When President William Ruto asks whether the Social Health Authority is working, the question is already too narrow.

Kenya’s healthcare crisis cannot be measured only by how many people have registered with SHA, how many claims have been processed or how many hospitals have received reimbursements. Health is produced or destroyed before a patient reaches a health facility.

The World Health Organization defines the social determinants of health as the conditions in which people are born, grow, live, work and age, together with their access to money, power and resources. It further warns that these non-medical conditions can influence health outcomes more substantially than healthcare services alone.

Taking stock of the Ruto administration must therefore involve more than examining SHA. We must assess whether its decisions have enabled Kenyans to live healthy lives. On that broader test, the government’s record is deeply troubling.

Food

In 2023, Kenyans learnt that approximately one million kilogrammes of sugar previously condemned as unfit for human consumption had been irregularly released instead of being destroyed. The parliamentary investigation established that condemned sugar had been released outside the required procedures. Food-safety regulators exist to prevent illness.

When condemned food returns to the market, citizens may be exposed to acute poisoning, gastrointestinal disease or longer-term harm from contaminants. Hospitals then inherit the consequences of regulatory failure.

The fake and substandard fertiliser controversy must be understood similarly. Farmers reported receiving products that failed to support expected crop production, while parliamentary inquiries, court proceedings and later audits raised questions about quality assurance, procurement and distribution through public systems.

Fertiliser may appear far removed from healthcare, but agriculture is one of Kenya’s most important public-health systems. When farmers receive ineffective or unsafe inputs, harvests decline. Food becomes scarcer and more expensive.

Farming households lose income, children consume less nutritious diets and families postpone medical care because they cannot afford transport, consultation fees or medicines. The eventual outcomes include malnutrition, childhood stunting, maternal anaemia, weakened immunity and mental distress among indebted farmers.

The edible oil importation saga belongs in the same category. When public interventions intended to lower the price of a basic food commodity become associated with questionable procurement, losses and storage concerns, the harm is not confined to taxpayers. Cooking oil, maize flour and vegetables compete in the same constrained household budget as medicine, school fees and transport to hospital. Every avoidable increase in food expenditure reduces a poor family’s capacity to seek care.

Taxation

The Finance Act 2023 doubled value-added tax on petroleum products from eight to 16 per cent. That increase affected more than motorists. Fuel prices influence the cost of transporting food, operating businesses, running ambulances, producing goods and reaching health facilities.

For a low-income household, the health effects of taxation are transmitted through daily deprivation. When transport becomes expensive, a pregnant woman delays attending antenatal care. A patient with hypertension skips a review appointment. A family buys cheaper, less nutritious food.

Economic policy becomes health policy because poverty determines who eats well, who lives safely and who can afford treatment before an illness becomes an emergency.

Affordable housing

The government presented affordable housing as a pathway out of informal settlements. In principle, secure housing can improve health. But a house is not healthy merely because it has concrete walls. It must have reliable water, functioning toilets, drainage, ventilation, waste disposal and safe access roads.

A 2026 United Nations report warned that Kenya’s housing drive risked locking in climate and habitability problems for decades if projects did not adequately address heat, infrastructure and environmental resilience.

Where residents encounter inadequate sanitation, sewage problems, stagnant water or poor drainage, the state has not delivered healthy housing; it has relocated disease into new buildings. Such conditions increase exposure to diarrhoeal diseases, intestinal parasites and mosquito-borne illness. Dampness and poor ventilation worsen respiratory disease.

Corruption

The Kemsa mosquito net controversy, in which the Global Fund cancelled a multibillion-shilling tender for insecticide-treated nets, showed how compromised procurement can. Those nets were intended to protect pregnant women and children from malaria. The SHA technology procurement has generated even more serious questions. The Auditor-General defended findings that the approximately Sh104 billion digital arrangement was marked by procurement irregularities.

A government committed to health must prevent hunger, protect food safety, guarantee habitable housing, reduce financial hardship and govern public resources honestly.

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Dr Bosire is a medical doctor and lawyer. stebosi51@gmail.com