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January 21, 2019

Universal Health Care: What was achieved in the course of 2018?

President Uhuru Kenyatta during the launch of Universal Health Coverage in Kisumu on December 13
President Uhuru Kenyatta during the launch of Universal Health Coverage in Kisumu on December 13

The national government has prioritised universal health coverage in its Big 4 agenda over the next five years.

UHC ensures all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, without exposing the user to financial hardship.

At least 3.2 million Kenyans in four counties will be the first beneficiaries of a new health package being developed by the government.

The 3.2 million beneficiaries will come from Kisumu, Isiolo, Nyeri and Machakos counties. Kariuki said the decision to pilot the programme in these counties was evidence-based on their disease burden.

For Kisumu, it is because it leads in the high number of infectious diseases like HIV-Aids and tuberculosis, while Machakos hospital visits are mostly because of accidents and injuries. 

Nyeri is leading in cases of non-communicable diseases, especially diabetes, and Isiolo is meant to see how the package will work among the nomadic population, Health CS Sicily Kariuki said.

This is a significant and perhaps the most important strategic priority because every year, more than one million Kenyans get trapped into poverty because of catastrophic out-of-pocket payments due to health reasons.

 

PROGRESS MADE

Kenya has made considerable but slow progress in reducing maternal, newborn and child mortality, but missing its 2015 Millennium Development Goal targets implies there is still a lot of pending work to give women and children the most basic of rights — the right to life and well-being.

Linda Mama, the free maternal care programme launched in 2013, has increased PHC utilisation from 69 per cent in 2013 to 77 per cent in 2016, as a result of foregone user fees.

Every year, the programme averts more than 2,000 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.

We have seen public-private partnerships designing innovative solutions to advance health.

For instance, Safaricom has linked up with NHIF to provide health care insurance to 2,000 households through M-Tiba.

As First Lady Margaret Kenyatta has often said, “No woman should die giving life,” which led to the launch of her signature Beyond Zero campaign. The government also declared a free maternal health care policy in 2013.

To enhance access to health care as a step towards UHC, the government has identified and settled on NHIF as an official vehicle for the successful implementation of UHC. In this regard, there has been urgent need for NHIF to expand its benefits and coverage to other members of the society.

NHIF is currently tasked with educating the public on their products and services for the benefit of all and will work closely with county Health departments to educate Kenyans at the grassroots.

Currently, NHIF is strengthening their systems to be more responsive to claim reimbursements, such as capacity building of staff at facilities, speeding up processes of reimbursements and issuing of cards after registration.

 

SETBACKS FACED

A lot of issues have riddled the path towards attainment of UHC.

For instance, public health workers have continued to strike in most counties, citing sloppy human resources management and dilapidated health infrastructure.

Incidents of patients paying more for services than before continue to be reported, with some being asked to purchase drugs and other pharmaceutical supplies from private providers (chemist/pharmacies/drug stores), notwithstanding their charges.

Despite the positive gains, Kenya’s progress towards universal coverage exhibits matters of concern like other developing countries.

Another concern is the variations in mortality, with differences between rural and urban communities, rich and poor and between developed and under-developed counties.

Even though Nairobi is the most developed county, it has the highest annual absolute number of maternal, newborn and child deaths compared to all other counties.

This will only increase as the city’s population rapidly expands. Conversely, maternal and newborn mortality rates are highest in counties such as Marsabit, Turkana, Kitui and Kilifi.

Too many people in Kenya (one in three)continue to die from preventable and treatable illnesses, such as pneumonia and malaria.

Even at the primary level, accessing health care remains a significant problem for most Kenyans. Four out of five Kenyans still 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.

 

AREAS OF FOCUS

Key issues that merit attention will include increasing investment in health care.

Health is one of the fully devolved functions, and for UHC to work effectively, county governments must align their systems and structures towards its implementation.

The Beyond Zero initiative needs to be supported for purposes of sustainability. We also need systematic planning and implementation of policies by involving all key stakeholders, and continuous investment in human resources and health infrastructure development.

With more than 70 per cent of Kenya’s population under 30, the government’s focus on UHC is critical for Kenya to reap a demographic dividend.

For the coverage to be achieved in five years, we have to identify and adopt medical technological innovations that improve early detection and prevention of diseases, while lowering the cost of treatment.

Investing in the latest innovations in medicine, therapies and medical devices should be a national priority, alongside achieving health insurance coverage for all. 

Innovations in medical technology save patients, families, employers, insurers, governments and hospitals the huge burden of treating and managing diseases. The World Bank estimates that half of the global population cannot access essential health services.

Whereas devolution is expected to bring on board various positive gains, it is important that there is constructive engagement between the national government and county government and other key stakeholders on how to effectively deliver health care to the Kenyan populace.

To ensure UHC is possible in Kenya by 2022, the focus should be on preventable and primary health care,  reproductive, maternal, neonatal, child and adolescent health.

 

UHC LAUNCH

WHO has pledged to support Kenya as it plans to roll out UHC in five years.

Director general Tedros Adhanom made the announcement in January during his first official visit to Kenya.

He said WHO is ready to partner with the government to improve healthcare as well provision and strengthen Kenya’s position as a regional hub for health services.

In a meeting with President Uhuru Kenyatta at State House, Nairobi, the global health agency also pledged to work with the government to bring in health experts who will help develop a model that will be efficient and effective in providing universal healthcare.

The President launched the programme in Kisumu county on December 13. Residents were urged to register in large numbers ahead of the pilot launch.

More than 160,000 households out of the targeted 240,000 have been registered.

The government will spend Sh3.9 billion to pilot UHC in Kisumu, Nyeri, Isiolo and Machakos counties.

The pilot projects will deal with finding out the capacity of NHIF, as well as improve infrastructure before rolling out to all counties. 

Health CS Sicily Kariuki, who visited Kisumu on November 16, said her ministry will roll out the UHC programme in two phases.

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