In recent years, policymakers in Kenya have sought to expand access to healthcare by embracing the private sector, undertaking a wide range of reforms and initiatives to encourage private actors to get into the business of healthcare. The role of for-profit actors in health has grown rapidly over the past decade, and the private sector now constitutes a major part of Kenya’s healthcare system. This embrace, coupled with chronic underinvestment in the public healthcare system that reduces the quality of service and pushes many to seek private care, amounts to de facto privatization. This report explores how privatizing healthcare—defined as increasing the role of the for-profit, private sector—has failed many Kenyans, undermined the right to health and set back the goal of universal health coverage.
The private healthcare sector in Kenya has generally failed to deliver on many of its proponents’ promises about value for money and access to quality, affordable care. The results have been disastrous for many, especially for poor, vulnerable, and historically marginalized communities. Privatizing healthcare has proven costly, led to the neglect of public health priorities, contributed to the rise of low-quality, low-cost providers that offer inadequate and unsafe care, and resulted in severe human rights problems including exclusion and denial of service.
Privatization makes healthcare more expensive for individuals and the government, and it is bad value for money. Private providers need to extract profits, face higher borrowing costs than the public sector, and often charge patients overwhelmingly more than public providers. Community members interviewed for this report—residents of informal settlements in Mombasa and Nairobi, as well as rural areas in Isiolo—described facing excessively high fees at private health facilities, where treatment can cost in excess of twelve times more than the public sector. Out-of-pocket healthcare spending in Kenya has risen 53 percent per capita between 2013 and 2018 as the role of private facilities has increased.
The burden on public coffers has been significant. The private sector is often promoted as a solution when public resources are scarce, but its growth has been highly dependent on the commitment of major resources from the Kenyan government. The government now transfers tens of billions of shillings to the private sector annually to contract with private facilities, subsidize access to private care, and pay for secretive public-private partnerships with global corporations. Far from simply filling a gap left by an insufficient public health system, the private sector has been intentionally invited in, and rewarded handsomely by the government and development actors for showing up.
The private sector offers wildly different care to the “haves” and the “have nots,” entrenching inequality in access to care. While those who can afford it may enjoy excellent private care, lower income areas are dominated by low-cost, low-quality private providers pedaling services that are often unsafe, inadequate, or even illegal. For many, this means an undesirable choice between shady or subpar private providers and public facilities that may be underfunded, far away, or lacking critical medicines.
Private providers’ focus is on making a profit, not providing a strong healthcare system that meets national objectives. Because of these misaligned incentives, the private sector neglects important public health priorities. Instead, it is heavily concentrated in the most profitable forms of care, and has spurned less commercially viable areas, patients, and services—including important preventative and family planning services. Healthcare workers described having to meet patient “targets” as well as enduring workplace conditions inferior to those in the public sector. Additionally, private providers, who are insulated from democratic processes, operate with significantly less transparency and accountability.
Privatization is impacting human rights severely. The private sector routinely excludes and denies access to those who cannot afford their services, while driving others into poverty and debt due to the high cost of care. Many people interviewed for this report described facing immense hardships to pay for private care, including selling important assets, like land, and forgoing educational and livelihood opportunities. Others described severe problems resulting from poor quality care at private providers, including unnecessary deaths and disabilities. The impact of privatization has been especially severe for women and people who are poor and low income, live in rural areas, and have disabilities.