Kenya has undertaken an ambitious plan to achieve universal health coverage (UHC). In fact, the 2018 Budget Policy Statement approved by Parliament has a goal to guarantee quality and affordable healthcare to all Kenyans by 2022. This means that we have less than five years to deliver the promise of UHC, which ensures that every Kenyan will have access to health services of sufficient quality while avoiding exposure to financial hardship.
The 2017 Statistical Abstract from the Kenya National Bureau of Statistics (KNBS), indicates that health facility visits for outpatient services totaled 65 million, including 44 million first visits and 21 million return visits in 2016. According to the Ministry of Health, health service expenses push nearly three million Kenyans below the poverty line annually. These Kenyans spend over 40 per cent of their non-food expenditures on health.
There are many questions around fairness in Kenya’s options for UHC that should be subjected to public deliberation. This article only begins to scratch the surface of how we define the differences in access to healthcare and highlights the need for evidence-based equitable resource distribution and spending, both nationally and within counties.
In distributing health resources, we should first ensure we are spending where resources are needed most, so that those who have limited (or no) capacity to spend on health services are cushioned from catastrophic expenditures. We must also ensure that those already getting health services continue to get them. There is no single ‘right way’ to go about this. There is, therefore, a need to subject questions on resource distribution to public debate, where we can discuss options that ensure every Kenyan clearly understands why the government is funding certain priorities in health and not others.
We may choose to measure need for health services by looking at certain proxies or looking at more specific measures of health needs when deciding on resource distribution. However, measurement by proxy can be problematic because it masks many nuances in assessing the need for health services while also trying to reduce inequalities in health services. Using population spread to predict health expenditures with the assumption that ‘the higher the population the higher the number of sick people’ may not always be accurate.
For example, Migori county ranks 13 out of 47 in terms of population and accounts for 2.5 per cent of Kenya’s total population. However, Migori ranks three out of 47 in terms of total number of sick people, accounting for nearly five per cent of sick people in Kenya. Other counties ( 22 in all) fare even worse when looking at the spread of sick people compared to the population spread. While we need to look beyond proxies, we also need to decide when to stop so that we do not bury ourselves in specifics that confuse citizens and policymakers.
We can also look at reasons why people are sick, dying, or why they visit health facilities and decide that distribution should reflect prioritisation in tackling the diseases that contribute the most. The KNBS states that 45 per cent of outpatient visits are for respiratory diseases or malaria. The 2015-16 household survey also states that malaria and flu accounted for 54 per cent of sick people. Further, the Economic Survey 2018 reports top causes of death in Kenya are pneumonia, malaria and cancer.
What the national government transfers to counties, whether in conditional grants or the equitable share, should respond to the spread of malaria and respiratory diseases. However, it is important to keep in mind that health facility visits are also indicative of areas that actually have access to facilities. Therefore, we have to look at prevalence of diseases to ensure we are allocating resources to address issues of access. This type of data will also help us start considering how to distribute health resources such as personnel, medications, and specialists
Data on the spread of the availability of immunisations and preventative care will also help predict future costs so that funds spent on healthcare are clearly linked to distribution criteria that reflects actual need.
This op-ed is part of a series for Equity Week
Research Analyst, International Budget Partnership