Around the World in HTAs: Kenya – Riding the Waves of Change

The health system in the country

Kenya’s health system is a mixed public and private sector model funded through a multi-payer system i.e. Ministry of Health (MoH), Social Health Authority (SHA), and County Governments. The health system is devolved into two levels: the national Ministry of Health primarily responsible for policy and regulation, and the county governments responsible for health service delivery. The public sector serves the majority of the population at various levels, from primary care at government funded health centres to specialised care in county and national hospitals. The private sector provides services mainly to the urban populations with most high-end facilities located in cities.

Universal Health Coverage (UHC) is one of the priorities of the government, which is driving significant change in the health system, and is supported by new policies. Kenya’s commitment to achieve UHC has led to the establishment of organisational structures for implementation and institutionalisation of Health Technology Assessment (HTA). In 2018, a Health Benefits Package and Advisory Panel (HBPAP) was established and tasked to develop an essential and affordable UHC benefit package and advise on a framework for HTA institutionalisation in Kenya.

Subsequently, a HTA focal point within MoH was introduced to oversee and coordinate HTA institutionalisation activities (2020), the Medicines Affordability Pricing Advisory Committee (MAPAC) was tasked to promote access, availability, and affordability of pharmaceutical products (2021), and a HTA technical working group was established to develop a HTA strategy for Kenya (2021).

More recently, Kenya’s pursuit of UHC has been defined by new health sector reforms, policies (i.e. the Social Health Insurance Act (2023), the Digital Health Act (2023), the Facility Improvement Fund Act (2024), and the Primary Healthcare Act (2023)), and initiatives like the recently launched social health insurance scheme (SHI) aimed to provide accessible, affordable and quality health services to the population. The value of HTA is enshrined in the health policy frameworks and their continued implementation will contribute towards efforts to institutionalise HTA in Kenya.

Road map for new health technologies

Kenya, like many countries in Africa, is facing increasing demands on its healthcare system due to a rapidly growing population, evolving disease patterns, and limited resources. HTA has emerged as an important tool in priority setting in healthcare, evaluating healthcare interventions, and guiding healthcare decision-making processes. As new health technologies and interventions, including therapies, digital health technologies and innovative diagnostics, continue to emerge, Kenya has made substantial progress in adopting a forward-thinking roadmap for integrating HTA into its healthcare system.

In 2024, Kenya passed the SHI Act regulations which require that the benefit package development process be developed using an evidence informed and systematic process, and outlines the decision-making criteria, and the HTA process (nomination, selection, assessment, appraisal, and decision making). It also stipulates the formation of an independent benefit package and tariffs advisory panel, which was established in 2025 by the Cabinet Secretary of Health.

Current challenges

In Kenya, HTA is yet to be institutionalised, and faces a number of challenges that hinder its full implementation:

1. The limited availability of skilled human resource to conduct HTA is a significant barrier to HTA implementation. A major constraint is the of number health sector professionals trained in HTA and/or with experience.
2. There is a lack of financial resources for HTA with notable government underfunding for research and more reliance on donor funding, which undermines institutionalisation for HTA and its sustainability.
3. The availability and quality of data for HTA remains low, despite efforts in improving health information systems in Kenya.
4. Since inception in 2018, there have been gradual steps taken in establishing the HTA process in Kenya, but this is yet to be finalised and made public. Public participation and transparency of the process will be paramount to ensure health sector stakeholders ownership and public buy-in.
5. Kenya lacks HTA methods and process guidelines and decision-making frameworks to guide the different steps of the HTA process.
6. Different stakeholder interests for HTA with barriers such as industries’ interests in safeguarding their revenue, and lack of awareness of HTA and its value among stakeholders at the county and hospital levels, delay its implementation. Contrarily, enablers such as an evident appetite for HTA to inform health resource allocation by national policymakers (e.g. during COVID-19 pandemic) and technocrats support in providing HTA recommendations in health policies are a positive start in overcoming the challenges.

Next steps

Kenya’s major leaps towards institutionalising HTA signals promising prospects. With the enactment in law, HTA institutionalisation is halfway there, and what is required is full implementation. There must be continued capacity building in HTA across various stakeholders, including healthcare professionals, policymakers, and researchers through local trainings and international collaborations for knowledge exchange programs. This will contribute towards the process of establishing a national HTA unit to provide oversight and coordination of HTA activities, and the development of national HTA guidelines for standardisation of the HTA processes.

Furthermore, the engagement of a broad range of stakeholders will be pivotal in the next phases to ensure buy-in of the HTA processes and sustainability of the system. The continued participation in the AfroHTA network will also be beneficial as this presents fresh opportunities cross-country learning, networking, and collaboration in HTA activities.