OPINION: When healthcare pushes you over the edge

We often think of healthcare as something we turn to when we are unwell. A service we access, a system we rely on. Yet for many Kenyan households, healthcare is something far more precarious: a financial cliff.

A single illness, an unexpected accident, or a hospital bill that exceeds a household’s income. A family that was just getting by suddenly finds itself in free fall, sacrificing school fees, skipping meals, or selling assets just to survive.

The World Health Organization refers to this as catastrophic health expenditure, when healthcare costs exceed 10 to 25 per cent of a household’s income, forcing impossible trade-offs. In Kenya, this experience is not rare. It is widespread and quietly devastating.

The World Bank estimates that close to 1 million Kenyans are pushed into poverty every year due to out-of-pocket medical expenses. Kenya’s National Health Accounts show that 24 per cent of total health spending comes directly from households, which is significantly above the global benchmark of 15 per cent set by the World Health Organisation (WHO).

A joint study by WHO and the KEMRI Wellcome Trust found that 13.7 per cent of households have experienced catastrophic health expenditure, with the burden falling most heavily on low-income families, the uninsured, and those managing chronic illness.

These figures may appear clinical, yet behind them are very real consequences. Skipped diagnoses, delayed treatment, abandoned care, choices no family should ever have to make.

Part of the challenge lies in the structure of our health financing. Kenya has made significant progress in policy reform and infrastructure investment. However, the financing model has not kept pace with how people live and earn.

With over 80 per cent of the workforce in the informal sector, most households operate with income that is irregular and unpredictable. Asking for consistent contributions from those without steady cash flow presents a structural contradiction.

The changing nature of illness adds to the complexity. Noncommunicable diseases such as diabetes, hypertension, and cancer now dominate hospital admissions. These are not treated and go conditions. They require continuity, financial consistency, and long-term access to care, three elements many households simply cannot guarantee.

This is where the conversation becomes more uncomfortable. Common solutions such as universal health coverage, digitisation, and public-private partnerships are all important. Yet these alone do not address the deeper issue: how to design health financing that protects people from poverty without overburdening the system or each other.

More difficult questions must be asked. What forms of insurance or pooling work in informal economies? How do we prevent healthcare from becoming a debt trap? Is there a way to shift focus toward early treatment and long-term prevention, instead of reacting to expensive late-stage illness? Are we investing enough in solutions grounded in household realities, rather than institutional convenience? 

A single answer may not exist. The future of health financing likely lies in multiple overlapping strategies. Micro contributions through mobile money, SACCO-based pooling, flexible benefit designs that prioritise outpatient and chronic care, and targeted subsidies for the most vulnerable populations.

Insurers in Kenya have begun to make meaningful shifts through the expansion of microinsurance. These products, built around low premiums, simple enrolment, and mobile platforms, aim to improve accessibility for workers in the informal economy. The growing adoption of these models reflects recognition of the protection gap and a willingness to respond.

However, the scale remains limited, and many of the most vulnerable are still uninsured or underinsured. The promise is clear, but unlocking its full potential will require broader uptake, deeper affordability, and integration with long-term, preventive care.

Most importantly, a shift in mindset is required. It is no longer enough to measure progress by budgets, infrastructure, or enrollment numbers. The real test is simpler, yet harder: are households truly protected?

A hospital bill should not be the difference between dignity and desperation. If it is, then we are not just managing a health crisis. We are presiding over the quiet unravelling of choice, progress, and human stability.

Catastrophic health expenditure is not only about the price of medicine. It reflects the cost of being unseen, unprotected, and excluded from a system that was never designed with you in mind.

There is room to build differently. Not as an ideal, but as an economic and moral imperative.