Mental health is no longer missing from policy conversations in Embu County. It appears in county plans, sector priorities, and health discussions. But for many residents, that recognition has not yet translated into real access to care. Services remain concentrated in a few facilities, the specialist workforce is critically thin, and mental health support at primary health care level is still far from where it needs to be.
This gap between commitment and implementation was sharply brought into focus during a community-led advocacy forum held in Embu in January 2026. The forum brought together civil society actors, county officials, service providers, and community advocates to examine whether county investment in mental health is truly improving access to quality services.
Mental Health Services
In Embu County, specialized mental health care is primarily available at Embu County Referral Hospital, with Siakago Level 4 Hospital being the only other facility reported to have a mental health clinic. For a county with a projected population of 662,000 by the end of 2025, that is a dangerously narrow service base.
|
HRH by Cadre |
No. available |
Facility | HRH Requirement – MOH,2014 | |
| Level 5 | Level 4 | |||
| Psychiatrist | 1 | ECRH | 4 | 2 |
| Psychologist | 2 | ECRH at VCT & OPD | 2 (clinical) | 1 |
| Psychiatric nurses | 8 | ECRH | 20 | |
| 1 | Siakago | 6 | ||
| Clinical Officer (psychiatry) | 0 | 2 | 1 | |
This shortage has direct consequences. It means delayed diagnosis, long referrals, limited follow-up, pressure on the referral hospital, and weak access for people living in underserved parts of the county. It also makes it harder to integrate mental health into routine services at lower-level facilities, where many cases could be identified and managed earlier.
Available county data points to substantial need for mental health services:
These figures matter because they show that mental health need is not isolated to one facility or one sub-county. Demand exists at both facility and community level. Yet gaps in data harmonization remain a major challenge. Referral data from the community system is not fully linked to facility systems, making it difficult to track whether those referred actually received care. Weak data quality controls also make it harder to plan, budget, and monitor progress effectively.
Embu County’s own planning documents already recognize mental health as a priority. The County Integrated Development Plan (CIDP) 2023–2027 includes commitments on community mental health, rehabilitation services, training of health workers, and construction of a mental health complex as a flagship project.
That should have created a clear pathway for stronger service delivery. But the January advocacy forum found that the connection between planning and budgeting remains inconsistent.
While some mental health-related targets under the health sector showed progress, other important actions especially under related sectors such as youth, gender, and social services were not funded. This meant some planned mental health awareness and rehabilitation interventions were not implemented at all. Participants also noted that critical priorities identified by technical mental health teams, including outreach clinics, decentralization of services, and recruitment of specialized staff, were not comprehensively reflected in county budget commitments.
This is where the county’s response starts to weaken. A priority that appears in a plan but lacks an operational budget is not a functioning priority. It is an intention.
The forum showed why community-led advocacy is becoming increasingly important in mental health governance. By reviewing county plans, service data, and budget priorities, communities are moving beyond general awareness and making a more evidence-based case for accountability.
The strongest demands emerging from the process are practical and overdue: expand mental health services beyond referral level, integrate care into primary health care, recruit and retain specialized professionals, invest in outreach services, and improve the quality of mental health reporting. There is also a growing push for dedicated investment in mental health infrastructure, including establishment of a mental health unit with substance use treatment services and full operationalization of the county’s planned mental health complex.
These are not unrealistic proposals. They are necessary if Embu County is serious about providing timely, affordable, and quality mental health care.
Embu does not lack evidence of need. It does not lack policy recognition. It does not even lack identified priorities. What it lacks is consistent budgetary and implementation follow-through.
The next step is not another statement acknowledging mental health. It is deliberate investment in services, staff, systems, and infrastructure, especially at primary health care level where access can be widened most effectively. Until that happens, mental health will remain visible in county documents but unevenly available in people’s lives.
For communities and advocates, the task is now clear: keep pushing until county commitments are no longer just written promises, but functioning services that people can actually reach.
