to routine consultations, outpatient treatment and other essential services, leaving vulnerable patients facing delays or the prospect of seeking more expensive private healthcare.

Meanwhile, the government is attempting to resolve a separate dispute over the contracting of county health facilities under SHA’s 2026–2029 HAKIKA framework.

Health Cabinet Secretary Aden Duale and Council of Governors Health Committee chairperson Abdulswamad Nassir have led consultations involving the Council of Governors, SHA, the Digital Health Agency and health regulatory bodies to address concerns raised by counties and prevent interruptions in patient care.

The government and governors agreed that existing SHA contracts for county public facilities, which had been extended to October 14, 2026, would not receive another extension.

SHA was also expected to establish HAKIKA contracting clinics across all 47 counties between October 5 and October 14 to help eligible facilities complete outstanding requirements.

A joint technical committee comprising representatives from SHA, the Council of Governors and county health departments was tasked with coordinating the process and resolving technical and operational challenges. SHA was also expected to provide weekly progress reports to the governors until eligible facilities were contracted.

Under the agreement, individual county health facilities would retain their contracts with SHA, while county governments would be recognised as contracting parties. Payments would continue to be channelled directly to the facilities’ Facility Improvement Financing accounts.

To address delays in documentation, facilities that had met other contracting conditions were granted a 30-day compliance moratorium to submit outstanding documents covering NSSF compliance, environmental licensing, fire safety, disability compliance and registration with the Office of the Data Protection Commissioner.

However, facilities must still hold valid licences for laboratory, pharmacy and imaging services and will only be contracted to provide services for which they are certified. Level Four and Level Five hospitals were given three months to meet mandatory laboratory licensing requirements.

On payments, SHA committed to settling clean claims within 90 days of receipt, in the order received.

Facilities were to be notified when payments could not be settled by the 14th of the month, while unpaid clean claims would be recognised as certified liabilities and prioritised in the next budget appropriation for settlement within the same financial year.

County governments also agreed to ensure all Level Five hospitals completed their transition to the Health Management Information System by October 30, 2026.

The unfolding challenges have placed pressure on the government to demonstrate that health financing reforms can translate into reliable services at the point of care.