In November 2024, nearly 30 children at Christ Chapel Children’s Home in Huruma, Nairobi County were afected by chickenpox.

Gloria Ndunge, founder and director, struggles to remember whether it was the raised bumps or the fever that appeared irst.

She recalls noticing blisters on one of the girls who had been sent home from school after feeling unwell. As the contagious disease, caused by the varicellazoster virus (VZV), began to spread through the home, the children grew increasingly distressed, according to Ndunge.

The cost of treating one child for chickenpox would have been at least Sh1,000, and this amount could be higher for younger children who required more than just soothing ointment. Ndunge relects on the past expenses involved in controlling such outbreaks.

Ndunge felt relieved that all the children received treatment at no cost to the institution, which struggles with limited donations, thanks to the medical coverage provided by the non-proit organisation, Ciby Care.

James Kioko, head of operations and co-founder of Ciby Care, a company that utilises technology and partnerships to provide quality healthcare access to children in underserved communities, on boarded the institution at the end of last year.

Healthcare in underserved communities

“Access to quality healthcare for children in underserved communities requires a multifaceted approach,” Kioko states, highlighting their exclusion from traditional insurance providers.

His brother and co-founder, Mike Mutuku, explains their strategy, "For Ndunge’s home, we partnered with a tele-health company that ofers remote medical services and provides coverage without an expiration time frame, unlike what is typically available in the market.”

For every contribution that Ciby Care makes toward the children’s healthcare, Checkups Hospital—currently their medical partner through its coverage plan, COVA— multiplies that contribution by four, ensuring that all 87 children at the home have access to comprehensive healthcare.

“We are not beneiting in any inancial way from this; in fact, we continuously incur costs. However, we are passionate about supporting children's homes,” Kioko explains, noting that this home is the irst in their portfolio.

The organisation plans to onboard more homes in the future.

Previously, Ndunge would take the children to public health facilities where they received no preferential treatment.

"I took them to the hospital just like any parent takes their child and incurred charges. There is no special treatment simply because the children come from a home," she explains.

She adds, "The regular shortage of essential supplies forced me to incur outrageous out-of-pocket expenses, around Sh40,000 per month, making it prudent to establish a local arrangement with a private health provider."

Common illnesses in charitable homes

The most common ailments afecting households with children aged from 3 months to at least 20 years include common colds, diarrhoea, vomiting, and chronic conditions that require ongoing management, notes Ndunge-a mother of four children.

Macharia Mathi, a clinical oicer from Checkups Cova, visited the home to deliver a wellness talk to the children.

She highlighted that common illnesses in orphanages often include fungal infections and gastroenteritis, an intestinal infection characterised by symptoms such as diarrhoea, vomiting, nausea, and stomach cramps.

"Children often run around, touching various objects without maintaining good hygiene. Additionally, since they tend to share items like clothes and bed sheets, there is a risk of spreading contact infections, such as fungal infections,” Mathi explains.

Mathi encouraged the children to pay attention to their personal hygiene by frequently washing their hands and avoiding the sharing of ersonal items like under- wear and toothbrushes.

According to Nd- unge, the lean number of workers at the institution means that children often miss out on individual care. “Sometimes providing the best for children is beyond our means. While we would like to give them nutritious meals, it is not always possible with the resources we have,” she stated.

Responsibility for providing healthcare

Under the Social Health Authority framework and the provisions of the Children Act 2022, the responsibility for providing healthcare to orphans in Charitable Children’s Institutions (CCIs) falls to both national and county governments, albeit with some delineation of roles.

For example, the national government is responsible for funding by allocating resources through the treasury, speciically aimed at orphans and vulnerable children, in addition to developing inclusive policies and regulations.

Conversely, county governments are tasked with delivering healthcare through public facilities, ofering free or subsidized services such as maternal care, immunization, and treatment for common illnesses.

In the 2024-2025 inancial year, the government allocated Sh31.3 billion to social protection and airmative action, a decrease from the previous allocation of Sh36.05 billion. The cash transfer for orphans and vulnerable children received Ksh7.9 billion, while the presidential bursary for orphans was allocated Ksh400 million, and the Child Welfare Society of Kenya received Ksh815 million.

Unclear budget allocation

Budget allocations for children in Children's Care In stitutions (CCIs) are unclear. Although the government has policies for vulnerable children's healthcare, the reality difers.

Judith Mutange, director of Great Mercy Children's Home in Kitale, notes she hasn't been able to register the children for the National Health Insurance Fund due to bureaucratic obstacles.

“It seems the government runs a segregated program, as children in private homes lack the same access to care as those in government homes," she stated. She also highlighted that the Edu-Afya medical cover (secondary school medical cover) only beneits students in public secondary schools and children in governmentrun homes.

A sub-county director from the Children's Department, who wishes to remain anonymous, highlights the ongoing challenges of accessing healthcare for children in the county. "Many families visit my oice for letters to secure free treatment, but hospitals often deny care or provide subpar services," she explained.

Hospitals frequently assume that children's homes have enough funds, leading to unnecessary payment demands. Devlin Mundi, the County Coordinator for Children’s Services in Embu County, suspects that this may discourage compliance with the 2018 state moratorium on registering new Children’s Care Institutions (CCIs).

The goal is to transition all children in CCIs to family and community-based care by 2030. However, Mundi notes that the process for obtaining free medical care is unclear and often cumbersome, causing many to give up.

Currently, the new Social Health Authority's portal does not permit the entry of names for children from charitable homes, as conirmed by multiple sources.

"This creates a signiicant burden for homes dealing with procedures such as heart surgeries or C-sections for teenage mothers in rescue centers, which require substantial funding," she added.

To her knowledge, only rehabilitation centers that accommodate children in conlict with the law have had access to free comprehensive treatment from the state.

She also mentioned that the Ministry of Labor and Social Protection has begun discussions with the Ministry of Health on how to streamline the process of accessing care for these children. Mundi recalled that in the past, the defunct NHIF insured children in Embu by grouping them in sets of ive and charging one premium for the entire group.

This approach allowed them to be treated as one family, but such arrangements are no longer available with the Social Health Authority. The practice of children's departments writing to government hospitals requesting fee waivers appears to be common among counties; however, it complicates the process of accessing care according to Mundi. The writer was unable to obtain comments from the Ministry of Labour and Social Protection by the time this article went to press, and the Social Health Authority also did not respond either before our publication deadline.

According to a report by UNICEF, approximately 45,000 children are living in residential care homes, such as child care institutions (CCIs). The main reasons for children being separated from their families or primary caregivers include parental death, neglect and abandonment, abuse and violence, disability, and conlict with the law.

In contrast to Mutange and Ndunge, David Katumo, who runs the Anaweza Children's Home in Machakos County, explained that the private children's home he previously managed received free healthcare as part of a pilot program for Universal Health Coverage, which included the counties of Isiolo, Machakos, Nyeri, and Kisumu.

"I went to the Children's Oice and registered all the children using my documents. From there, they began receiving comprehensive services from government facilities. The only additional cost was for medications for children who were HIV positive and needed immune boosters," Katumo explained.

However, after the pilot phase ended, the religiousbased institution returned to paying out of pocket for healthcare.

"The regular shortage of essential supplies forced me to incur outrageous out-ofpocket expenses, around Sh40,000 per month, making it prudent to establish a local arrangement with a private healthcare provider -GLORIA NDUNGE