Provision of UHC is part of the country’s efforts to attain the highest standard of the desired status of health. It aims at ensuring all Kenyans quality, promotive, preventive, curative and rehabilitative health services without suffering financial hardship. Some of the benefits of UHC are: it lowers the healthcare cost in the economy; forces doctors to offer similar standards of services; and eliminates administrative costs by reducing the need for private insurance firms. Implementation of UHC in Kenya is faced with the following challenges:

1. Healthcare financing: This is a critical challenge in implementing UHC. According to the NHIF Strategic Plan 2018-2022, healthcare funding challenges include low total funding for healthcare, which is just 7 percent of the Total Government Budget, compared to the Abuja Declaration target of 15 percent; inefficient use of available funds (both technical and allocative inefficacies). For example, in health insurance schemes there has been weak management of benefit utilisation; existence of multiple fragmented health insurance pools at national, county, donor and private sector levels; leakages in the flow of healthcare funds of over 30 percent; low health insurance coverage (about 17 percent coverage), meaning 85 percent of the population does not contribute towards insurance; and inadequate funding for research and development for the health sector in the country (Government of Kenya, 2018). WHO (2017) also argues that healthcare financing is one of the key challenges to implementing UHC. The health sector in Kenya is hugely financed by the private sector, including households’ out-of-pocket (OOP) expenditure (Government of Kenya 2014).
2. Service delivery: High incidence of communicable diseases accounting for the highest proportion of the disease burden in the sector, and increase in non-communicable diseases (NCDs) – hypertension, heart disease, diabetes, cancer and substance abuse. These are putting pressure on the health sector (Government of Kenya, 2018; Government of Kenya, 2014). Poor service delivery in maternal and child health nutrition, exacerbated by inadequate emergency services for delivery, underutilisation of antenatal services and inadequate skills and competencies of health workers. There has also been a marked rural-urban migration of people between age 20-34 years, putting pressure on health facilities. Instability in East Africa is also a big challenge – with Kenya taking in most of the refugees.
3. Human resources: this is characterised by skewed distribution of skilled health workers, with rural and peripheral or marginalised areas facing huge gaps, while some urban areas have surplus personnel. Yet in Kenya, about 70 percent of the population lives in rural and remote areas (Government of Kenya, 2014). The human capital deficit in the sector is felt at both National and Country Government levels.
4. Industrial action among various health cadres seeking better working conditions and terms of service have occasionally presented serious challenges to service delivery. Therefore, there is a need to enhance human resources (WHO, 2017; Government of Kenya 2018, and Government of Kenya, 2014). The Economic Survey report 2019 indicates that the number of health personnel increased from 165,333 in 2017 to 175,681 in 2018 (Government of Kenya, 2019). The report further shows that registered nurses accounted for the highest proportion of personnel at 29.9 per cent with enrolled nurses taking the second slot at 13.3 per cent in 2018. The proportion of registered personnel per 100,000 population increased to 368 in 2018 from 355 in 2017. But more needs to be done to address the human resource gaps.
5. Health products as technologies – inadequate budget for procurement of health products and related modern technologies and distribution to health facilities. Strengthening health information systems is another challenge that needs to be addressed (WHO, 2017). Lack of data is a big issue in most LMICs. Kenya, Malawi, Peru and Haiti are among the early adopters of electronic medical records, which demonstrates ‘how an information system can help with micro-targeting those furthest’ (UNDP, 2019:69).

1. Health Infrastructure: skewed distribution of available infrastructure with a bias to urban areas. This is compounded by the existence of obsolete equipment that require replacement. The number of health facilities has been growing in recent times. According to Government of Kenya (2019), medical clinics rose by 18.6 per cent to 3,646 in 2018, out of which 94.2 per cent were private clinics. This points to the extent to which people are likely to suffer financial risk, considering that those seeking services from private clinics pay out-of-pocket. The number of dispensaries and health centres increased in 2018 by 11.6 per cent and 3.1 percent to 4,597 and 1,806, respectively, most of which were publicly owned. Health facilities increased by 9.7 per cent to 10,820 in 2018. Overall, public facilities increased by 2.5 per cent, to 5,246, equivalent to 48.5 per cent of total health facilities, while private hospitals increased by 22.3 per cent to 4,327 in 2018. Faith-based organisations FBOs) and non-governmental organisations (NGOs) together accounted for 11.5 per cent of the total health facilities.
2. Leadership and governance: Weak multi-sectoral coordination, especially on devolution of Human Resources Management. Lack of decentralised trade unions to agree on Comprehensive Bargaining Agreements (CBA) with county governments. There is also weak regulation and coordination of conventional and traditional medicine; and lack of adherence to set standards and regulations, leading to counterfeit drugs.
3. Emergence and re-emergence of diseases such as TB is a major problem. Although there has been a decline in HIV prevalence, the number of infections has been increasing.
4. Climate change: Unpredictable weather patterns are affecting human health through increased disease vectors, waterborne diseases and under nutrition caused by floods and droughts. A study by UNDP (2019:186) revealed that in Kenya, Ethiopia, and Niger ‘children born during droughts are likely to suffer from malnutrition’.
5. High dependency ratio of 5.4 (UNDP, 2019), means that there is a high financial burden on individuals who have to shoulder the burden of healthcare. According to UNDP (2019), globally there were 18.8 million internal displacements associated with disasters in 135 countries. Disasters caused by floods displaced 8.6 million, while storms – including cyclones, hurricanes and typhoons – accounted for 7.5 million.
6. Another concern is that, given limited resources, many countries have adopted a selective approach which prioritises certain areas. WHO is working with countries to move back to a primary healthcare model which aims at addressing all of a person’s health needs, as opposed to just treating specific diseases (World Health Organisation, 2019).
7. Rapid population growth – the population of Kenya was 47.6 million during the 2019 census, from 38.6 million in the 2010 population census.  One of the strategies, therefore, is to revisit healthcare systems and related human resources if the country is to access good quality and affordable health.