The Social Health Insurance Fund (SHIF) laws were rushed through the legislative process and at one point, they were declared unconstitutional for lack of public participation by the High Court. The greenlight for implementation was granted by the Court of Appeal and the government proceeded to implement the laws. However, lack of clear transition plan for the NHIF staff to SHA has proved to be a major obstacle. The staff need to be assured and motivated to embrace and implement the new scheme without looking behind their backs. Unfortunately, their contracts were extended for a period of six months awaiting SHA to undertake its staff establishment. As they lender services they are awaited by three fates, redeployment to SHA or other public institutions, or retire voluntarily. Why was the rush to rollout a new scheme before undertaking staff establishment? Indeed, this was a huge gabble no wonder the parent Ministry of Health seems to be the driving force behind the SHA. Listening to some high-level ministry officials discussing SHA indicates their comprehension is better as compared to that of SHA board and staff.
The promises and realities of SHA are a contrast. Citizens were mobilized to register and promised rosy services, far better than the ones offered by NHIF. But alas, those that sought services from health facilities were heartbroken. The digital registration, approval and claim process were often faced with technical hitches that took longer than anticipated hindering access to services. Most of the health facilities including the private sector took longer to be boarded into the scheme due to trust levels as a result of debts owed to them under the defunct NHIF, forcing many patients to pay out of pocket in order to access the services or miss the services all together. In paper the benefit packages under SHIF far outweigh the NHIF’s as they included outpatient care, inpatient care, chronic diseases management, and specialized treatments. However, this came with an increase in contributions at 2.75% of household income.
These patient stories are a call to action. The question of ‘why the rush?’ is now secondary to the question of ‘how do we fix this?’ We must learn from these experiences, engage with communities, and work collaboratively to build a healthcare system that truly serves the needs of all Kenyans. Let’s move forward with a commitment to a complete and effective SHA, not a half-baked idea.
Change is a gradual process, often driven by active community involvement in advocacy, inclusive decision-making, and governance. By participating in activities such as budget planning, monitoring public service delivery, and auditing implementation processes, citizens can foster accountability and transparency among public officers and political leaders. When communities take the initiative to oversee public service delivery and financial management, they encourage leaders at both county and national levels to provide timely and quality services.
Health Rights Advocacy Forum (HERAF), a non-governmental organization focused on transforming health systems through strengthened voice and accountability, identified challenges within the Civil Society Organizations (CSO) network in Masinga and Yatta sub-counties, Machakos County. Over the years of project implementation, the lack of active Community-Based Organizations (CBOs) has limited the effectiveness of advocacy and oversight efforts in these areas. Mapping exercises revealed that while self-help groups, women’s groups, and youth groups were active, no formal CBOs were operational.
To address this gap, HERAF trained leaders of these groups on the Public Benefits Organizations (PBO) Act and County Governments Relations (CGR) Act. The goal was to integrate these smaller groups into structured CBOs at the ward level and connect them to the Machakos County CSO Network (MCCN). This integration aims to enhance community oversight, monitor service delivery, and strengthen engagement with stakeholders in Machakos County.
By supporting the formation and integration of CBOs under the MCCN umbrella, HERAF has facilitated collaboration among CSOs, CBOs, and NGOs. This partnership will boost visibility for community groups advocating for their rights and priorities while fostering social enterprises to address local challenges.
The non-state framework promotes effective information sharing, as the network operates at the sub-county level, with representatives from each village. Members benefit from opportunities to benchmark, participate in training sessions, and build capacity in areas such as budget audits, fundraising, and resource mobilization. This structured approach empowers communities to drive sustainable change and ensure their voices are heard in governance and decision-making processes.
The establishment of the dental unit at Masinga Level 4 Hospital is a testament to the government’s responsiveness to the needs of its constituents. It reflects a collaborative effort between the government and the community. By voicing their concerns and advocating for better access to dental care, the community played a pivotal role in influencing the government to establish the unit. Their voices were heard. The newly equipped Dental Unit at Masinga Level 4 Hospital stands as a beacon of progress, showcasing the tangible outcomes that empowered communities contribute towards better health.