Kenya
The second African case after Uganda, with devolved county health financing rather than a single national route.
9 domains reviewed · 8 high-confidence · 6 dated estimates · 9 material gaps
WHO region: Africa. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 22
- Newest source 2026
Lessons from Kenya
- One ministry circular, a national association and a trained team per hospital scaled palliative care across Kenya's provincial hospitals without a large new budget line. It depended on an association with direct ministry access and a central medical supplies agency able to move morphine. Replicating it needs both.61
- Devolution did not settle palliative funding either way: counties varied widely and some would not release staff for training. Under devolution, a funded national-to-subnational mechanism is safer than assuming subnational governments will prioritise palliative care.60,62
- Kenya widened scope to nurses and clinical officers through the professional councils, over years of consensus building. Prescriber reform is sustained work with nursing and allied health councils, not a single notification.63,60
- A national hospice association can extend hospice reach by setting up palliative care units in public hospitals that refer discharged patients on to hospices.61
- Where national health insurance leaves palliative care out of its benefit package, hospice use tends to favor patients who can pay.290
- Weekly phone calls, a hotline and a take-home kit of basic medicines can support families caring for dying cancer patients at home where home hospice is not available.405
- Where methadone is free, daily travel and lost income remain barriers, which supports decentralized and take-home dosing.581
Palliative care
Is morphine available in Kenya?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 3 percentSOURCE-CHECKED · 2018 DATA
Health facilities offering palliative care, Kenya, 201860
Last checked 2026-09-24.
Of which five percent had morphine available, per a 2018 study cited by the source.
Cite this figure:
Oral morphine solution is produced nationally, and the integration programme moved morphine powder to hospitals through the national medical supplies agency. Availability at facility level remained low.63,61
What is national consumption on a morphine-equivalent basis, and is morphine stocked at county level?
Help answer it:Search PubMedHow does Kenya regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A national palliative care policy was launched in October 2021.60
What does the narcotic drugs statute require for a county hospital to hold and dispense morphine, and did anything change with the 2021 policy?
Help answer it:Search PubMedWho can prescribe morphine in Kenya?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
A 2024 continental review lists Kenya among the African countries where nurses may prescribe morphine. The same review's listing proved overstated for Malawi and Tanzania when checked against country-specific sources, so the Kenyan permission is uncorroborated. The Clinical Officers Council has recognised palliative medicine as a licensed specialty, and the Nursing Council recognises a palliative nurse practitioner diploma.63,60,103,100
Does Kenyan law give nurses independent authority to prescribe morphine, and under what training and licensing conditions?
Help answer it:Search PubMedHow does palliative care reach patients in Kenya?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 78 servicesSOURCE-CHECKED
Palliative care services identified, Kenya, 202363
Last checked 2026-09-24.
Services documented in the literature to early 2023, not a census.
Cite this figure: - 0.15 per 100,000MODELED ESTIMATE · 2023
Palliative care services per 100,000 population, Kenya, 202363
Last checked 2026-09-24.
Cite this figure: - 11 hospitalsSOURCE-CHECKED · 2016 DATA
Provincial hospitals with integrated palliative care units, Kenya, 201661
Last checked 2026-09-24.
Cite this figure: - 30,000 patients, cumulative lower boundSOURCE-CHECKED · 2016 DATA
Patients served by the integrated hospital units, Kenya, 201661
Last checked 2026-09-24.
Reported as over 30,000.
Cite this figure:
Growth ran through public hospitals: a 2010 ministry circular directed provincial hospitals to set up palliative care units with the national association, later extended to further county hospitals. A western Kenya survey found limited training and opioid prescribing experience among frontline clinicians.61,63,64
Who pays for palliative care in Kenya?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Health has been devolved to counties since 2013. Sources report high variation between counties and counties reluctant to release staff for palliative training.60,62
Does devolution help or fragment palliative funding on balance, and what does the Social Health Authority actually cover? No primary document on the new scheme was read.
Help answer it:Search PubMedHow are palliative care clinicians trained in Kenya?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 7 studentsSOURCE-CHECKED · 2022 DATA
Clinical officer higher diploma in palliative medicine, first cohort, Kenya, 202260
Last checked 2026-09-24.
Cite this figure: - 220 staffSOURCE-CHECKED · 2016 DATA
Hospital staff trained under the integration programme, Kenya, 201661
Last checked 2026-09-24.
