When the National Hospital Insurance Fund of Kenya began covering dialysis sessions under its Supa Cover scheme in 2014, the scheme aimed to reduce out-of-pocket costs for kidney failure patients. Yet a decade later, a critical gap remains: the country has no national chronic kidney disease registry. Patients move between dialysis centers, submit claims without linked outcome data, and clinicians track disease progression through fragmented paper records or clinic-specific spreadsheets. The result is a system that pays for treatment but cannot measure whether that treatment keeps people alive, out of hospital, or on a path to transplant.

Dialysis Is Covered, but the Registry Is a Black Box

NHIF's Supa Cover scheme reimburses dialysis sessions at a rate that covers roughly 4 to 6 sessions per week, depending on the facility and the patient's specific plan. For a patient requiring thrice-weekly hemodialysis, this means the insurance pays for most or all of the sessions needed. Providers submit claims electronically, detailing the patient's diagnosis, the number of sessions, and the facility where treatment occurred. But the claims system does not require—or even allow—entry of clinical outcomes such as hemoglobin levels, blood pressure control, or whether the patient achieved adequate dialysis clearance measured by Kt/V.

Without a central registry, a patient who switches from a public hospital in Nairobi to a private center in Kisumu essentially disappears from the first facility's follow-up. The new center starts afresh, often repeating baseline tests that had already been done. Disease progression—measured by declining residual kidney function, worsening anemia, or rising infection rates—cannot be tracked across the care continuum. The NHIF claims database, which could serve as a crude backbone for a registry, remains unlinked to any clinical data system.

Kenya's Renal Association has repeatedly called for a mandatory national CKD registry, but as of 2025, no legislation or policy directive has been enacted. The Ministry of Health, in its 2021–2025 Noncommunicable Disease Strategy, listed strengthening surveillance for kidney disease as a priority, but allocated no specific budget for a registry. Meanwhile, the number of dialysis centers has grown from fewer than 20 in 2010 to more than 100 today, most of them private, each operating its own record-keeping system.

Kenya's Kidney Disease Burden Outpaces the Data

Chronic kidney disease affects an estimated 4 to 7 percent of Kenyan adults, according to community-based screening studies. The leading causes are hypertension, diabetes, and glomerulonephritis—conditions that are themselves underdiagnosed and undertreated in many parts of the country. Yet only about 5,000 patients are currently on dialysis in Kenya, a fraction of the estimated need. The rest either die without access to treatment or are managed conservatively until kidney failure becomes fatal.

Screening for CKD is not routine in primary care. Most patients are diagnosed only when they present with symptoms of advanced kidney failure—swollen limbs, fatigue, nausea—at which point dialysis or transplant is the only option. The country has fewer than 200 nephrologists, concentrated in Nairobi, Mombasa, and a handful of other urban centers. Rural patients often travel long distances to reach a dialysis unit, and many drop out of treatment within the first year due to transport costs, loss of income, or death.

Without a registry, the true prevalence of CKD in Kenya remains a modelled estimate. The World Health Organization's 2025 noncommunicable disease action plan encourages countries to establish disease registries for kidney disease, but progress across sub-Saharan Africa has been slow. Kenya's neighbors—Tanzania, Uganda, Ethiopia—face similar challenges, and no regional registry exists to pool data for cross-border learning.

The absence of data also hampers prevention. If the Ministry of Health knew which districts had the highest rates of CKD—perhaps driven by untreated hypertension or use of nephrotoxic herbal remedies—it could target screening and education programs. Instead, resources are allocated based on historical patterns or donor priorities, not on real-time disease burden.

NHIF Reimbursement Rules Create Perverse Incentives

The per-session payment model used by NHIF encourages facilities to maximize the number of dialysis sessions they provide, regardless of whether patients need that frequency or whether outcomes improve. A center that dialyzes a patient three times a week receives roughly the same per-session rate as one that dialyzes twice a week, making thrice-weekly sessions more profitable. But for some patients, especially those with residual kidney function, twice-weekly dialysis may be sufficient and less burdensome.

