The tragedy playing out in Kenya’s public health system is no accident and no coincidence. Under William Ruto’s stewardship, the promises of universal healthcare, strengthened public hospitals, and equitable access to services have become hollow slogans. A 2022-23 Medium Term Expenditure Framework acknowledged serious under-funding of priority health services and widespread pending bills across public facilities. In this context, the explosion of private clinics — often marketed as “modern”, “luxury”, “premium” options — is not what it appears. It is not the rising tide lifting all boats, but rather a fleeing of services from the sinking ship.
Across counties, public hospitals groan under the weight of financial mismanagement, understaffing and equipment shortages. A new audit by the Office of the Auditor-General uncovered that, despite massive public investment, many public hospitals have failed to fulfill mandates of care delivery. That failure falls squarely on the leadership of a government that promised reform but delivered deterioration. The accountable portfolios — the national health ministry under Ruto’s government, the county health departments, and the coordination between them — have all faltered. When the state abdicates responsibility, private firms fill the vacuum, but that is not progress; it is privatization by neglect.
The ratio of health professionals to population remains woefully inadequate and unevenly distributed. A report in 2015 already showed major disparities: some counties had as few as 0.8 doctors per 10,000 people, while Nairobi recorded 9.5. Fast-forward to today, and the situation has only worsened in many rural areas. The government under Ruto has not reversed these trends; rather, the focus has shifted away from public provisioning towards promoting private sector involvement, which inevitably skews access in favor of those who can pay.
The mid-term review of the Kenya Health Sector Strategic and Investment Plan noted that devolution created fragmentation in county health services, delays in budget release, and gaps in documentation of service provision. These structural failures bind themselves to the Ruto administration’s broader governance weaknesses: slow budget disbursement, lack of performance accountability, and political distraction rather than technical fixing of systems. The consequence for patients: long waits, denied care, referrals to private clinics, or worse, no care at all.
In 2024, the investigative report “Kenya’s Health Care Crisis: Where is the Money?” exposed that development assistance and public investment in health were being siphoned through opaque channels and that private leasing of questionable medical equipment proliferated under weak oversight. It is not enough to build hospitals or buy machines if you don’t ensure operational funding, staffing, maintenance, supply chains, and oversight. The government led by Ruto has shown a preference for flashy announcements rather than gritty systems work.
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Most Kenyans observe that private clinics are everywhere. At first blush, this seems like choice, competition, and more access. But dig deeper and you find that the private sector’s growth is compensatory: where the state failed, entrepreneurs stepped in. That is not a public good. It is the public system surrendering the field. The government’s responsibility is to guarantee that the public system is strong. Under Ruto, the retreat of the public system is real.
Recent revelations from the Social Health Authority (SHA) show 19 critical failures, including delays in accessing care for severe conditions like cancer, prolonged wait times for infants and pregnant women, infrastructure deficiencies, and operational neglect. These systemic failures point to governance breakdown. The national government sets policy and funding frameworks; the counties manage execution. The finger of blame must rest on Ruto’s leadership for tolerating, enabling, or ignoring these failures.
In the middle of this, patients are squeezed. A report from 2024 noted that thousands of Kenyans cannot access treatment even though they are nominally covered by public medical insurance schemes – because the system simply doesn’t deliver. You cannot have universal coverage on paper while public hospitals lack basic supplies, boots on the ground, or functional referral systems. Ruto’s administration must be held to account for the disconnect between coverage promises and delivery realities.
When the public health system collapses, the wealthy go private, and the poor are left behind. That is the social contract broken. Under Ruto’s vision of “Big 4” and other initiatives, the health dimension is supposed to be one of the pillars. Yet the results on the ground say the opposite: widening inequalities, privatized desperation, and a crumbling public backbone. The mushrooming of private clinics is a symptom — not some alternative success story.
Take the supply chain and equipment problem: many public facilities in Kenya have long experienced stock-outs of essential drugs, broken equipment, lack of maintenance, and non-functional laboratories. A health sector policy brief highlighted these as structural issues in the workforce, infrastructure, commodities, and management. Leadership is required to drive reform in procurement, oversight, accountability, and data systems. Instead, what we see is lip-service, delayed budgets, and patchwork interventions under the Ruto administration.
Counties are on the front line of delivering health, but they rely on funding flows from the national government. The MTEF for 2022-25 revealed unfunded priorities for the health sector, showing an unmet gap between resource requirements and allocations. That gap is a political choice. The government could re-prioritize health spending and focus on service delivery. Choosing not to means its commitments are faint. Ruto shoulders the blame for the continuing under-investment.