Cite this figure:
Two higher diploma routes exist: one for clinical officers at Moi Teaching and Referral Hospital College, and one in oncology and palliative care at the Kenya Medical Training College, whose graduates staffed the hospital programme. No accredited residency or fellowship for doctors was reported.60,61
How many clinicians hold a completed palliative higher diploma?
Help answer it:Search PubMedHow does Kenya prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Kenya integrated palliative care units with oral morphine into 11 provincial hospitals. Opioid agonist therapy started in Nairobi in 2014 and had reached 3,354 people by 2023; methadone is free in public facilities, but daily dosing costs clients time and travel. Among people who inject drugs living with HIV in Nairobi, naloxone awareness was 25%.61,580,581,582
Does Kenya have prescription monitoring for controlled medicines, and do opioid control rules limit morphine prescribing in county hospitals?
Help answer it:Search PubMedHow do children get palliative care in Kenya?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
Across eight tertiary hospitals in four East African countries, four of them in Kenya, oral morphine was among the childhood cancer medicines with frequent stockouts, and a Kisumu hospital had the highest mean unavailability at 48.5%. Children with life-limiting conditions in Kenya and three other countries named pain, family relationships, play and school, and worry about death as outcomes that matter.584,585
How many children receive palliative care in Kenya, and which services beyond tertiary hospitals serve them?
Help answer it:Search PubMedHospice care in Kenya
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Kenya?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Nairobi Hospice opened in 1990, and until about 2010 palliative care in Kenya was mainly provided by a small number of hospices. Since then, the national hospice and palliative care association has helped set up palliative care units in public hospitals that link discharged patients to a hospice where one exists. Some hospices, such as one in Western Kenya, run inpatient beds and rural outreach.12,61,289
How many Kenyan hospices are NGO, faith-based or government-run, and how many have inpatient beds?
Help answer it:Search PubMedWho can get hospice care in Kenya?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
At one Western Kenya inpatient hospice, women with breast cancer were admitted a median of one year after diagnosis, 98% had pain on admission, and over 70% died in the hospice (single site). Authors at Nairobi Hospice report anecdotal evidence that many people see a hospice as a death sentence and use it as a last option.289,290
Do Kenyan hospices use formal prognosis or diagnosis criteria for admission?
Help answer it:Search PubMedWho pays for hospice care in Kenya?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
At Nairobi Hospice, most insured patients had National Health Insurance Fund coverage, which did not include palliative care in its benefit package. Kenya uses user fees in higher-level facilities, and the authors state that utilization at Nairobi Hospice is mostly by affluent patients who can afford the services (single site, 2013 data).290
Has Kenya's newer social health insurance added a hospice or palliative care benefit, and what share of hospice income is donor money?
Help answer it:Search PubMedHow many people reach hospice in Kenya?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Before hospital integration began around 2010, the few hospices were not widely spread and served only a few patients and families. Kenya has more than 70 palliative care centers, yet utilization is low, and only 27% of Nairobi Hospice patients surveyed lived in Nairobi County, with rural access described as a challenge.61,290
What share of Kenyan deaths from cancer or other serious illness receive hospice care?
Help answer it:Search PubMedWhat fills the gap in Kenya
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Most end-of-life care in Kenya is given at home, mostly by women in the family. Caregivers linked to a mission hospital clinic described role overload, financial stress and little preparation for end-of-life care, with female caregivers especially vulnerable. Bereaved women caregivers in Nairobi described family dynamics shaping talk about death and advance decisions.400,401
Subnational evidence- Community health workers and home-based care
In rural western Kenya, 105 community health volunteers trained in palliative care evaluated 1,443 patients and referred 154 in the following month, including teleconsults with providers. Evaluation was done by the program team.404
Subnational evidenceSelf-reported- Traditional and complementary healers
In an exit survey of 433 cancer patients at traditional health practitioner outlets, herbal medicine was the most used remedy, sought for unresponsive conditions, inaccessible biomedical services and second opinions. Among 201 traditional practitioners, 85.5% based palliative decisions on the patient's state after consulting caregivers, and 83% combined examination, conventional tests, herbal medicine, follow-up or referral.402,403
Subnational evidence- Phone and remote support
A telehospice pilot in Eldoret gave 30 discharged cancer patients weekly phone calls, a 24-hour hotline and comfort kits of medicines. Participation in weekly calls was 100%, and 10 participants died at home during the eight weeks.405
Single-site evidenceSelf-reported
Sources cited here
- 63Bastos F, Garralda E, Montero A, Rhee JY, Arias-Casais N, Luyirika E, et al.