There is no bonus for achieving target outcomes such as adequate dialysis clearance (Kt/V ≥ 1.2), hemoglobin levels within the 10–12 g/dL range, or good blood pressure control. Facilities that invest in quality improvement—better water treatment, more frequent blood tests, dietary counseling—do so at their own expense, with no guarantee of higher reimbursement. As a result, some private centers cut corners: reusing dialyzers beyond recommended limits, skipping monthly blood tests, or employing fewer nurses per shift.

Public hospitals, which are reimbursed at the same per-session rate as private centers, face a different set of pressures. They are often understaffed and underfunded, with machines that break down frequently and limited budgets for consumables. A public unit may have to ration sessions, dialyzing patients only twice a week because of machine shortages, while a private center across town offers thrice-weekly sessions and attracts the better-insured patients. Public hospitals, understaffed and underfunded, may ration sessions to twice weekly, while private centers offer thrice-weekly sessions to better-insured patients.

A Single Registry Holds Lessons for Kenya

Moi Teaching and Referral Hospital in Eldoret runs one of the few systematic CKD registries in Kenya. Launched in 2012 with support from the Academic Model Providing Access to Healthcare (AMPATH) partnership, the registry covers roughly 1,200 patients in western Kenya. It collects demographic data, cause of kidney disease, dialysis start date, laboratory results, and outcomes including death and transfer to other facilities.

The data from this registry have already yielded important insights. Dropout rates are high: about 30 percent of patients stop dialysis within the first year, often because of financial constraints or death. Mortality on dialysis is estimated at 10–15 percent per year, though precise figures are hard to come by because many patients are lost to follow-up. The registry also tracks referral patterns: most patients come from within a 100-kilometer radius, and those from farther away have worse survival, likely due to delays in starting dialysis.

Despite its value, the registry's funding is precarious. It relies on short-term grants from international partners, not on a line item in the hospital's budget or the Ministry of Health's allocation. Data entry is done by research assistants whose contracts are renewed annually. There is no plan to scale the registry to other regions or to integrate it with NHIF claims data.

What the Moi registry demonstrates is that a low-cost, paper-plus-digital registry is feasible in a resource-limited setting. The challenge is not technical but political and financial. Without a mandate from the national government and a dedicated funding stream, the registry will remain a pilot project, not a national tool.

What a National Registry Could Fix

A national CKD registry would allow Kenya to link patients across facilities, avoiding duplicate testing and ensuring continuity of care. When a patient moves from Nairobi to Eldoret, the receiving nephrologist could access the patient's dialysis history, recent lab results, and medication list. This would reduce the risk of errors—such as restarting dialysis at the wrong dose or missing a critical lab trend—and save money by eliminating repeat investigations.

Tracking outcomes at the population level would enable the Ministry of Health to compare survival rates across facilities, identify centers with better-than-expected results, and investigate why others underperform. Risk-adjusted payment models could then reward high-performing centers, creating financial incentives for quality improvement rather than volume. Facilities that achieve higher rates of arteriovenous fistula use (the preferred vascular access) or lower infection rates could receive a bonus, while those with poor outcomes could be required to submit improvement plans.

A registry would also support transplant planning. Currently, there is no accurate count of how many dialysis patients are suitable for transplant, how many are on waiting lists, or what the average wait time is. A registry could generate a dynamic list of potential recipients, linked to tissue typing and organ availability. This would reduce the time patients spend on dialysis and improve long-term survival.

Finally, a registry could identify clusters of CKD for targeted prevention programs. If data showed that a particular county had a high incidence of hypertensive nephropathy, the Ministry of Health could deploy screening teams, train primary care workers to manage blood pressure, and ensure that antihypertensive medications were available at local dispensaries. Prevention is far cheaper than dialysis, but without data, prevention efforts remain scattershot.

