Every year, one million Kenyans are
driven below the poverty line
by healthcare-related expenditures. Poverty predisposes them to disease and slows all aspects of growth in the economy.
Poor health hobbles economic growth. Noble Laureate in Economics Robert Fogel noted in 1993 that better diets, clothing, housing and quality healthcare all play an important role in generating economic growth. Strengthening healthcare systems to increase access to affordable, appropriate and quality health services in any country is a prerequisite for long-term development and structural transformation.
Africa accounts for a quarter of the world’s disease burden but has less than five per cent of the world’s doctors. The continent lags far behind in basic healthcare coverage for services such as immunization, water and sanitation, and family planning. Kenya is no exception.
The 2010 Constitution devolved primary and secondary healthcare services to the 47 counties, leaving the national government to focus on policy and research.
Kenya’s health financing envelope is progressing gradually but falls short of the 2001 Abuja Declaration, in which nations committed to allocating 15 per cent of their national budget to the health sector. In fact, Kenya is outperformed by some of its neighbours in this area. In fiscal year 2014-15, Uganda allocated eight per cent of its national budget to the health sector compared to Kenya’s four per cent.
The challenges facing the health sector range from the spread of non-communicable diseases to inadequate funding of health interventions. The devolution of healthcare, coupled with the
Bill of Rights, elicits huge funding demands.
In its Vision 2030, Kenya committed to becoming a competitive and prosperous nation with a high quality of life for all its citizens by 2030, including a quality health delivery system.
Revamping the national health insurance scheme to comprise everyone capable of paying premiums, rather than only those in formal employment has shifted the burden of healthcare costs from the individual to the collective by raising more money for healthcare.
Nevertheless, four out of every five Kenyans have no access to medical insurance. That is why Kenya needs to adopt more innovative ways of financing its healthcare system.
The 2014 World Bank Group’s Kenya Public Expenditure Review considers the private sector a lead in local healthcare markets because it owns 60 per cent of all primary healthcare facilities, while 40 per cent are government-run.
Public-private partnerships can be institutionalised for financing Universal Health Care. A case in point is the strong PPP established in 2015 by six private sector companies
(Philips, Merck Sharp & Dohme-MSD, GlaxoSmithKline-GSK, Safaricom, Kenya Health Care Federation and Huawei)
to improve maternal health in historically marginalised counties.
This initiative — targetting Mandera, Marsabit, Migori, Isiolo, Lamu and Wajir, and spearheaded by the national government and the UN — has yielded positive health outcomes. Similar approaches can be adopted for the health system at both the national and county levels.
Kenya is known for developing innovative home-grown solutions to challenges. It can easily move towards a cashless economy, which will be critical for driving Kenya’s socio-economic transformation.
For instance, M-Pesa was conceived to address the challenge of rural banking but it has also provided a platform for mHealth, the use of mobile devices to support the practice of medicine and public health.
Kenya can institute targetted taxation as an innovative financing policy to complement existing financing mechanisms. Partnering with mobile phone service providers and charging a small fee for targeted healthcare initiatives can generate the necessary resources to support UHC.
An estimated Sh12.5 billion is transacted daily through mobile money transactions. By contributing roughly one per cent on a graduated scale, Kenya can easily raise Sh125 million daily to finance UHC.
For example Initaid, an International Drug Purchase Facility for Aids, tuberculosis, and malaria
is supported mainly (70 per cent) through the airline ticket tax.
The airline solidarity contribution is an innovative attempt to gain the benefits of a global tax. Kenya can do the same by charging a small tax at its international airports and border crossings for a ring fenced public health account.
There is no one-size-fits-all health financing solution. And Kenya must continuously adapt in the face of rapid technological changes.
UN Resident Coordinator to Kenya