A new study published in BMC Health Services Research explores critical financial management challenges that hindered the effectiveness of Kenya’s Universal Health Coverage (UHC) pilot across four counties. Despite improving access by removing user fees, the pilot faced severe setbacks due to delayed fund disbursements, misalignment between national and county budget cycles, and the centralization of procurement through the Kenya Medical Supplies Authority (KEMSA). These issues resulted in operational shortfalls, facility-level debt, and stock-outs of essential supplies. Moreover, health facilities lacked autonomy and were largely excluded from planning and budgeting decisions—further weakening the delivery of services.
The article calls for systemic reforms to ensure the sustainability of future UHC expansions. Recommendations include better alignment of budget timelines, hybrid procurement models that balance central oversight with local flexibility, and stronger financial autonomy at the facility level. The findings underscore the broader relevance for health financing—including immunization programs—where public financial management inefficiencies can derail even well-intentioned health initiatives.
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