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Background: Universal Health Coverage (UHC) aims to promote equity in access, ensure quality healthcare and offer financial protection. Karatina Sub-county hospital is in Nyeri County, a pilot UHC county. The study sought to determine the influence of UHC program on health service provision in the outpatient department of this hospital. Methods: The study was a descriptive cross-sectional survey. Interviewer administered questionnaires and hospital records of patient numbers were used for data collection. Systematic random sampling was used. Key informant interviews collected qualitative data. The sample size was 228 respondents and 6 healthcare providers. The SPSS software was used to analyze quantitative data. Qualitative data was analyzed using a deductive approach. Results: There was a 67% increase in patient numbers. Most patients were below 60 years old and low-income earners. Close to 80% were hospital revisits. About 56% were managed for acute illnesses and 31% for chronic illnesses. Fifty five percent of patients waited for over two hours before being attended. The hospital provided about 2/3 of all health services required. Majority (>80%) of the patients were satisfied by the overall services received at the hospital. The main challenges under UHC were understaffing, long patient waiting time and inadequate hospital resources. There is only partial financial protection. Conclusion: There is improved access and partial financial risk protection. Overall service provision is better, but the quality of care is compromised due to the challenges experienced. [ABSTRACT FROM AUTHOR]