Kenya’s deep economic divide is shaping the health outcomes of communities in starkly different ways, with access to care largely determined by where one lives and how much they earn, according to the Rural & Urban Private Hospitals Association of Kenya Chairperson Brian Lishenga.
Speaking during an interview with Radio Generation on Thursday, Lishenga explained that health outcomes in the country are driven by what he called the “social determinants of health.”
These include income levels, living conditions, demographics, lifestyle, and access to basic infrastructure such as clean water and proper sanitation.
He noted that Kenya stands out in Africa for its sharp contrast between wealth and poverty.
“Kenya is one of the most interesting countries in Africa, where you have super-rich people, and then you have just people who are extremely poor. You have a small but, you know, was growing middle class, it was growing. It has suffered a lot of assaults recently, so, but you have this huge gap,” he said.
Lishenga pointed out that this divide is most visible in urban centres like Nairobi, where affluent estates are often located next to densely populated informal settlements.
He gave the example of Muthaiga and Mathare, two neighbouring areas with completely different health realities.
In wealthier areas, better road networks, stable housing, reliable water systems and sewerage, and proximity to well-equipped hospitals make it easier for residents to seek treatment and maintain good health.
People in these neighbourhoods are also more likely to have health insurance because they have more disposable income.
By contrast, residents of low-income settlements face overcrowded living spaces, poor sanitation, unreliable water supply, and limited access to health services.
These conditions increase their exposure to infectious diseases and reduce their ability to pay for medical care.
“If you’re in Mathare, just because of the ecology, the living conditions, the disease conditions that you are likely to experience are very different from your neighbour who lives in Muthaiga,” he said.
He gave tuberculosis as an example, saying the disease spreads faster in cramped settlements.
“Tuberculosis, okay, is more likely to be happening in Mathare than it is likely to be happening in Muthaiga just because you have people sharing one-room houses. If one person catches a cough, that’s it. Everybody’s going to catch a cough,” he said.
Lishenga also criticised how the government designed the rollout of the Social Health Authority (SHA), saying it was based on expenditure data rather than the actual disposable income of households.
According to him, this flawed approach ignored the economic realities of low-income families and risked making healthcare coverage inaccessible for those who need it most.
“One of the mistakes that we did with the SHA rollout is that we looked at expenditure; we do not look at disposable income. So you think that wasn’t captured in the the methodology used was wrong, and we advised that it was wrong. It was truly academic, truly academic, and not steeped, you know, rooted in reality,” he said.
He stressed that any national health programme must take into account the differing social and economic environments people live in to ensure that care is equitable and effective.