As Kenya continues to make strides toward achieving Universal Health Coverage (UHC), the Ministry of Health is implementing bold initiatives that are redefining healthcare access nationwide. Central to this transformation is the Social Health Authority (SHA), designed to bring comprehensive healthcare services to all Kenyans, aligning with the Bottom-Up Economic Transformation Agenda (BETA).
The SHA, coupled with the new Fee-for-Service (FFS) program, marks a crucial shift in the country’s healthcare landscape, seeking to bridge longstanding gaps in access, quality, and sustainability across public health facilities.
With the expiration of the Medical Equipment Service (MES) program in December 2023, a comprehensive approach was required to ensure continuity for critical healthcare services, including surgical, renal, ICU, and radiology care. While MES equipped numerous health facilities, the program’s conclusion highlighted the need to sustain and build on its gains. In response, the Ministry of Health (MOH) and the Council of Governors (COG) developed the Fee-for-Service (FFS) model—a modern, robust solution to maintain Kenya’s medical infrastructure and ensure healthcare continuity.
The Fee-for-Service model introduces an innovative approach to healthcare delivery by shifting the financial responsibility of medical equipment upkeep from county facilities to contracted vendors. Under SHA, vendors provide state-of-the-art equipment while covering installation, maintenance, upgrades, and consumables. This covers high-demand areas like radiology, ICUs, and surgical theaters, allowing facilities to operate without the financial strain of equipment upkeep. Counties can instead focus on patient care, while vendors guarantee that advanced technologies remain accessible and functional.
The FFS program is expected to provide equipment worth KSh 113 billion across various categories, bringing advanced medical technologies, from imaging machines to dialysis units, to public facilities. By covering these expenses, vendors guarantee a remarkable 95% uptime, ensuring equipment availability whenever needed. Additionally, the SHA mandates that outdated equipment be replaced at no additional cost, keeping Kenya’s healthcare sector updated with the latest advancements.
Beyond equipment provision, the FFS model emphasizes skill-building and financial stability. Vendors are obligated not only to maintain equipment but also to transfer essential skills to county health workers through continuous training. This empowers local healthcare professionals to operate advanced equipment confidently, building expertise at the grassroots level. In cases of equipment upgrades or technological advancements, vendors also provide refresher training, ensuring that Kenya’s health workforce remains skilled and adaptable.
The financial structure of FFS promotes sustainability by allowing counties to generate and retain revenue for local reinvestment in healthcare. Through SHA, the Ministry of Health reimburses facilities for services rendered at pre-approved rates, fostering financial stability. Facilities collect revenue from SHA services, co-funding arrangements, and insurance reimbursements, keeping a portion for reinvestment. Payments to vendors are remitted from a Special Purpose Account managed jointly by the MOH and COG. This structure enables counties to channel funds back into their healthcare systems, enhancing resources and sustaining facility operations long-term.
The Ministry of Health has developed a comprehensive administrative framework to ensure smooth implementation of the FFS model. An inter-participatory agreement (IPA) between the Ministry and the Council of Governors (COG) has already been signed. An intergovernmental agreement defines roles and responsibilities between the national and county governments, aligning the program with local health priorities. Project management committees at national and county levels will oversee the program’s rollout, while a Secretariat, consisting of representatives from the Ministry and COG, coordinates activities across counties. Equipment deployment is underway, with counties finalizing requisitions to ensure service continuity.
In partnership with governors and county health officials, the Ministry has tailored this program to Kenya’s unique healthcare environment, engaging local officials from the outset to ensure that the FFS model meets local healthcare needs. The program has already gained momentum, with over 23 vendors contracted and ready to support counties as they finalize equipment lists. This collaborative approach ensures that local voices shape the program, aligning it with county-level health priorities.
The Fee-for-Service model is not unique to Kenya; similar approaches have shown success globally. In South Africa, for example, a comparable FFS system in public-private partnerships has addressed gaps in radiology and diagnostic services, bringing critical imaging to underserved areas and reducing the need for patients to travel long distances. In India, an FFS approach was piloted in remote regions to improve access to specialized services like dialysis and diagnostics. This allowed the Indian government to expand healthcare access to underserved populations without imposing costs on local facilities. These examples underscore the potential of FFS models to enhance healthcare delivery, reduce patient expenses, and ensure quality care in resource-limited settings.
Kenya’s Fee-for-Service program reflects the Ministry’s commitment to creating a sustainable, accessible healthcare system through innovative public-private partnerships. This model offers a holistic approach to equipping health facilities with cutting-edge medical tools, building local capacity, and fostering financial sustainability—key elements for achieving UHC. The FFS program is poised to improve healthcare quality at the grassroots level, ensuring that all Kenyans, regardless of location, have access to timely, effective medical care.
For county health facilities, the FFS model represents more than just a solution to the MES program’s expiration. It embodies a future-oriented vision for healthcare. By addressing operational costs, reducing logistical barriers, and enabling revenue retention, the FFS model allows facilities to prioritize patient care and community health. With a focus on accessibility, efficiency, and long-term sustainability, Kenya’s healthcare system is advancing along a resilient, innovative path that meets the needs of a growing population.
Dr Deborah Mlongo Barasa is Kenya’s Cabinet Secretary for Health
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