By Dr Catherine Kanari and Dr Meshack Ndirangu Wanjuki
At a health centre in Kiambu, a young mother named Amina awaits with her baby. She has been feeling weak and not sleeping well. The nurse checks her baby’s weight and her blood pressure. But beyond the physical symptoms, Amina carries an invisible burden of sadness. Like many Kenyans, she doesn’t know where to turn for help. It might be depression, but mental health services are hard to find at the community level, and the family’s income is already stretched thin, making care feel out of reach. Amina’s struggle is common.
Surveys indicate that roughly one in four adults exhibits signs of depression or anxiety at any given time. However, mental health care has long been overlooked. Kenya allocates a tiny portion of its health budget to mental health, much of which is consumed by a few tertiary facilities, leaving most communities without affordable counselling or basic treatment nearby. The access gaps are stark: approximately 75% of Kenyans cannot obtain care, nearly half of the counties lack psychiatric units, and there are only about 120 psychiatrists (fewer than 500 specialised mental health workers) for a population of over 50 million. The economic impact is significant; mental ill-health costs an estimated Kes 62.2 billion (~US$572 million) in 2021, roughly 0.6% of GDP, due to lost productivity, unemployment, and health system expenses. Poverty and mental health reinforce each other: rigorous evidence shows that poverty, job loss, and financial stress increase depression and anxiety (and the risk of suicide), while untreated conditions hinder studying, employment, and small-business performance, creating a vicious cycle of distress, unnecessary hospital visits, and substance use.
As Kenya advances towards universal health coverage, mental health must not be overlooked. Through innovative financing and primary care-led delivery, we can prevent suffering, restore livelihoods, and safeguard families. There is genuine momentum to change direction. Kenya has established the Social Health Authority and enacted a Primary Health Care law to reinforce clinics and dispensaries across the country. A national Mental Health Board is in place to steer policy. Now is the moment to turn reforms into tangible results.
We suggest six practical steps to make mental health care accessible in all communities while directly tackling poverty and unemployment as key causes.
Create a Mental Health & Addiction Fund using sin taxes. Allocate a small portion of excise taxes on alcohol, tobacco, sugary drinks, and betting to a ring-fenced Mental Health & Addiction Fund. Ensure complete transparency and independent oversight so every penny is directed towards prevention, counselling, essential medicines, rehabilitation, and community support, especially in underserved counties. Protect policymaking from industry influence: if gambling or alcohol companies contribute, they must have zero say over decisions.
Include mental health services in the UHC primary care benefits and ensure adequate funding. Establish screening, counselling, essential psychotropic medicines, and referral pathways at local clinics within the UHC package, with the same financial protection as for diabetes or hypertension. As Kenya adopts a PHC capitation system (a fixed amount per person served), it should explicitly allocate funds for mental health within that formula, allowing clinics to hire, train, and provide care without hidden costs to patients.
Scale task‑sharing so help is available where people live and work. Train and support nurses, clinical officers, and community health promoters under WHO’s MH GAP to manage common conditions like depression, harmful alcohol use, and anxiety at the village level with specialist backup when needed. Recognise and remunerate these lifesaving tasks under capitation and performance payments, so providers are rewarded for results, not paperwork.
Kenya could also explore innovative financing models through avenues like Social Impact Bond, bringing together government, donors, and private/philanthropic investors to pilot Individual Placement and Support (IPS) integrated into primary care, with repayments contingent on independently verified results.
Alongside competitive employment, the pilot could support income-generating and self-employment pathways, including microenterprise start-up and growth for Micro, Small, and Medium Enterprises (MSMEs), county apprenticeships and public works, and artisan attachments, paired with coaching, seed capital, and market linkages. Outcome triggers might include weeks in work, earnings gains, business survival/profit thresholds, reduced hospital days, and clinically meaningful improvements data. The UK’s IPS SIBs (with Oxford’s Government Outcomes Lab involvement) set precedents, suggesting that Kenya could adapt and, if cost-effective and equitable, scale the model.
Pool funding under a single national plan; Bring government, development partners, funders, research partners, and other key stakeholders into a unified coordinated framework for mental health and addiction, ending fragmented projects and duplication. These pooled resources can be used to scale effective initiatives, ensure equitable coverage across counties, and reduce administrative waste.
Govern as one system, with data as the operating system; Establish unified governance under the Mental Health Board with a single monitoring and evaluation framework, clear roles for national and county leaders, and public dashboards to track access, quality, and outcomes. Integrate mental health indicators into KHIS and publish county scorecards. Reward measurable improvements, for example, clinics that screen adults, provide follow-up within three months, reduce clinical scores and parameters for common mental health conditions, and support a return to work, can receive small outcome bonuses.
What would this look like for Amina? At her local clinic, she would be screened, receive brief counselling, and, if needed, affordable medication without catastrophic costs. If she wants to start a small enterprise or return to work, she would be connected to an IPS‑style employment team that liaises with local employers, helps with placement, and stays alongside her on the job. The program’s funding would depend on results, sustained work over weeks, increased earnings, and an improved mental health status, as verified by independent data.
In 2025, Kenya is at a pivotal stage. We have made a promising start with new insurance reforms and training healthcare workers and community health workers in mental health. Now, we must build on this foundation through action. Envision a Kenya where a young man can walk into a local clinic and receive help for anxiety before it gets out of control, or where a mother like Amina can access counselling as easily as a malaria test. That is dignity, recovery, and value for money. This future is achievable. It’s time to move beyond talk and make mental health a core part of healthcare. Mental health is just as important as physical health, and by acting now, we can ensure a happier, healthier future for every Kenyan.
Dr Catherine Kanari is the Mental Health Lead at Amref Health Africa.
Dr Meshack Ndirangu Wanjuki is the Country Director of Amref Health Africa in Kenya.