BWIRE: Universal access to healthcare; Which way for Kenya

Health experts hold that the path being pursued by the Government will not deliver universal health care to Kenyans as anticipated.

In Summary

•Recently, the government fought off attempts to allow private players to provide Covid-19 vaccines at a charge.

•Health experts hold that the path being pursued by the Government will not deliver universal health care to Kenyans as anticipated.

NHIF Building.
NHIF Building.
Image: NHIF

The provision of quality health care in Kenya remains one of the most sought after commitment by successive governments. Commendable efforts and interventions can been seen in ambitious plans and inclusion of universal access to health in the big four agenda, moves to amend the National Health Insurance Fund Act, to make the body the principal provider of universal health and making provision of maternal and reproductive health services to Kenyans free. However, it remains unclear how such commitment can be achieved when increasingly, it seems the government is privatising the provision of health services. Recently, the government fought off attempts to allow private players to provide Covid-19 vaccines at a charge.

In the Social pillar of the Vision 2030, the Government commits to improve the overall livelihoods of Kenyans, the country aims to provide an efficient and high quality health care system with the best standards. This will be done through a two-pronged approach: devolution of funds and management of health care with emphasis on the need for increasing investment in preventive health care rather than on curative care help to expand immunization coverage, improve reproductive health needs and allocate additional resources to facilitate an effective multi-sectoral response to epidemics.

The Government committed to provide health services through a robust infrastructure network as well as expand medical insurance coverage to increase access to health services. Through encouragement to the private sector, Kenyan intends to become the regional provider of choice for highly-specialised health care, thus opening Kenya to “health tourism” as an income-generating activity. Flagship project to singled out include; revitalise community health centres to promote preventive health care (as opposed to curative intervention), de-link the Ministry of Health from service delivery in order to improve management of the country’s health institutions primarily by devolution of health management to communities and healthcare experts.

Additionally is to create a National Health Insurance Scheme through amending the NHIF Act in order to promote equity in Kenya’s health care financing; and scaling up the output-based approach system to enable disadvantaged groups to access health care from preferred health facilities. The proposals to the NHIF Act amendment bill, if enacted that will position it as a strategic purchaser of healthcare services to deliver UHC continue.

However health experts hold that the path being pursued by the Government will not deliver universal health care to Kenyans as anticipated; that the path of being taken is largely privatizing health care provision thus negating earlier efforts towards the goal of universal health coverage.  The increasingly, national policies that favour increasing private sector participation in healthcare, alongside chronic underinvestment in the public system, have contributed to an explosion of for-profit private actors who often provide poor value for money, neglect public health priorities, and push Kenyans into poverty and crushing debt.

A report titled “Wrong Prescription: The Impact of Privatizing Healthcare in Kenya,” released jointly by Hakijamii and the Center for Human Rights and Global Justiceat New York University (CHRGJ) finds that privatization has proven costly for individuals and the government, has shut people out of access to healthcare, and is undermining the right to health.

The report draws from more than 180 interviews with healthcare users and providers, government officials, and experts in Mombasa, Nairobi and Isiolo. Others described tragic consequences of low-quality care at private providers, including unnecessary deaths and.

The report concludes that the government should rethink its support for the private sector and prioritize the public healthcare system, which still delivers the majority of inpatient and outpatient care in Kenya despite being starved of resources. .

“Privatization is the wrong prescription for achieving universal health coverage,” said Philip Alston, former United Nations Special Rapporteur and co-author of the report. “Proponents of private healthcare make all sorts of promises about how it will lower costs and improve access, but our research finds private actors have really failed to deliver.”

“Promoters of private care have gravely misdiagnosed the situation,” noesNicholas Orago, Executive Director of Hakijamii and co-author of the report. “While many associate private care with high-quality facilities, the ‘haves’ and ‘have nots’ experience entirely different private sectors.

Privatizing care has proven costly for both individuals and the government. The private health sector relies heavily on government funding, including tens of billions of shillings each year to contract with private facilities, subsidize access to private care, and pay for secretive public-private partnerships. Individuals face excessively high fees at private facilities, where treatment can cost in excess of twelve times more than the public sector.

“Healthcare is a big business, with global corporations and private equity firms lining up to profit off the sector in Kenya,” said Rebecca Riddell, Co-director of the Human Rights and Privatization Project at CHRGJ and co-author of the report. “These companies expect returns on their investments, leading to overwhelmingly higher prices in the private sector while scarce public resources prop up private profits.”

“The disconnect between profits and public health goals should cause policymakers to rethink their reliance on the private sector,” said Bassam Khawaja, Co-director of the Human Rights and Privatization Project and report co-author. “Many essential health services are incredibly valuable or even lifesaving but may not be profitable as one-off transactions.”

Interventions in the health sector including current drive to increase uptake of the Covid-19 in the country will rely on investment in the public sector rather than relying on the push by the private sector. Attempts by the government to regulate costs by private medical insurances have previously faltered, leaving Kenyans at the mercy of the players. As earlier promised, efforts to provide more preventive rather than curative health services require more resources especially financing to the public sector rather than allowing the commercialization of such services.