Ahmednadhir Sheikh, Garissa county health executive./HANDOUT
Few things stir public emotion like healthcare: it is about life, dignity, and survival. Yet, paradoxically, health reforms across the world, whether in wealthy nations or emerging economies , consistently stumble over political obstacles.
History and contemporary experience alike show that the challenge is rarely about technical feasibility but about navigating vested interests, ideological divisions, and the sheer weight of politics.
When Britain introduced the National Health Service (NHS) in 1948, it was not welcomed with the universal acclaim that hindsight might suggest.
Doctors’ unions resisted, fearing loss of autonomy and income. Conservatives argued it was too expensive and an intrusion of the state. Aneurin Bevan, the Health Minister, had to famously “stuff their mouths with gold” to secure doctors’ cooperation.
Today, the NHS is celebrated as a pillar of British society, but its birth was politically bruising. The same was true in the United States with Medicare and Medicaid in the 1960s. President Lyndon B. Johnson pushed through reforms that now seem indispensable, yet opponents then warned of “socialised medicine” and the death of American freedom.
Half a century later, the Affordable Care Act (ACA) under President Obama faced similar rhetoric. Rather than being judged on its merits, it became a lightning rod in partisan battles, with dozens of attempts to repeal it. Globally, many governments attempting Universal Health Coverage (UHC) find themselves in similar storms.
Nigeria’s National Health Insurance Scheme (NHIS) has been hobbled by political patronage and weak implementation. Even in high-income countries, reforms collide with entrenched interests: pharmaceutical lobbies, private insurers, or professional guilds.
Consider Germany’s long history of social health insurance, dating back to Bismarck in the 1880s. While revolutionary for its time, it was not merely a social policy but also a political manoeuvre to undercut socialist movements by tying workers to the state.
Similarly, Thailand’s much-admired Universal Coverage Scheme (2001) was as much a populist masterstroke by Thaksin Shinawatra as it was a health breakthrough. Politics gave it life – but politics also threatens its sustainability whenever governments change.
FROM THEORY TO KENYAN REALITY
Kenya now walks the same path, but with a new sense of political courage. Previous attempts to implement Universal Health Coverage (UHC) with a proper financing model failed, largely due to a fear of political fallout and a reluctance to challenge the powerful interests entrenched in the existing health system.
These past failures highlight a fundamental lesson in public policy: significant reform demands adaptive leadership. The approach, as advocated by proponents of this theory, requires leaders to make necessary but often unpopular decisions, pacing changes at a rate the public can absorb.
It’s a strategy of managing the discomfort and loss that change inevitably brings, rather than trying to placate everyone. In a departure from this gradualist approach, Cabinet Secretary Aden Duale, seemingly willing to shoulder political costs by the potential backlash from vocal opponents, has taken the health reform agenda head-on.
In just five months, his leadership has catalysed remarkable progress. For the first time, the regulation of health facilities is being taken seriously.
This marks a decisive break from years of lax enforcement and opaque practices, signaling a government willing to confront the systemic issues that have long plagued the sector.
This audacious pace, while productive, is a high-stakes gamble; it bets that the tangible benefits of the reforms will outweigh the political cost of the disruption. As with any system undergoing change, teething problems are inevitable.
What is striking is how these early challenges are being amplified in public discourse, often overshadowing the real progress being made. Around the world, reforms that open the windows to let in light tend to stir the most dust. And Kenya is no exception. It is when the dust becomes poisonous and unnatural that there is a cause for concern.
WHY THE POLITICS?
Healthcare is inherently political because it involves redistribution – from rich to poor, healthy to sick, young to old. It touches on values of solidarity, fairness, and the role of the state. But it is also political because it is a soft spot: it strikes people at their most vulnerable moments. Illness, survival, and even death are deeply personal realities.
That makes healthcare uniquely emotive, a natural magnet for political contestation. The enormous financial stakes attract powerful lobbies, while the visibility of reforms makes them ripe for electoral promises or populist rhetoric. Unlike, say, infrastructure projects, health reforms stir visceral reactions because they confront people’s deepest fears about dignity, suffering, and the value of life itself. And it is no surprise that in Kenya — a country perpetually in political and election mode, with a noisy freedom of speech and an energetic social media space — healthcare has become a lightning rod.
When the health sector begins to stand out as one of the few visibly working departments, politicising its progress almost becomes the most valuable currency of politics.
TRANSPARENCY SHOULD NOT BE PUNISHED
Today, the Cabinet Secretary for Health and the CEO of the Social Health Authority (SHA) are being roasted and lambasted for something that should, in fact, be commended: making data public.
The health sector is opening itself to scrutiny more than ever before, with a level of transparency rarely seen in Kenya.
While that visibility shows real progress, it inevitably exposes flaws, gaps and uncomfortable truths, but that is precisely the essence of reform. It is inexplicable that when opacity reigned, when data was hidden and systems went unexamined, there was far less noise.
Now that transparency is being pursued as a matter of principle, every release of information is treated as a scandal. Yet this is exactly how mature systems are built: by airing the facts, however unflattering, so that solutions can be found. Other countries that successfully reformed their health systems went through this stage.
The United Kingdom’s NHS, the United States’ Medicare, and Thailand’s Universal Coverage Scheme all faced criticism even when the data revealed only limited inefficiencies, shortages, or wastage. But hiding data — or sanitising it to look perfect—never solved anything; open but healthy debate ultimately strengthened those systems.
Kenya is at that turning point now. Regularly sharing with the public health data such as SHA disbursements is a bold statement that accountability will no longer be optional. It is an initiative to be celebrated, not scandalised. The government should not be vilified for making health financing and facility data transparent; they should be applauded.
The real test is whether the public, politicians, and stakeholders can resist the temptation to weaponise data for point-scoring, and instead use it constructively to build a fairer, more efficient health system. The noise is undoubtedly meant to drown out progress. If Kenyans are serious about health reform, then transparency must be seen not as weakness, but as the foundation of trust.
In the long run, Kenyans stand to gain from a health system where standards are enforced, resources are accounted for, and service delivery is not left to chance. The turbulence we are experiencing is not failure, but part of the difficult and necessary birth pangs of a bold health reform agenda. History reminds us that even the most bitterly contested reforms, in time, become beloved institutions.
The tragedy is when today’s short-term politicking kills genuine reform and denies tomorrow’s generations the strengthened health systems they deserve.
Let us, therefore, critique the government as both our right and our responsibility. But let us do so with objectivity, ensuring that our scrutiny builds a better today and an even stronger tomorrow.
The writer Ahmednadhir Omar Sheikh is the Garissa County Executive for Health
Reach him at [email protected]
