Feasibility and Outcomes of Social Enterprise Models to Enhance Financial Sustainability in Kenyan Health Systems: A Systematic Review

Abstract This systematic review evaluates the feasibility and outcomes of social enterprise models in Kenyan health systems as mechanisms to enhance financial sustainability by combining social missions with revenue generation. A comprehensive search of databases and grey literature focusing on Kenya and similar settings was conducted. Two independent reviewers screened and extracted data on regulatory, governance, infrastructure, stakeholder, and economic factors, resolving discrepancies by consensus. Methodological quality was assessed using standardized tools, and findings were synthesized narratively following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, informed by resource dependence and institutional theory within a social enterprise framework. The results show that implementing social enterprises in Kenya is feasible but depends on enabling institutional environments. Fragmented policies limit operational flexibility, and infrastructural deficits restrict scalability, with only 58% of facilities supporting innovative financing. Weak governance affects strategic coherence, with approximately 40% of enterprises struggling to maintain direction. Economic volatility, including 5.7% annual inflation, threatens revenue stability. Reported benefits include improved healthcare access, enhanced operational efficiency, and progress toward financial autonomy. While community participation fosters local legitimacy, 65% of enterprises face challenges mobilizing local resources without external aid. Overall, social enterprises can strengthen the resilience of the Kenyan health system; however, a sustained impact requires regulatory harmonization, infrastructure investment, stronger governance, robust partnerships, and the integration of digital health innovations to address systemic disruptions.