•The benefits package will be accessed across all counties. In areas where there may be county-specific needs, these will be adapted into the package.
•The ministry and county governments are currently engaging in adapting these key lessons into a UHC national scale-up model.
A few minutes after Public Service CS Sicily Kariuki entered Nakumatt Ridgeways supermarket on Friday afternoon, January 26 last year, her phone rang.
Joe Mucheru was calling. “Hallo, Daktari?” he said. She stared at the screen again to confirm it was indeed the ICT CS on the line, before responding that she’s fine, and politely informing Joe he had dialled the wrong number.
“Haven’t you heard the news?” he responded. Kariuki had been appointed the Cabinet Secretary for Health, and it was on the radio.
She would lead one of President Uhuru Kenyatta’s four pillars, the ambitious plan to provide affordable health care for all.
The President’s vision is anchored on the Constitution, which guarantees health for all Kenyans.
Kariuki had to hit the ground running, rallying support from community health volunteers — arguably the lowest health cadre — to Kenya’s bilateral partners abroad.
After preparations lasting more than a year, President Uhuru Kenyatta launched the Universal Health Coverage pilot in Kisumu on December 13 last year, making Kenya the first country in Africa to do so.
The World Health Organisation gave a resounding approval and its director-general Dr Tedros Adhanom Ghebreyesus — a trailblazing former health minister of Ethiopia — attended the launch.
“The changes you are undertaking have the power not just to change the lives of millions of Kenyans, but to change the lives of millions more in the region,” Dr Tedros said.
The pilot is underway in Kisumu, Machakos, Nyeri and Isiolo, where 3.2 million people have registered for the Afya Card to access subsidised services in public health facilities.
The ministry is currently taking stock of the lessons learnt, with plans to expand coverage across Kenya this year.
“We view UHC not as a destination but as a continuous process, which will involve constant widening of the social safety nets to ensure no one is left behind,” Uhuru said at the launch.
Last week, the Star had a chat with Kariuki to discuss the outcome of the pilot and the planned national rollout.
With nearly-free services in the pilot counties, has the health-seeking behaviour of people changed?
So far, we have recorded an average increase in the utilisation of health services, ranging from 20 per cent to 44 per cent. This increase is evident in both outpatient visits and inpatient visits. Most of the citizens who are seeking services in health facilities are presenting with the common ailments and conditions that form the top 10 causes of diseases in Kenya.
How many health workers are taking part in the pilot?
The pilot is accessible in all public health facilities in the four counties. And all health workers attached to public facilities are taking part in the exercise. This includes all publicly employed doctors, nurses, clinical officers, laboratory and pharmaceutical technology officers and all allied health workers.
Please share some of the lessons learnt from the pilot
The main lesson is that for UHC to succeed, we must strengthen our health systems. This means we must have a robust financing mechanism, a well-trained and adequate workforce, reliable information on which to base decisions and policies; and we also need well-maintained facilities and logistics to deliver quality medicines and technologies.
But most importantly, we must move towards a primary health care approach. We must increase access to services at the community level, and ensure these services meet the needs of the community and are responsive to their needs. With primary health, we can keep 80 per cent of people out of the hospital.
As I have mentioned, a key success of the UHC pilot is in the availability of essential medicines and commodities in the public facilities.
Moving forward, essential medicines must be available in all facilities. We must bring back confidence in the system.
The ministry and counties also reaffirm the key role that health workers play in ensuring the success of the UHC programme.
It appears primary health will be the focus of UHC. How do Community Health Workers fit in the plan?
The national and county governments are investing in community health services jointly. We plan to recruit 100,000 community health volunteers.
Definitely, going forward our investments will be primary-health focused. Utilising a primary health care approach will ensure that health services are brought close to the people and that the services are responsive to their needs. The investment is little but the rewards so high.
Our focus on primary health care will ensure all dispensaries, health centres and sub-county hospitals have adequate medicines, commodities and necessary health workers.
How much does the pilot cost?
We have allocated Sh3.9 billion, above the counties’ allocation to health. This money has not even been fully used up. This tells you quality health is not necessarily the amount of money you have. Cuba was able to achieve the great milestones (Cuba has a life expectancy of 80 years) when it was shut out by the rest of the world. You can manage the little you have to achieve good outcomes.
When should we expect the national scale-up of UHC?
In the past seven months, we have picked key lessons from the pilot exercise. The ministry and county governments are currently engaging in adapting these key lessons into a UHC national scale-up model. After the consolidation of these lessons, the President will launch the national scale-up of the UHC programme.
How will this happen — will you take a phased approach or adopt the entire benefit package at once?
The evidence we have from other countries who have made strides in the UHC journey informs us that we require a progressive approach to ensure sustainability.
A key element of UHC is the ‘U’, which stands for universality. This means a country’s entire population should have access to the benefits package. The government is, therefore, working to ensure national scale-up involves a package that can be accessed by the entire population.
The benefits package will be accessed across all counties. In areas where there may be county-specific needs, these will be adapted into the package.
What will be the annual cost of the national roll-out?
Upon joint consultation with county governments on the lessons learned in the pilot exercise and development of a UHC national scale-up model, the Ministry of Health and Council of Governors will share the aggregated resource needs for national scale-up.
We anticipate this consolidation will be finalised in the coming weeks.
Please update us on NHIF reforms
Within the next week, I shall host the media in a briefing meeting, where I will receive the final NHIF panel report.
So during this meeting, we will share the NHIF reform roadmap that will contain key transformation features that will ready the fund to play its role as a strategic purchaser of services for UHC.
Which other institutions will be reformed or overhauled to handle the national UHC?
As I said earlier stated, the success of UHC is heavily reliant on an optimally functioning health system.
Key components of the health system include health financing, health information systems, medicines and technologies, and health leadership and governance.
Key reforms will be required to optimise the functioning of the Kenya Medical Supplies Authority and regulatory bodies such as the Medical Board and Pharmacy Board.
The Health Act has already enacted bodies, such as the Kenya Health Professional Oversight Authority, to play a key role in ensuring the provision of quality services.
Which partners have come in to support UHC?
In planning the national scale-up, the Ministry of Health is collaborating with county governments and development partners like the World Bank Group, WHO, Unicef, UNFPA, GAVI, Global Fund, UNAids and BMGF, and through bilateral agreements with Thailand and Cuba.
The partnerships centre on technical support towards the design of the scale-up model.
In the coming weeks, together with the partners I have mentioned, the National Assembly and the Senate, a health sector joint communique on health investment will be deliberated and finalised for presentation to the apex body, the national health summit, with the President and the Council of Governors.