OBJECTIVES: In Kenya, diabetes prevalence is comparable to Western countries.   In Sub-Saharan countries, the emphasis must be on prevention because the Western model of emphasizing treatment is unaffordable and unachievable.  This study is a cost benefit analysis (CBA) of a diabetes prevention program in rural Kenya. METHODS: Convenience sample of adult residents from a rural county in Kenya (Kiambu) were randomized to one of two WTP techniques, Structured Haggling (SH) and Payment Card (PC).  Program benefits (WTP) were collected via face-to-face interviews using the ex-ante approach.  Program costs were estimated based on World Health Organization program cost estimation guidelines for low income countries in Africa, and program costs tabulated in the literature (eg Haddix et al 2006), supplemented expert opinion: diabetes educators at the Kenya Diabetes Management and Information Centre. RESULTS: WTP data was collected from 158 rural residents (70% male, 2.5% diabetic,11% own a vehicle and mean monthly expenditures of Ksh10,933 (US2011$ 127.12). Mean annual WTP for the prevention program was Ksh628.75 (US2011$7.30) for PC and Ksh683.97 (US2011$7.95) for SH per respondent per year, p=0.516.  Mean annual cost for providing the program to rural residents (assuming 100 clients/week) was Ksh1,228 (US2011$14). Therefore, program cost exceeded the benefit resulting in a negative net social benefit (NSB). CONCLUSIONS: Based on WTP (benefit) data, residents valued the diabetes prevention program in rural Kenya.  From a societal perspective, however, the costs for implementing the program outweighed the benefits.  The evaluated program is a stand-alone project.  Policy makers may consider a number of options that can reduce the operating costs of the program including, implementation of the program as part of established diabetes clinics, or administering the services to already gathered groups such as at religious functions: such an approach may result in a positive NSB.