Three Barriers to Unlinking—and How to Bridge Them

The first barrier is the absence of a unique patient identifier that works across Kenya's fragmented health system. NHIF uses a membership number, but this is not linked to the Ministry of Health's patient ID system or to the civil registration database. A patient may have multiple NHIF numbers if they switch employers or schemes, and no crosswalk exists. A universal health identifier, such as the one proposed in Kenya's 2017 Health Act, has not been implemented.

The second barrier is the fragmentation of IT systems. NHIF's claims platform, the Ministry of Health's District Health Information System (DHIS2), and private hospitals' electronic medical records do not communicate. Even within the public sector, data from different programs—HIV, tuberculosis, maternal health—are stored in separate silos. Building an interoperable registry would require either a centralized database or an application programming interface that allows systems to share data securely.

The cost of building and maintaining a national CKD registry is estimated at roughly US$500,000 to $1 million over five years, according to health informatics experts consulted for this article. That sum covers software development, server hosting, training of data clerks, and ongoing quality assurance. While not trivial, it is a fraction of what NHIF spends on dialysis in a single year. The return on investment—in terms of improved outcomes, reduced waste, and better planning—would likely be substantial.

The third barrier is political will. Chronic kidney disease is not a priority disease in Kenya's health agenda, which focuses on HIV, tuberculosis, malaria, and maternal-child health. The Renal Association has lobbied for a CKD registry bill, but it has not gained traction in Parliament. The WHO's 2025 noncommunicable disease action plan includes guidance on registries, but Kenya has not yet adopted it. A simple first step would be for NHIF to mandate reporting of a minimal clinical dataset—diagnosis, date of dialysis start, hemoglobin, Kt/V, and outcome—as a condition of accreditation for dialysis centers. This would create the data backbone without requiring a new law.

From Coverage to Continuity: The Policy Window

Kenya's health financing landscape is in flux. NHIF is undergoing reforms aimed at expanding chronic disease coverage, and the 2025–26 budget includes provisions for scaling up dialysis services. The Renal Association continues to push for a national CKD registry bill, and the Ministry of Health has signaled interest in piloting a registry in two or three counties. The WHO's 2025 noncommunicable disease action plan, which explicitly calls for disease registries, provides international momentum.

Kenya's Data Protection Act of 2019 requires a legal framework for patient consent and data sharing. Any registry must be designed with clear privacy safeguards, allowing patients to opt out and ensuring that data are anonymized for analysis. The experience of the Moi registry, which has operated under ethical approval for over a decade, shows that such protections are feasible.

A pilot linking NHIF claims data to clinical records from a sample of dialysis centers could start within 12 to 18 months, if funding and political will align. Such a pilot would test the technical feasibility of data linkage, assess the quality of claims data for research, and generate preliminary outcome data that could persuade policymakers to scale up. It would also give patients a reason to stay in care: knowing that their data are being used to improve treatment might increase adherence.

But the window may close if attention shifts to other priorities. The COVID-19 pandemic, for example, diverted resources from noncommunicable disease programs and delayed the implementation of many health information systems. Without sustained advocacy from the renal community and a clear demonstration of value, the registry could remain an idea on paper. The gap between coverage and continuity will persist.

Policymakers should seize this moment to mandate a minimal clinical dataset for dialysis reimbursement, fund a pilot registry in two counties, and link NHIF claims to clinical outcomes. The Renal Association and civil society must continue to press for a dedicated budget line for the registry in the Ministry of Health's annual estimates. International partners, such as the World Health Organization and the International Society of Nephrology, can provide technical assistance and advocate for registry funding as part of Kenya's noncommunicable disease response. Without these actions, patients will continue to dialyze in the dark, and the investments in dialysis coverage will yield far less than they could.

This article is for informational purposes only and does not constitute medical or legal advice. Patients with chronic kidney disease should consult their healthcare provider for guidance on treatment options and health insurance coverage.