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November 15, 2018

Primary healthcare reforms key to achieving Universal Health Coverage

Patients at the Coast General Hospital Mombasa, 2016. /FILE
Patients at the Coast General Hospital Mombasa, 2016. /FILE

On this Madaraka Day, we reflect on the progress Kenya has made over the last 55 years.

When President Jomo Kenyatta first took office, he has a vision to eradicate poverty, ignorance and disease.

Today, Kenya has made tremendous gains on all accounts. Kenya’s economic prosperity curve is one of the most impressive in the continent.

Literacy rates are improving slowly, but surely, as over 78% of men and 81% women can read and write.

However, several health indicators show urgent need for action, especially at the primary health care level, in order to ensure every Kenyan can live a healthy and full life. 

Too many people in Kenya continue to die from preventable and treatable illnesses.

Consider the following statistics: one in three Kenyans die from preventable and treatable illnesses, such as pneumonia and malaria.

One in every 26 Kenyan children dies before reaching the age of one. Diarrhoeal diseases are among the top five killers of children below the age of five. These numbers are unacceptable.

Preventable and treatable diseases can be easily managed at the primary level of any functioning health system.

Data shows that PHC can deliver 90% of all the essential healthcare services people need throughout their lives, and is less expensive and more accessible than hospital-based care.

Routine check-ups are also crucial for early diagnosis, which helps prevent non-communicable diseases before they become complicated conditions that take years and money to treat.

As Hon. Sicily Kariuki, Cabinet Secretary for Health in Kenya, stated: "Primary health care (PHC) is the best bet for Kenya to attain universal health coverage."

Even at the primary level, accessing health care remains a significant challenge for most Kenyans. Four out of 5 Kenyans lack any form of health insurance.

As a result, many don’t seek timely care, and when they do, they often need to borrow money or sell assets to cover medical costs.

Every year, healthcare expenses push one million Kenyans below the poverty line – $1.90 per person per day – and keep them poor.

This must change – and soon – and a functioning primary healthcare system will be key to avoiding these catastrophic health expenditures.

Kenya’s PHC system continues to face several challenges, including financing, access and quality of care. And these challenges disproportionately affect the poor, particularly those who live in the most remote areas.

The latest report on healthcare financing shows that Kenya’s health financing continues to be dependent on donor funding. Donors contributed 63% of the Ministry of Health’s development budget.

By comparison, the government contributed only 36%. There is clear need to rethink how healthcare financing is mobilized and pooled; which services are purchased how; and how service delivery is accredited and quality controlled. Out-of-the box partnership models must be part of the solution.

Earlier this year, President Uhuru Kenyatta announced his Big Four agenda, which identified universal health coverage (UHC) as a key pillar of social-economic development.

This announcement cemented continued support of the government to improve access to primary care, particularly through strengthening maternity services.

For example, Linda Mama, the free maternal care program launched in 2013, has increased PHC utilisation from 69% in 2013 to 77% in 2016, as a result of foregone user fees.

Every year, the program averts more than 2000 maternal deaths and 30,000 child deaths. Linda Mama is a powerful example of rapid progress that can be achieved when countries invest in reaching every citizen regardless of where they live or ability to pay.

Within the strategic plans for attaining the Big Four, including UHC, public-private partnerships, technology and innovation take center stage – and for good reason, considering Kenya is a hotbed of innovation and entrepreneurism.

Already, we have seen examples of public-private partnerships designing innovative solutions to advance health.

For instance, a Community Life Center has been established by the Mandera County Government in partnership with Philips and the United Nations to explore how innovations in facility financing, management and service delivery can advance maternal, newborn and child health in a county with some of the highest rates of maternal death in the world.

Similarly, Safaricom has linked up with the National Hospital Insurance Fund (NHIF) to provide health care insurance to 2,000 households through M-TIBA.

M-TIBA enables users to send, save and receive funds and benefits to access healthcare services using their mobile phones at selected healthcare facilities.

An example of a promising last-mile health partnership is the telehealth clinic model launched by Merck Group in partnership with the Ministry of Health.

Teleclinics increasingly allow patients in remote areas of Kenya to interact with specialists in major hospitals via video conferencing. Though new in Kenya, India’s telemedicine initiatives date two decades and now reach the majority of the country.

Achieving UHC, however, will be as much about the effectiveness of partnership initiatives as it will be about the scale and form such co-operation takes.

It will be critical, therefore, from the offset of any public-private partnership, to establish robust monitoring and evaluation mechanisms to track and ensure accountability, efficiency and effectiveness. And based on these measures, scale the best solutions.

The Government of Kenya recently co-created with the United Nations system a Sustainable Development Goal Partnership Platform to help optimise public-private collaboration, unlock intellectual and financial resources from the private sector, and drive innovations in support of the attainment of Kenya’s UHC agenda, and its broader Big Four agenda.

Kenya is at a prime moment in history and can lead the way toward achieving UHC. The commitments the country makes in the health of its people now will serve as a point of reference for the rest of Africa for years to come.

 

Anjali Nayyar is the Executive Vice President for Global Health Strategies (GHS) and Siddharth Chatterjee is the UN Resident Coordinator to Kenya

 

 

 

 

 

 

 

 

 

 

 

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