At Kadika Comprehensive School in Suna East, the queues began forming long before the medical tents became busy.
Men and women arrived carrying referral notes, medical cards and in some cases, nothing more than the hope that somebody would finally attend to an ailment they had been living with for months or even years.
Children came with their parents. Elderly residents waited patiently for consultations. Others sought screening for conditions they had never had the opportunity to test for.
For a day, the school in Migori County was transformed from a place of learning into a temporary health facility.
But the sheer number of people turning up for free medical services raised a more uncomfortable question: what happens to those who cannot afford to seek care when there is no free medical camp?
The recently held medical outreach at Kadika Comprehensive School, organised by the Safaricom M-Pesa Foundation in partnership with the Migori County Government, provided more than free consultations and medication.
It offered a snapshot of the healthcare pressures facing a county of about 1.3 million people — from malaria and waterborne disease risks to chronic illnesses, specialised treatment, health insurance gaps and shortages of healthcare workers.
By mid morning, more than 1,500 patients had already been attended to, with organisers targeting at least 3,000 beneficiaries during the exercise.
The numbers were striking.
They also underscored the reality that for many households, the biggest healthcare challenge is not necessarily the absence of a disease, but the ability to reach, afford and sustain treatment.
A hospital without walls
The M-Pesa Foundation’s intervention was deliberately designed to replicate a higher-level health facility within the community.
According to Mrs Sophie Onyango, a programme manager at Safaricom-M-Pesa Foundation, the organisation’s objective is to take healthcare services to people rather than wait for patients to travel to hospitals.
“Our primary mission is to transform lives by bringing healthcare closer to the communities,” Ms Onyango said.
The Foundation conducts three medical camps every month, with a target of reaching all 47 counties.
The Migori exercise was its second camp in the county.
More significantly, Ms Onyango said the camp was operating at the capacity of a Level 4 health facility, allowing residents to access a broad range of services in one location.
That distinction matters in a county where geographical distance, transport costs and household income can determine whether a patient seeks treatment early or waits until an illness becomes serious.
For some residents, the school compound offered something that ordinary healthcare does not always provide easily — multiple services under one roof and at no cost.
The hidden burden of untreated conditions
The camp went beyond the treatment of common ailments.
Children and adults were screened for cleft lip and cleft palate, with confirmed cases referred to Nairobi for corrective surgery free of charge.
Patients were also screened for fistula, a condition that can leave affected women with severe physical and social consequences when untreated.
Migori is among the counties providing routine services for treatable fistula, according to officials.
Such specialised interventions reveal another dimension of healthcare inequality.
A patient may have access to a dispensary or health centre but still require referral to a specialised facility many kilometres away.
The cost of transport, consultation, tests, accommodation and treatment can become prohibitive for low-income families.
The result is that some conditions that are medically treatable can become prolonged social and economic burdens.
The problem after the free medicine runs out
Perhaps the most important question raised by the outreach is what happens after the tents are dismantled.
Medical camps are useful for identifying illness and providing immediate treatment, but chronic diseases require sustained medication and monitoring.
The M-Pesa Foundation sought to address that problem through its “Care Beyond the Camp” initiative.
Ms Onyango said patients with chronic conditions would receive a three-month supply of medication.
“We are not only providing medication at the camp. Under our ‘Care Beyond the Camp’ initiative, we have committed to providing a three-month supply of medication for patients with chronic conditions,” she said.
That commitment is significant because a prescription without continuity can offer only temporary relief.
For patients suffering from chronic illnesses, missing medication can lead to complications, repeated hospital visits and increased financial pressure on households.
The three-month support therefore attempts to bridge the gap between emergency outreach and sustained treatment.
But it also raises a broader policy question: how can patients be guaranteed continuous care once external support ends?
Migori’s malaria challenge
The county’s health burden is also shaped by its environment.
Malaria remains a major concern, with local health officials linking the high prevalence in parts of Migori to environmental conditions favourable to mosquito breeding.
Partners have continued supporting the county with malaria medicines and mosquito nets.
Yet malaria cannot be viewed only as a hospital problem.
Its persistence is closely tied to housing conditions, stagnant water, drainage, climate variability, household incomes and access to preventive measures.
For families repeatedly spending money treating malaria, prevention can be just as important as treatment.
Floods turn an environmental problem into a health crisis
Migori’s exposure to flooding adds another layer to the public-health challenge.
Floods can contaminate water sources and increase exposure to waterborne diseases, particularly in communities where access to treated water is already limited.
