Inside the new look 2021 UHC plan

The year 2020 was to be the biggest for health in Kenya – and still is.

By December 2020, millions of Kenyans were to have the broadest access to health services since Independence, courtesy of a Sh40 billion per year Universal Health Coverage.

But then Covid-19 happened.

The country has so far spent more than Sh200 billion in fighting Covid-19 in the last nine months, leaving more than half of Kenyans to pay for health services out of pocket.

Much of this money was spent on personal protective equipment, ventilators, ICU equipment, and the upgrade of health facilities to respond to the growing Covid-19 burden.

The move toward UHC was launched on December 13, 2018, by President Uhuru Kenyatta and former Health CS Sicily Kariuki, who is now in the Water ministry.

At least 3.2 million residents of four pilot counties - Machakos, Kisumu, Nyeri and Isiolo – received free services in public hospitals at a cost of Sh3.9 billion.

The plan was to be expanded countrywide in March this year.

However, the growing threat from Covid-19 around the world, reaching Kenya on March 13, changed everything.

UHC is one of the Big Four agenda Uhuru wants to transform Kenya with by 2022. The others are manufacturing, food security and affordable housing.

The pandemic has since grounded the economy and most of the Big Four.

However, on October 31, Uhuru quietly launched a biometric registration exercise to salvage the UHC.

The programme will now be refashioned and relaunched nationally in 2021.

Each household will pay Sh6,000 a year to the National Hospital Insurance Fund to access the rejigged UHC services.

Only about one million poor Kenyans will access free services. The rest will have to pay NHIF premiums.

However, the government will still top up so that premium-paying Kenyans can access enhanced services under a new essential benefits package.

In implementing the rejigged UHC, the government will focus on five major pillars.

First, the government will drastically restructure NHIF, to create a national social health insurer that can meet the needs of Kenyans by strategically purchasing services for their health.

“In this regard, I direct the Ministry of Health and the Attorney General to fast-track the necessary legislation that will codify these reforms in law and foster the sustainability of the fund,” Uhuru said on October 31.

The government will then establish a mandatory UHC scheme, which will be managed by NHIF and regulated by the Ministry of Health.

Third, the ministry will adopt a new Essential Health Benefits Package, which will enable Kenyans to access a defined set of health services at Sh6,000 a year. 

The package will cover several areas including outpatient and inpatient services, communicable and non-communicable disease management, maternity, dialysis, radiology, mental health, minor and major surgery, substance abuse rehabilitation, emergency services and cancer treatment.

However, to access the services, each household must pay Sh6,000 to NHIF every year.

Fourth, the government will provide health insurance to initially cover one million households who are vulnerable and unable to pay the Sh6,000. 

The identification of these one million households by the Ministry of Health, Ministry of Labour and Social Protection, is ongoing.

The President said the biometric registration of identified poor households will be used to improve efficiency and curb fraud and abuse.

“I urge the NHIF to ensure that the precious funds committed to its custody, by both subscribers and supporters, are utilised prudently with utmost transparency and accountability.  Any person who attempts to defraud the NHIF or abuse its processes, will be dealt with accordingly as provided for under our laws,” Uhuru said during the launch of the biometric exercise on October 31 in Mombasa.

The Council of Governors has endorsed the refurbished scheme and pledged its full support for its successful execution.

CoG chairman Wycliffe Oparanya said for effective implementation of the policies that will guide the UHC, funds must be made available to the counties.

He said Kenya has brilliant brains but lacks trust in each other.

"Because there is no trust, implementation becomes a problem," the Kakamega governor said.

He said counties must have a say in NHIF to ensure there is a smooth flow of funds to the proposed UHC Fund.

Currently, there is only one representative of counties in the Kemsa board.

"Since 70 per cent of these medicines go to counties, we should have 70 per cent representation in Kemsa," Oparanya said.

Health CS Mutahi Kagwe said the launch of the biometric registration of indigents into the UHC is the beginning of a new journey that will have some challenges ahead.

"We have a new baby in town with teething problems. We expect challenges, but we will be addressing the challenges as they come," Kagwe said.