Comprehensive scoping review of palliative care development in Africa: recent advances and persistent gaps. Frontiers in Health Services 2024;4:1425353. DOI 10.3389/frhs.2024.1425353. Country tables covering literature from 2017 to 2023: service counts and ratios, countries where nurses may prescribe morphine, and national production of oral morphine solution.
- 61Ali Z.
Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya. ecancermedicalscience 2016;10:655. DOI 10.3332/ecancer.2016.655. A 2010 Ministry of Health circular directed provincial hospitals to establish palliative care units with the association; staff trained, patients served, morphine powder supplied through the national medical supplies agency, and extension to further county hospitals.
- 60Elias H, Dow LA, Boit J, Asirwa CF, Cornetta K.
Developing palliative medicine as an accredited medical specialty in Kenya. JCO Global Oncology 2022;8:e2200025. DOI 10.1200/GO.22.00025. A higher diploma in palliative medicine for clinical officers at Moi Teaching and Referral Hospital College, recognition of palliative medicine as a specialty by the Clinical Officers Council, devolution making counties reluctant to release staff for training, and the national palliative care policy launched in October 2021.
- 103Palumbo N, Tilly A, Namisango E, Ntizimira C, Thambo L, Chikasema M, Rodin G.
Palliative care in Malawi: a scoping review. BMC Palliative Care 2023;22(1):146. DOI 10.1186/s12904-023-01264-8. National policy of 2014; opioid barriers identified in 2013 and the Narcotics Act of 1957 reportedly unamended; nurse prescribing only in emergencies under an informal Ministry of Health agreement despite endorsement by the medical and nursing councils; morphine consumption for 2009 and 2013; central procurement and continuing stockouts; an accredited five-day introductory course from 2006 and a Bachelor of Science in Palliative Care from 2018. Full text read.
- 100Hartwig K, Dean M, Hartwig K, Mmbando PZ, Sayed A, de Vries E.
Where there is no morphine: the challenge and hope of palliative care delivery in Tanzania. African Journal of Primary Health Care and Family Medicine 2014;6(1):E1-8. DOI 10.4102/phcfm.v6i1.549. A church hospital network's palliative programme across rural hospitals; morphine dispensing licensed hospital by hospital through the Tanzania Food and Drug Authority; nurses trained in morphine delivery but gated by facility licences and pharmacy restrictions; counts of licensed facilities from 2010 to 2012. Full text read.
- 64Zubairi H, Tulshian P, Villegas S, Nelson BD, Ouma K, Burke TF.
Assessment of palliative care services in western Kenya. Annals of Palliative Medicine 2017;6(2):153-158. DOI 10.21037/apm.2017.01.02. Abstract read. Key informant survey at facilities in Siaya County, 2015 to 2016.
- 62Cartmell KB, Doherty EA, Gikaara N, Ali Z, Qanungo S, Melikam ES, Powell RA.
Kenyan palliative care providers' and leaders' perceptions of palliative care research needs and support to facilitate rigorous research. BMC Palliative Care 2023;22:135. DOI 10.1186/s12904-023-01199-0. Focus groups held in 2018 describing high county-level variation after devolution and morphine distribution as a persistent problem.
- 580Koech E, Welsh C, Karanja M, et al.
The pathway to establishing and implementing opioid agonist therapy (OAT) for people who inject drugs in Nairobi, Kenya. Front Public Health 2026;14:1717635. Describes how Kenya set up opioid agonist therapy from 2014 and how many people were started on it; program implementers describing their own work (self-evaluation). Abstract read.
- 581Masai TW, Kuria MW, Ayinde OO, et al.
The hidden costs of 'free' treatment: A cross-sectional study of patient-incurred costs for daily methadone maintenance treatment in Nairobi, Kenya. PLOS Ment Health 2025;2(9):e0000383. Survey of 249 methadone clients at one Nairobi referral hospital on travel time and out-of-pocket costs of daily dosing; single site. Abstract read.
- 582Maurano M, Bukusi D, Masyuko S, et al.
"We only trust each other": A qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya. PLOS Glob Public Health 2024;4(7):e0003435. Qualitative study of the overdose risk setting among people who inject drugs living with HIV in Nairobi, including naloxone awareness; small purposive sample. Abstract read.
- 400Too W, Lelei F, Adam M, et al.