County officials said the government has been working with partners to support water treatment initiatives.
The connection between environment and health is becoming increasingly difficult to ignore.
When heavy rains flood homes, farms and roads, they can also disrupt access to health facilities, contaminate drinking water and create breeding grounds for disease vectors.
For communities already struggling with healthcare costs, an environmental crisis can quickly become a household health crisis.
The SHA question
Another concern emerging from the camp was the relatively low level of registration under the Social Health Authority (SHA).
County Health Executive Mr Caleb Opondi said only 54 per cent of Migori’s estimated 1.3 million residents had registered.
That leaves a substantial population outside the system at a time when the government is seeking to make SHA central to healthcare financing.
The medical camp therefore doubled as a registration point.
The Foundation and county government helped 50 vulnerable people register and receive support under SHA.
But the figures suggest that registration remains an unfinished task.
For poor households, health insurance is potentially a critical protection against catastrophic medical expenses.
The challenge is ensuring that people understand the system, register and can actually access the benefits when illness strikes.
178 facilities, but who will staff them?
Migori County oversees 178 health facilitis, according to Mr Opondi.
On paper, such a network suggests considerable reach.
In practice, however, healthcare infrastructure is only as effective as the personnel available to operate it.
A clinic without enough nurses, clinical officers, laboratory personnel or other specialists can leave patients waiting longer or travelling elsewhere for services.
The county says it is conducting its fourth recruitment drive to increase the number of healthcare workers across its facilities.
The move is intended to address staffing shortages and strengthen service delivery.
It is a critical intervention, particularly as the county seeks to move healthcare closer to communities through primary healthcare and community-based services.
Government and private sector
Deputy Governor Dr Joseph Mahiri, who represented Governor Ochilo Ayacko at the event, acknowledged the role of the M-Pesa Foundation and other partners.
Among them were Zuri Health, which provided general healthcare services; Kenya Institute of Special Education (KISE), which supported hearing and speech services; and Gertrude’s, which offered paediatric and mental-health support.
The county also deployed Community Health Promoters, clinical officers and nurses, while county facilities were designated to support follow-ups and referrals.
“We appreciate the M-Pesa Foundation and all the partners who have come together to bring these services closer to our people. This partnership demonstrates what can be achieved when different stakeholders work together to improve healthcare,” Dr Mahiri said.
He urged residents to take advantage of the free services and continue with recommended follow-up care.
The partnership illustrates an increasingly important reality in Kenya’s health sector: county governments remain responsible for delivering healthcare at the devolved level, but private foundations, development partners and other organisations can provide resources, specialised services and additional capacity.
The challenge is ensuring that such interventions complement rather than substitute the public health system.
The community as the first line of defence
For Kadika Comprehensive School head teacher Paul Odhiambo Otieno, the decision to bring the medical camp to the institution demonstrated the value of taking essential services into communities.
“I thank God and the organisers for choosing Kadika Comprehensive School as the host site for this important event. We warmly welcome all of you and pledge our full institutional support,” he said.
The choice of a school as the venue was itself significant.
Schools are often among the most accessible public spaces in rural and peri-urban communities and can serve as effective platforms for health education, screening and community mobilisation.
It also brings healthcare closer to families who might not ordinarily visit a hospital unless somebody is already seriously ill.
A bigger question than one medical camp
The Kadika camp may have ended, but the healthcare questions it exposed remain.
How many residents will continue taking their medication after the three-month supply runs out?
How many people remain unregistered under SHA?
How many patients with potentially treatable conditions have never been screened?
How will Migori manage the healthcare needs of a growing population with 178 facilities and persistent staffing pressures?
And, perhaps most importantly, how can free medical camps become gateways into a stronger, continuous public healthcare system rather than isolated interventions?
The M-Pesa Foundation says its medical camps are designed to reach communities across Kenya.
In Migori, the response suggests that the need is substantial.
The long queues and high turnout were not simply evidence of the popularity of free treatment.
They were a reminder of the economic reality confronting many households: when healthcare is expensive, distance is far and income is uncertain, illness can quickly become a financial crisis.
For a patient who cannot afford a consultation, a free camp can be life-changing.
But the real measure of success will come later — when the tents are gone, the crowds have dispersed and patients return to their homes.
That is when Migori’s healthcare system will be tested most.
Because ultimately, the goal cannot be to wait for another medical camp.
It must be to build a system in which quality healthcare is close enough, affordable enough and continuous enough that residents do not have to wait for one to come to them.
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