Barriers and opportunities for youth entrepreneurship in primary health care ecosystem in Kenya

Background Youth entrepreneurship is increasingly promoted as a route to innovation, employment and improved service delivery in primary health care (PHC). In Kenya, however, the youth attempting to build health ventures encounter a health ecosystem that is not configured to support entrepreneurship. Evidence to date has focused on individual entrepreneurs rather than the system around them. This study examined the barriers and opportunities for youth entrepreneurship across Kenya's PHC ecosystem, combining the perspectives of the youth with those of the actors who shape their prospects. Methods In an analytical cross-sectional mixed-methods study, 1,612 trainees, interns and early-career health professionals completed a survey incorporating an eight-item entrepreneurship readiness scale. Qualitative interviews were completed with 55 key informants including educators, employers, financiers, legislators, and health regulators. Eight focus group discussions were held with early career PHC workers and youth innovators. Quantitative data were analyzed using descriptive and bivariate statistics, while qualitative data were analyzed thematically. Results More than half of the youth (57.6%) had attempted to start a business with a higher proportion of males (60.6%) than females ( χ 2 = 4.1, p = 0.042). Youth were primarily motivated by the need for financial independence and skills development with high confidence in financial management. Low entrepreneurship skills confidence was identified around product development, fundraising business planning, licensing and sales. Opportunities were identified in digital health, telemedicine, and home-based care. Barriers to entrepreneurship were identified as limited access to finances, inadequate mentorship, capacity gaps, systemic challenges such as regulatory complexity, and inadequate institutional support. Conclusion and recommendations The youth in Kenya demonstrate strong ambition for entrepreneurship in the health ecosystem. Their ability to establish and scale health ventures remains constrained. Addressing systemic and capacity barriers through targeted capacity building, structured mentorship, supportive health entrepreneurship policies, and enabling environments is essential to strengthening youth-led innovation in Kenya's PHC ecosystem.