April 9th, 2026

Despite progress in lowering user fees, significant financial barriers to healthcare persist in Kenya.

According to the Kenya Household & Health Expenditure and Utilization Survey, KHHEUS, 2018, out-of-pocket expenses surged by 90% between 2013 and 2018. Furthermore, the 2024 FinAccess Household Survey report shows  that 44% of Kenyans were going without medicine due to cost. While this was a notable improvement from 54% during Covid-19, it is alarming.

In order to understand Kenyan households’ health needs and their healthcare seeking and financing behaviour, FSD Kenya in collaboration with Ekko Insights and Georgetown University is undertaking a healthcare financial diaries study.  The study entails sampling and collecting data fortnightly from approximately 300 households over a period of one year.

To ensure these insights translate into action, an advisory group comprising of key players in the health sector and finance space was identified and is guiding the design and implementation of the study. Their expertise ensures the research remains relevant for future health policy and value adding health financial solutions. The study spans six field sites across eight counties (Bungoma, Homa Bay, Isiolo, Kwale, Migori, Murang’a, Nairobi and Trans Nzoia), representing a diverse cross-section of Kenya (70% rural and 30% urban), to capture the country’s varied geographical and socio-economic landscapes, with a deliberate focus on key populations of policy interest such as expectant mothers and individuals managing chronic health conditions.

The data collection for the study started in October 2025 and is set to conclude in November 2026. So far, 2,860 interviews have been conducted with the 323 participant households and about 140,000 cash flows generated.

Some preliminary insights are already emerging:

• The digital shift: There is a notable uptick in digital payment usage compared to the 2012/2013 financial diaries study. This change is largely attributed to the waiver of fees on transactions below KShs 100 which was effected in 2016.
• Medication stock-outs: Public dispensaries frequently suffer from medication stock-outs. As a result, communities rely almost universally on private pharmacies. However, this shift brings new risks, as some pharmacies are understaffed or provide inconsistent quality of care. Use of alternative medicines is also common.
• Transportation barrier: The growing proximity of healthcare facilities has not necessarily translated to better access to care. Access to care for chronic diseases in local dispensaries remains limited. Patients thus need to travel to higher level facilities which can be costly financially and timewise and a barrier to many.

FSD Kenya will continually share the preliminary insights through blogs and will actively engage through curated stakeholder events. A comprehensive data analysis, synthesis and communication phase is planned for 2027. This will include providing support to key actors in translating the insights into health policy and financial solutions with an aim of improving Kenyans access to quality healthcare.

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