Universal Health Coverage, or UHC, is ultimately about whether people can access the health services they need without facing financial hardship.
For many communities in Kenya, however, the experience of healthcare does not begin at a referral hospital. It begins at home, in the community, at a dispensary, health centre or through a Community Health Promoter.
That is why strengthening primary healthcare in Kenya is increasingly important to the country’s Universal Health Coverage agenda.
Kenya has been placing greater emphasis on preventive and promotive healthcare, community health systems and Primary Care Networks as part of broader health reforms. In 2026, the Ministry of Health identified strengthening community health, expanding Primary Care Networks and supporting Community Health Promoters among its key budget priorities.
For communities, this raises an important question:
What does Universal Health Coverage actually look like at the local level?
The answer depends not only on national policy, but also on whether communities can access quality services, participate in health decisions and hold health systems accountable.
What is primary healthcare?
Primary healthcare is the level of the health system closest to where people live and work.
It includes health promotion, disease prevention, early diagnosis, basic treatment, maternal and child health services, family planning, management of common conditions and referrals when more specialised care is required.
A strong primary healthcare system can reduce pressure on hospitals by helping people receive appropriate services earlier.
Kenya’s Ministry of Health has described Primary Care Networks as a mechanism for connecting community health units, dispensaries, health centres and referral hospitals. These networks are intended to improve coordination, referrals, follow-up and continuity of care.
This means primary healthcare should not be understood simply as a collection of facilities.
It is a system.
And communities are an essential part of that system.
Why community health matters for Universal Health Coverage
Community health workers and Community Health Promoters can provide an important connection between households and formal health services.
They can support health promotion, disease prevention, maternal and child health, treatment adherence, follow-up and health surveillance.
In 2026, the Ministry of Health reported that Kenya had more than 100,000 Community Health Promoters and continued to identify community health as a key component of UHC implementation.
But having community health personnel is only one part of the equation.
They also need appropriate training, equipment, supervision, information systems, supplies and sustainable financing.
The 2026 Budget Policy Statement highlights some of the challenges that still require attention, including inadequate equipment and skills among some Community Health Promoters, technology limitations and concerns around the financing of CHP incentives.
These issues demonstrate why health policy cannot stop at announcing programmes.
Implementation matters.
From policy to lived experience
A health policy can look strong on paper while producing uneven results on the ground.
The difference is often determined by implementation.
A community may have a health centre but still struggle with:
- Long distances to services
- Shortages of medicines and supplies
- Limited staffing
- Referral delays
- Costs associated with accessing care
- Limited information about available services
- Weak follow-up mechanisms
- Barriers affecting young people, women and other underserved groups
These challenges are why community participation matters.
People who use health services possess knowledge that may not be visible in national statistics alone.
They know where services are difficult to access.
They know which costs prevent people from seeking care.
They know whether information is reaching households.
They can identify gaps between policy commitments and everyday realities.
Why health policy needs community evidence
Pathways Policy Institute has positioned community engagement, research, policy analysis and capacity strengthening at the centre of its work.
The organisation’s approach is based on creating avenues through which communities and advocates can meaningfully influence health, sexual and reproductive health and environmental policies.
This approach is particularly relevant in a devolved health system.
Kenya’s Constitution established national and county governments with different responsibilities, meaning that many health decisions and resources are managed at county level.
Consequently, national health ambitions have to translate into county plans, budgets and services.
That creates an important role for evidence-based community advocacy.
Financing is part of the UHC conversation
Universal Health Coverage requires more than policies and facilities.
It requires financing.
Kenya’s recent health policy discussions have increasingly focused on primary healthcare financing, pooled financing, strategic purchasing and improving the alignment of resources with population health needs.
The 2026 Budget Policy Statement also identified additional financing needs for primary healthcare and recommended stronger tracking of family planning financing.
This illustrates an important principle:
What governments budget for reveals what can realistically be implemented.
Communities therefore need the ability to understand health budgets and participate meaningfully in decisions about priorities.
What can strengthen community-centred primary healthcare?
Several approaches can help.
1. Strengthen Community Health Promoters
CHPs need training, equipment, supervision, data tools and reliable financing.
2. Improve Primary Care Networks
Effective referral systems can help patients move between community services, primary facilities and referral hospitals.
3. Use evidence in policy advocacy
Community experiences should be documented and combined with budget and health data to inform policy discussions.
4. Strengthen public participation
Citizens should have meaningful opportunities to participate in county health planning, budgeting and implementation.
5. Track health spending
Communities and civil society organisations can use budget information to examine whether resources are reaching priority services.
6. Centre underserved communities
Health systems should pay attention to geographical, economic, gender and age-related barriers that affect access to services.
The role of civil society in UHC
Government remains central to health system development, but civil society can play an important complementary role.
Organisations such as PPI can help communities understand policies, analyse budgets, generate evidence, build advocacy capacity and engage decision-makers.
PPI’s previous work has included health budget analysis, SMART advocacy training and engagement with county governments around health planning.
Its publications also include research examining health and reproductive health priorities in counties such as Laikipia, Samburu, Isiolo and Narok.
This kind of locally grounded work can help connect national health objectives with county realities.
Looking ahead
Kenya’s UHC journey is increasingly moving towards integrated primary healthcare, community health, digital systems and stronger coordination between different levels of the health system.
The Ministry of Health has described a shift towards integrated service delivery through primary healthcare platforms rather than fragmented disease-specific approaches.
The next challenge is ensuring that these reforms are experienced meaningfully by communities.
Universal Health Coverage should ultimately be measured not only by the number of policies adopted or facilities connected to digital systems, but also by whether people can obtain the right care, at the right time, at an affordable cost.
Strong primary healthcare begins with strong communities.
And when communities have information, evidence and meaningful opportunities to participate, they can become active partners in building healthier and more accountable health systems.
About Pathways Policy Institute
Pathways Policy Institute is a community-based policy and accountability non-profit organisation working at the intersection of population, health, environment and climate justice. PPI uses research, training, capacity strengthening and community engagement to support meaningful participation in public policy.