Dear mandate holders,

We, the undersigned civil society organizations,1 write to call your attention to ongoing and potential future harms associated with privatization and commercialization of healthcare in Kenya.
We strongly urge you to issue, individually or jointly, allegation letters to the Kenyan government,as well as to the World Bank Group and the United States government, given the central role they
have played in promoting greater private sector participation in healthcare in Kenya.

In recent years, the Kenyan government and development actors have encouraged the growth of the commercial private healthcare sector—notwithstanding its unaffordability, focus on wealthy urban patients, varying quality, and other associated problems—while comparatively neglecting the public one.2 Kenya’s signature policy for delivering universal health coverage (UHC), the planned adoption of mandatory social health insurance, appears set to further accelerate the growth of the private sector, despite documented issues including exclusion, impoverishment, and
inadequate and unsafe care.

We believe that the way in which the government is increasing the role of the private health sector is misplaced, and that current forms of privatization and commercialization of healthcare in Kenya pose a threat to human rights—especially the right to health, and particularly for women,individuals experiencing poverty, people with disabilities, those in rural areas, and other
underserved or marginalized groups. We very much hope you will engage and advise the key actors on this crucial issue at such an important moment of political transition in Kenya, and we
thank you for your efforts to ensure the realization of human rights.

I. Background
General context
Healthcare in Kenya is delivered by a mix of providers, including non-governmental organizations,faith-based, and for-profit private providers, as well as public healthcare facilities. Public facilities have traditionally provided most healthcare services, and still did so as of the most recent national survey on health utilization in 2018.3 The need for improvements is undisputed. Even before COVID-19 exposed shortcomings in the healthcare system, the Ministry of Health called healthcare quality “inadequate countrywide.”4 A 2018 survey of nearly 3,000 public and private
healthcare facilities found that only a small fraction (6 percent) had all basic amenities and none had all essential medicines on the day of the survey.5 Access to healthcare is highly unequal along socio-economic and geographic lines.6 The cost of healthcare is a significant problem in Kenya,

where more than a third of the country live under the national poverty line;7 in fact healthcare costs pushed an estimated 1-1.1 million people into poverty in 2018.8 Policy efforts to increase the role of the private health sector In recent years, several major changes to healthcare policy and delivery have taken place in Kenya.9 Some of these have involved the public healthcare system, but policy reforms have largely focused on increasing the role of the private health sector in a manner that inevitably gives rise to serious human rights risks that are already materializing. To be clear, the Kenyan government has not sought to sell off its public facilities.10 Rather, it has undertaken a multi-pronged push to increase private sector participation in healthcare, while permitting the continued deterioration of public services.

Key national policies explicitly seek to expand the private sector’s role. These include the overarching Kenya Health Policy 2014-2030, which aims to strengthen the role of the private
sector as both a financier and a provider of healthcare services, and the Kenya Health Sector Strategic Plan 2018-2023, which calls for expanding the role of private healthcare and financing
through private insurance products, specialized private hospitals, and other public-private partnerships.11 The government has offered tax incentives,12 effectively subsidized private
providers,13 and pursued large-scale contracts14 including public-private partnerships.15 Former President Uhuru Kenyatta, cabinet members, and other high-level officials have referenced the
role of private investment in achieving universal health coverage and presented the health sector as an opportunity for private firms, with President Kenyatta declaring the country “open to private
sector investment in healthcare.

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