Betwixt playing the waiting game and waiting in vain: Temporal governance and the thin alignment of care under universal health coverage in Kenya

Abstract 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.