In economic terms, the failure to adequately fund public health has a multiplier effect: workers go on strike, morale collapses, the private sector grows, and the sick pay more or drop out of care. In 2021, Human Rights Watch documented how health workers in Kenya lacked protection, exposing them to avoidable risks during the COVID-19 pandemic. If frontline workers aren’t valued and supported, the system weakens. Ruto’s leadership did not transform this frontline weakness into reform.
Public health requires coordination, planning, transparency, and strong oversight. Yet in Kenya, we see fragmentation, policy drift, weak data systems, and a lack of enforcement. A blog article noted that while accessibility had improved in some areas, significant challenges remained, especially for equitable access and resource efficiency. When leadership fails to enforce minimum standards, responsibility falls to private providers to fill the void — but that is a failure of the public system, not a competitive success story.
The relentless growth of private clinics is often celebrated in the media as “investment in health”. But this framing misses the fact that many of these clinics replicate high-cost models, leave out the poorest patients, and relieve the state of its obligation. When the state steps aside, the marketplace takes over. That is precisely what is happening under Ruto’s watch: the government is stepping aside. The public sector is abandoned.
When rhetoric surpasses reality, citizens pay. For example, the new health care reforms and insurance schemes may look good on paper, but execution has been weak. The 2024 audit of public hospitals described “big trouble” in Kenya’s public hospitals: financial woes, equipment shortages, and inadequate staffing. The government led by Ruto cannot claim moral high ground when its flagship services are failing. The blame is institutional and personal: if you promise change, you must deliver.
Governance also means ensuring equitable distribution of facilities. Yet private clinics concentrate in urban and affluent areas, while remote and poor counties continue to suffer. That morphological pattern speaks volumes. The structural inequality of service provision is a governance failure. Ruto’s government has had the chance to redistribute resources and focus on marginalized areas; instead, we have watched a widening gap.
We must ask: when the number of private clinics skyrockets, is the public system genuinely improving, or is it quietly collapsing? In Kenya, the available evidence points to the latter. The private sector cannot sustainably replace the public sector for rural, poor, remote communities. The government has the duty to build and maintain a public system; Ruto’s leadership has allowed that system to fester, decay, and increasingly rely on private substitution.
The final test of a health system is: can the poorest access care when they need it? In Kenya, under-funded hospitals, broken referral chains, lack of medicines, and strikes tell another story. The SHA’s failures, equipment deficits, staff strikes, and backlog of patients show the system is buckling. Ruto’s administration is not absolved by good intentions; good intentions are not hospitals and clinics. Lives depend on delivery.
We cannot ignore the political economy: investing public funds in health creates long-term returns in productivity, resilience, and national stability. Allowing the public sector to decay means a debt not just financial, but social and human. Ruto, as President, bears responsibility for choices made: prioritization, oversight, accountability. His decisions shape how resources flow, how contracts are awarded, and how counties deliver. He cannot pass the buck to county governors alone.
The proliferation of private clinics often siphons experienced staff away from public hospitals, as the public system fails to retain talent under poor working conditions. That brain-drain within the country is a direct result of public leadership not providing incentives, safe workplaces, and clear job security. Ruto’s era has seen many strikes, threats of walk-outs, and resignations. That is leadership failure.
Meanwhile, for every new fancy private hospital built in Nairobi or other urban hotspots, there is another public ward without oxygen, no ICU, understaffed, and patients waiting. That is the evidence before our eyes. The government’s role is to ensure that public services work not only for the few who can pay, but for all. Ruto’s policies have leaned too heavily toward market solutions without safeguarding public provision.
If we are serious about health equity, the state must restructure, re-allocate, reform. That means more than just policy documents; it means accountability, decentralization done right, data-driven decision-making, transparent procurement, infrastructure maintenance, and respect for health workers. All of this rests at the feet of national leadership — and Ruto hasn’t done enough.
The rich paying for private care while the rest suffer is not innovation, it is injustice. The private sector cannot substitute for public health systems in a country with Kenya’s demographics and geography. The government must support the public system to serve all. But under Ruto we watch the public system shrink. The blame lies where it must: at the top.
What then should be done? A full overhaul of public health governance, with Ruto’s government initiating a national audit of public health facilities, restructuring human resources, enforcing standards, increasing funding, ensuring counties deliver. Without such steps the mushrooming of private clinics remains a camouflage for systemic collapse. The responsibility sits squarely on Ruto.
Therefore, the growth of private clinics in Kenya is not a beacon of hope but a warning flag. The public health sector is in shambles, and the collapsing system is enabling private profit in place of public service. The evidence is right before our eyes. Ruto’s leadership promised much; delivered little. The Kenyan people deserve more than a marketplace of health — they deserve a functioning public system.