Betwixt playing the waiting game and waiting in vain

Temporal governance and the thin alignment of care under universal health coverage in Kenya

Bibliographic Data

ID19220587
AuthorsEdwin Ambani Ameso (0000-0003-3903-2942, African Studies Centre, corresponding author)
Year2026
Pagese70074-e70074
Publication date2026-06-02
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueMedical Anthropology Quarterly (JOURNAL)
Journal identifiersISSN: 0745-5194 • E-ISSN: 1548-1387
PublisherWiley (PUBLISHER • GB)
DOI10.1111/maq.70074
PMID42228809
OpenAlexW7163154982
LanguageEN
References cited29

This article investigates how Kenyan citizens access healthcare within the framework of Universal Health Coverage (UHC) reforms. Based on ethnographic fieldwork, it reconceptualizes waiting as a politically structured phenomenon rather than a simple delay. The analysis shows that UHC reforms do not eliminate waiting but instead redistribute it, resulting in new bureaucratic bottlenecks, infrastructural limitations, and unpredictable care timelines. The concept of 'thin alignment' is introduced to characterize a temporally unstable condition in which endurance and improvisational strategies coexist as patients navigate fragmented healthcare systems. Individuals depend on kinship networks, informal payments, religious practices, and social connections to make their suffering visible and actionable. By emphasizing temporality, this article illustrates how UHC reconfigures access to care and informs broader discussions on infrastructure, inequality, and the politics of care

Bureaucracy · Corporate governance · Ethnography · Health care · Improvisation · Phenomenon · Politics · Global Maternal and Child Health · Healthcare Systems and Reforms · Poverty, Education, and Child Welfare