For years, Kenya’s maternal health agenda has rightly focused on ensuring that women can reach a health facility when they need care.

But Kenya is now confronting a more uncomfortable reality: Getting to the hospital is not enough.

A woman can reach a health facility on time, be attended to by a health worker but still lose her life because the facility does not have the medicines, equipment, skilled personnel, water, sanitation, blood, electricity or emergency systems needed to save her.

The latest evidence from Kenya’s 2024 Quality of Care and Human Resources for Health Assessment, highlighted by the World Health Organization (WHO) in August 2026, demands that we rethink how we understand maternal and newborn deaths. WHO reports that more women and newborns in Kenya are now dying because of the quality of care they receive after reaching a health facility than when they were unable to access one in the first place.

This means Kenya must now move from asking whether people can access healthcare to asking a more fundamental question: “When a patient reaches a health facility, is the health system actually ready to save their life?”

Is the Quality Healthcare Bill a step in the right direction?

The Quality Healthcare and Patient Safety Bill 2025 seeks to establish a legal framework for quality healthcare, patient safety, standards, accreditation and accountability. It recognizes rights to safe and quality care, timely and effective care, qualified healthcare professionals, dignity and equity, safe health products and technologies, information and the right to be heard. It also proposes a dedicated Quality Healthcare and Patient Safety Authority and mechanisms for inspection, accreditation, quality improvement and enforcement. 

However, the Bill must go further because: Quality cannot exist without the conditions to deliver it

The emerging maternal and newborn health crisis demonstrates why,

1. A health worker cannot effectively manage postpartum hemorrhage without the medicines and equipment required.
2. A maternity unit cannot provide safe care without adequate water and sanitation.
3. A facility cannot prevent infection where hand hygiene infrastructure is inadequate.
4. A hospital cannot respond to emergencies if essential equipment is unavailable or non-functional.
5. Training a health worker is not enough if that health worker is deployed to an understaffed facility without the tools necessary to act.

The Bill therefore needs to make a much stronger connection between quality standards and the availability of the resources required to meet those standards.

Water, Sanitation and Hygiene (WASH) must be treated as a core patient-safety requirement

The Bill’s recognition of WASH and waste management is welcome. However, WASH should not remain a general facility requirement buried within broader quality standards. For Hakijamii, this is a critical area for strengthening the Bill.

The law should have clear, measurable and enforceable WASH standards for health facilities, including:

• reliable and sufficient water supply,
• functional hand hygiene facilities at points of care
• safe, accessible and gender-responsive sanitation
• appropriate menstrual hygiene facilities
• safe healthcare waste management
• infection prevention and control
• adequate drainage and wastewater management and
• contingency arrangements for water and power interruptions.

These standards should be monitored as part of facility licensing, accreditation, inspection and quality scoring. A facility without water should not be considered fully ready to provide safe healthcare.

The Bill must address the maternal and newborn emergency specifically

The Bill proposes that quality improvement programm prioritize maternal healthcare, primary healthcare, mental healthcare and emergency medical treatment. This is positive. However, Kenya’s current crisis requires more specific obligations.

The legislation should require health facilities providing maternity and newborn services to demonstrate readiness to manage common and life-threatening emergencies. This should include minimum standards for staffing, medicines, blood availability, diagnostic capacity, emergency equipment, referral systems, newborn care, infection prevention and emergency response.

From standards to financing

One of the biggest risks in quality-of-care legislation is creating standards without creating the conditions and resources necessary to meet them. The Bill establishes responsibilities for national and county governments and requires counties to maintain quality improvement programs. It also provides for quality monitoring and reporting. But the legislation should also go further in answering:

Quality must also mean equity

The right to quality healthcare must not depend on where someone lives. A woman giving birth in Nairobi should not have fundamentally different prospects of survival from a woman giving birth in an ASAL county like Narok, an informal settlement like Deep Sea or a remote rural community in Turkana.

The Bill already recognizes equitable healthcare and requires counties to promote equitable access and monitor quality across their jurisdictions. But Kenya needs stronger disaggregated quality indicators that reveal disparities by county, facility level, geography, disability, gender and socioeconomic status.

A national average can hide a crisis.

If one county has functional maternity services and another does not, the national average should never be used to disguise that inequality.

Patients and communities must have a stronger voice

The Bill gives patients the right to be heard and provides for complaints and internal dispute-resolution mechanisms. This is an important foundation. But quality improvement should not be driven exclusively by regulators and health facility managers. Patients, women, caregivers, Community Health Promoters and communities should have a meaningful role in monitoring the quality of health services.

The Bill should strengthen mechanisms for:

• community participation in quality monitoring,
• patient satisfaction surveys
• social accountability
• public disclosure of facility quality ratings
• community feedback on WASH and service availability and,
• timely response to complaints.

People who use health facilities every day often know where the system is failing long before that failure appears in an official report.

From access to quality and from quality to accountability

Kenya has made important progress in getting people into health facilities. The next frontier must be ensuring that those facilities are functional, safe, adequately staffed, adequately supplied with medical equipment, WASH-compliant and accountable. The Quality Healthcare and Patient Safety Bill provides an important foundation for this transition. Parliament itself describes the Bill as establishing a framework for quality standards, patient rights, accreditation, inspection and accountability.

Kenya now has an opportunity to make the legislation much stronger. The Bill should guarantee not only the right to quality care, but also the conditions necessary to deliver that care. That means connecting quality standards to financing, staffing, medicines, equipment, emergency preparedness, WASH, referral systems, data, community participation and enforceable accountability.

At Hakijamii, we believe that the right to health cannot be separated from the conditions in which healthcare is delivered.

• Access without quality is not enough.
• Quality without resources is not enough.
• Healthcare without water, sanitation and hygiene is not safe healthcare.
• And standards without accountability will not save lives.

Kenya must therefore move beyond the question: “Can a woman reach a health facility?”

and ask: “When she reaches that facility, is the system ready to provide safe, timely, dignified and quality care?”

That is the real test of Kenya’s commitment to the right to health.

Every woman deserves more than a place to give birth. She deserves a health system that is ready to save her life.

                                                    By Fredrick Odhiambo – Hakijamii Program Officer: Health, Water & Sanitation