From Innovation to Transformation: Leveraging Murang'a and Kisumu Counties' Experiences for National Universal Health Coverage in Kenya

Abstract

Background: Kenya’s commitment to Universal Health Coverage (UHC) by 2030 has produced an ambitious legislative landscape, yet persistent gaps between policy and implementation remain. The 2018 four-county pilot, the 2023 Social Health Insurance Act, and the replacement of the National Hospital Insurance Fund by the Social Health Authority (SHA) in October 2024 represent bold reforms, but one year after SHA’s launch, 92% of health facilities reported financial distress, with claims settlement rates averaging just 34% (Kawira, 2025).

Method: Drawing on a review of peer-reviewed and grey literature, this paper examines two counties as analytical anchors: Murang’a, which has achieved near-complete health system digitisation and a pioneer telemedicine hub-and-spoke programme, and Kisumu, an original UHC pilot county that developed the Marwa Solidarity Health Cover and M-TIBA digital insurance platform. An integrated analytical framework combining the WHO health systems building blocks, Diffusion of Innovations theory, implementation science, and knowledge transfer theory underpins a comparative analysis matrix and a new County Innovation-to-National Transformation (CINT) conceptual model.

Result: Murang’a and Kisumu Counties demonstrate strategically complementary innovations – Murang’a strengthening supply-side efficiency and geographic equity, Kisumu strengthening demand-side financial protection and income equity – constituting a comprehensive county-generated architecture for national UHC. Fifteen evidence-grounded policy recommendations are proposed across five thematic clusters.

Conclusion: Three reforms are most urgent: establishing SHA reimbursement for telemedicine services, fully operationalising community health workers through the Primary Healthcare Fund, and creating a national inter-governmental UHC learning platform.

Keywords: Universal Health Coverage; devolution; digital health; community health; health financing; Murang'a County; Kisumu County; Kenya; Social Health Authority; telemedicine; policy learning

DOI: 10.7176/JHMN/121-01

Publication date: August 30th 2026