Preparedness, resilience and unmet needs of informal caregivers of advanced cancer patients in a Regional Mission Hospital in Kenya: Qualitative Study. BMC Palliat Care 2023;22(1):16. Interpretive phenomenological study of 12 home-based caregivers of patients with advanced cancer linked to the Kijabe mission hospital palliative clinic, Kenya. Single faith-based site. Abstract read.
- 404Elias H, Kisembe E, Nyariki S, et al.
Impact of training on knowledge, confidence and attitude amongst community health volunteers in the provision of community-based palliative care in rural Kenya. BMC Palliat Care 2024;23(1):97. Pre-post and 12-month mixed-methods evaluation of a palliative care training for 105 community health volunteers in rural western Kenya (AMPATH). Evaluated by the program team. Abstract read.
- 583Goombs M, Mah K, Namisango E, et al.
The quality of death and dying of patients with advanced cancer in hospice care in Uganda and Kenya. Palliat Support Care 2024;22(5):1169-1178. Survey of bereaved caregivers of hospice patients with advanced cancer in Uganda and Kenya on quality of dying and death; hospice-based samples. Abstract read.
- 584Petricca K, Kambugu J, Githang'a J, et al.
Access to essential cancer medicines for children: a comparative mixed-methods analysis of availability, price, and health-system determinants in east Africa. Lancet Oncol 2023;24(5):563-576. Prospective 52-week tracking of stockouts and prices of 37 childhood cancer medicines, including oral morphine, at eight tertiary hospitals in Kenya, Rwanda, Tanzania and Uganda, plus stakeholder interviews; funded by childhood cancer charities. Abstract read.
- 585Namisango E, Bristowe K, Murtagh FE, et al.
Towards person-centred quality care for children with life-limiting and life-threatening illness: Self-reported symptoms, concerns and priority outcomes from a multi-country qualitative study. Palliat Med 2020;34(3):319-335. Qualitative interviews with 120 children with life-limiting conditions or their caregivers in Kenya, Namibia, South Africa and Uganda on symptoms and concerns that matter to them. Abstract read.
- 12Merriman A, Mwebesa E, Zirimenya L.
Improving access to palliative care for patients with cancer in Africa: 25 years of Hospice Africa. Ecancermedicalscience 2019;13:946. DOI 10.3332/ecancer.2019.946. Nurse and clinical officer prescribing authority; free government oral morphine; local manufacture from 2011.
- 289Tarus A, Cornetta K, Morogo D, et al.
Palliative Care Needs in Breast Cancer Patients Entering Inpatient Hospice in Western Kenya. J Pain Symptom Manage 2021;63(1):71-77. Retrospective chart review of 62 women with breast cancer admitted 2011-2019 to one inpatient hospice in Western Kenya; single site, authors run the service (quality improvement exercise). Abstract read.
- 290Kimani CW, Kioko UM, Ndinda C, et al.
Factors Influencing Progressive Utilization of Palliative Care Services among Cancer Patients in Kenya: The Case of Nairobi Hospice. Int J Environ Res Public Health 2023;20(19). Cross-sectional survey of 169 cancer patients at Nairobi Hospice in 2013 on factors in continued use, including insurance and employment; single site. Full text read.
- 405Cornetta K, Nyariki S, Manji I, et al.
Telehospice for Cancer Patients Discharged from a Tertiary Care Hospital in Western Kenya. J Pain Symptom Manage 2023;65(5):378-387. Feasibility study of weekly phone monitoring, a 24-hour hotline and comfort kits for 30 cancer patients discharged from a referral hospital in Eldoret, Kenya. Run and evaluated by the program team. Abstract read.
- 401Githaiga JN, Swartz L
Socio-cultural contexts of end- of- life conversations and decisions: bereaved family cancer caregivers' retrospective co-constructions. BMC Palliat Care 2017;16(1):40. Four mini focus groups with 13 bereaved women family caregivers in Nairobi on end-of-life conversations and decisions at home. Urban, small sample. Abstract read.
- 402Cheboi S, Kariuki P, Mutai J, et al.
Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya. J Oncol Pharm Pract 2022;29(3):669-678. Client exit survey of 433 cancer patients leaving traditional health practitioner outlets in Kenyan towns; reports self-perceived improvement. Outcomes are self-reported. Abstract read.
- 403Cheboi SK, Ng'ang'a WS, Nyamanga P, et al.
Providers' Competencies and Management Practices for Traditional Palliative Cancer Care Service Delivery in Kenya. Health Serv Insights 2023;16:11786329231211780. Mixed-methods study of 201 traditional health practitioners in major Kenyan towns describing how they deliver palliative cancer care. Abstract read.