Kenya’s public health system is caught in a contradiction so severe it defies logic, and I mean seriously broken that anyone with two brain cells fighting for third place would see through. The country produces hundreds of qualified doctors every year, yet over 4,000 remain unemployed. Specialists are so scarce that a single consultant may be stretched across five hospitals, earning millions while basic care collapses in the facilities they are paid to serve. Patients at Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) are turned away from cancer treatment because there is no one to operate the machines. This is not a resource crisis. It is a governance crisis and the fault lies across multiple institutions. I wouldn’t get into the politics and how that hospital is extremely mismanaged and it’s a cash cow for some.

The Scale of the Crisis

Kenya has fewer than 15 doctors per 100,000 people, less than a third of the World Health Organization’s recommended 44 per 100,000. To meet current demand, the country requires at least 52,000 doctors. Yet out of 5,352 doctors registered between 2018 and 2021, only around 1,000 were employed. Meanwhile, approximately 40 percent of newly graduated doctors leave the country annually, and an estimated 4,000 health professionals emigrate each year. Countries like the UK has absorbed so many nurses and doctors and I know many waiting for opportunities to leave for greener pastures outside. The Auditor-General’s 2025 report revealed that Moi Teaching and Referral Hospital alone faces a shortage of 1,032 health workers, with only five general surgeons instead of eleven and six oncologists instead of fourteen. What’s happening to this country and do we really have leaders with working brain cells?

Who Is at Fault?

The blame cannot be placed on a single actor. So today I will not talk about county run hospitals I want to talk about National run hospitals. The Ministry of Health has presided over chronic underfunding and failed to implement sustainable employment frameworks. The Ministry’s own 2025–2030 strategic plan acknowledges “inadequate planning and financing,” noting that “training programs don’t align with population health needs”. While the government recently posted 6,484 interns, including 2,000 medical doctors, this is a temporary fix and it’s not even a quarter of the number needed. KMPDU has documented that many practising doctors have not received Collective Bargaining Agreement arrears dating back seven years, and that’s not something I want to dwell on.

Teaching institutions bear responsibility for producing specialists without ensuring absorption into the workforce. Kenya has only around 500 specialists for a population exceeding 52 million, think about that for a minute, it means one specialist has to see 100,000+ people. Training programmes exist, but career progression remains unclear, leading to poor retention and high turnover.

Gatekeeping by established specialists is a subtler but potent force. Senior consultants with dual appointments in public hospitals and lucrative private practices have little incentive to advocate for expanding the specialist pipeline when scarcity sustains their bargaining power and income. As one governor observed, “specialist doctors earn huge salaries, yet most do not work as required in public hospitals”. Why earn 1,000,000 in one hospital when you can earn the same in five hospitals? Do you think this individual will want someone to come compete?

The Kenya Medical Practitioners and Dentists Council (KMPDC) has failed in its regulatory mandate. KMPDU has alleged political interference and bribery at the Council, warning that “undue pressure to license unqualified individuals had turned healthcare into a perilous game of Russian roulette”. The Council’s failure to enforce practice standards has allowed absenteeism and dual practice to flourish unchecked. Secondly, they do nothing to mentor, inspire and lure kids into the profession.

The Multiple Hospital Problem

The practice of specialists being spread across multiple facilities is both a symptom and a cause of the crisis. At KUTRRH, the CyberKnife the only public one in the country conducted just 250 radiation sessions against a target of 800 in 2024/25, leaving 550 cancer patients untreated. The hospital required Sh3.998 billion for staff salaries but received only Sh3.017 billion, a funding gap of nearly Sh1 billion. This is not a resource problem; it is a deployment and funding prioritisation failure and the misappropriation of resources mostly money. They kicked out the former boss so that they can bring someone who is easy to push and steal with. A simple audit will show this.

Doctors with Private Clinics

Health Cabinet Secretary Aden Duale has issued stern warnings against doctors operating private clinics during official working hours, calling the practice “fraud”. The pattern is well documented: specialists use public hospitals to build patient lists, then divert those patients to their private clinics for profit. Kenyatta National Hospital has 26 fully equipped theatres, yet patients face review dates two months away while being offered next-day appointments at private facilities. From January, the Social Health Authority will block payments to doctors who claim from private facilities during public working hours. But enforcement remains the challenge. This is a ministry’s failure since most doctors just like most lawyers are a greedy lot. I bet there is a special place in hell for such.

What Should Be Done

Kenya needs a systemic overhaul, not piecemeal fixes. First, the government must move beyond annual internship postings and commit to mandatory annual hiring of at least 3,000 doctors, as KMPDU has demanded.
Second, a National Health Services Commission proposed by the Kenya Medical Association should be established to centralise workforce planning, track deployment, and enforce retention incentives.
Third, the government must clear all outstanding CBA arrears, which are a primary driver of demoralisation and emigration.

Fourth, KMPDC must be reformed to enforce practice standards, including strict monitoring of dual practice and transparent specialist registration. Actually abolish dual practice. If you feel one hospital salary isnt enough, start your private practice and stick there.
Fifth, hospitals like KUTRRH and KNH must receive ring-fenced funding for specialist positions, with competitive remuneration packages that make public service viable. We have to prioritise Kenyans health.
Sixth, Kenya should expand specialist training through regional programmes like ECSACOP, which uses in-service apprenticeship models in existing facilities. Finally, the government must invest in retention incentives hardship allowances, housing, security, and career progression pathways to make rural and underserved postings dignified and sustainable. Plus all new doctors should serve a minimum of 6 months in rural medicine if they want to continue with government employment. This will help them and the rural areas, plus the burden of referral and level 5 hospitals will ease.

Kenya’s healthcare crisis is not about a lack of doctors. It is about a system that trains them, then abandons them; that pays specialists millions while denying them the support staff to operate…that builds cancer centres without oncologists to run them. The fault lies with a Ministry that plans poorly, institutions that train without absorption pathways, a regulatory council that fails to regulate, and a professional culture that tolerates absenteeism and dual practice. Until these are addressed, Kenya will continue to produce doctors it refuses to employ while patients die waiting for care that exists but cannot be delivered.
I am not a medical expert but anyone with a working brain can actually see the problem. So these are my two cents.
Danny’s Desk