The Sh260B question: A nation one diagnosis away from bankruptcy

There is a quiet fear that lives in Kenyan homes. It lingers behind every cough, every sudden fever, every late-night emergency. It is the fear that one illness will erase a lifetime of effort. For millions of families, that fear is no longer hypothetical. It is real. It is immediate. It is devastating.

We were told that the new health financing system would protect us. We were told it was efficient, digital, foolproof and tamper-proof. We were told that Universal Health Coverage (UHC) was not a slogan but a guarantee. Yet today, when a mother rushes her child to the hospital and is told “the system is down”, what she hears is something far more chilling: you are on your own.

Meanwhile, Kenyans continue to contribute. Month after month, deductions are made in the name of security and peace of mind. But what peace exists when hospitals turn away patients because claims cannot be processed? What security is there when dialysis patients must fundraise to stay alive?

Between September 2022 and February 2026, more than Sh260 billion intended for healthcare has been lost, stolen, or mismanaged. That figure is so large it risks becoming abstract. So let us make it human. That money could have employed every unemployed medical intern in Kenya for decades. It could have built thousands of health facilities in underserved villages. It could have equipped every county hospital with dialysis machines and critical care units. It could have filled the funding gap left by the withdrawal of foreign support for HIV, TB and malaria programmes.

Instead, we have ghost hospitals billing for patients who never existed. We have fraudulent claims paid out in billions. We have expensive IT systems that collapse when Kenyans need them most.

And when the Auditor-General raises red flags, what follows is not accountability but deflection: technical glitches, system upgrades, blame shifted backwards to past administrations, silence where there should be answers. This silence is not accidental. It protects impunity.

In 2010, I was proud to have led a team that ushered in a new Constitution that enshrined the right to the highest attainable standard of health. Article 43 is not a campaign pledge. It is the law. It binds every government, every agency and every public officer. Healthcare is not charity. It is not a favour bestowed by politicians. It is a right guaranteed by our supreme law.

Yet today, Kenyans are paying twice: once through mandatory contributions and again out of pocket when the promised coverage fails. Some sell land. Some exhaust their savings. Some quietly return home to die. This is not because Kenya lacks resources. It is because we have tolerated theft without consequence.

When Covid-19 procurement scandals were exposed, few were held accountable. When NHIF fraudsters were named, prosecutions stalled. When medical equipment lay idle while bills mounted, no systemic reform followed. Now, under the new system, fraudulent claims worth billions are detected only after payment. A few minor players are arrested. The cartels remain intact.

Impunity is not just a moral failure. It is a public health crisis. Every shilling stolen from healthcare is not merely money lost; it is medicine denied, a bed unavailable, a life shortened. Corruption in this sector not only distorts budgets. It buries people.

And yet, this story does not have to end in despair. Other nations with fewer resources have built working systems. Rwanda covers over 90 per cent of its population through community-based insurance and strict accountability. Thailand achieved universal coverage through disciplined public financing and the expansion of primary care. Ethiopia invested in health extension workers reaching the most remote villages. A Martha Karua administration would apply these tested and tried lessons to ensure that no Kenyan dies because they cannot pay for healthcare. We have the same resources as these countries. We have excellent doctors. We have more hospitals. We need leaders who care more about Kenyans than about the next election.

Kenya has capable doctors. We have trained nurses. We have infrastructure. What we have lacked is political will and uncompromising accountability. Universal healthcare is achievable in Kenya. But it cannot coexist with unchecked theft. It requires transparent procurement, digitised but secure systems, independent oversight and swift prosecution of fraud. It requires leadership that views healthcare not as a revenue stream for cartels but as a sacred obligation.

Above all, it requires citizens who refuse to normalise failure. We are told to be patient. We are told reforms take time. But a child in need of oxygen cannot wait for a committee report. A dialysis patient cannot survive on press conferences. The dying do not care about excuses; they care about results. This battle is not about partisan rivalry. The issue at hand is whether we are willing to live in a Kenya where illness is a financial detriment.

The ballot remains the most powerful instrument we possess. Not violence. Not chaos. The vote. In 2027, Kenyans will have a choice. They can uphold the mandate of those who have overseen the disappearance of billions intended for health, or they can opt for leadership that views the right to health as indisputable.

A nation is judged not by the height of its skyscrapers or the scale of its projects, but by how it treats its most vulnerable: by whether a mother can walk into a hospital at 3 a.m. and be assured that care will be given without humiliation, delay or hidden costs.

We have lost Sh260 billion. But more painful than the money is the trust that has eroded. Trust can be rebuilt. Systems can be repaired. However, this can only occur if we insist on accountability and refuse to reward failure.

Kenya can be a country where no family fears bankruptcy because of illness; where no patient is turned away because “the system is down”; where health is truly a right, not a privilege. That future is not a fantasy. It is a decision. The question before us is simple: will we continue to watch, or will we choose differently?

For the sake of every Kenyan family living one diagnosis away from ruin, we must choose differently.

Karua is the leader Peoples Liberation Party