Moving Kenya Towards Universal Health Coverage

The past two years have witnessed an increasing focus on Universal Health Coverage, defined as the provision of quality, affordable healthcare across the population, as a viable goal for countries in the global south. Previously seen as the purview of strong welfare states such as Denmark and Sweden or socialist countries such as Cuba, this has now changed. Countries like Thailand, with a population of 70 million and, closer to home, Rwanda, with a health service coverage rate of over 90%, have illustrated that Universal Health Coverage is a goal that can be embraced and indeed achieved by southern nations—as long as an articulated and clear plan, and strong leadership, is in place to drive it.

“This could have a significant effect on lowering maternal and neonatal mortality rates across the country.”

When the Jubilee manifesto was launched in 2012, it outlined both social protection and health goals that explicitly speak to the idea of Universal Health Coverage. A few process hurdles notwithstanding, the Jubilee government recently made good on its political commitment of eradicating fees for birth deliveries in public health facilities. Already we are seeing an increase in attended deliveries (a national health goal Kenya has had for years) in a number of health facilities across the country. With sustained momentum, this could have a significant effect on lowering maternal and neonatal mortality rates across the country. This uptake in service utilization is an important factor of Universal Health Coverage, which ultimately seeks to remove the financial barriers that stop people from accessing care when they need it.

In July, the National Hospital Insurance Fund (NHIF) released the results of a study funded by the Rockefeller Foundation that will put in place a Household Insurance Subsidy Programme (HISP). The HISP will enable provision of a comprehensive in- and out-patient healthcare service package for the very poor. The implementation plan for putting the HISP into action is now under development between Kenya’s Ministry of Health and a number of stakeholders. This subsidy programme will enable several thousand households across the country to access ‘free-to-patient’ health care services, which should result in earlier healthcare-seeking practices.

There is precedent for moving Kenya towards Universal Health Coverage. The Kenyan Constitution states that every Kenyan has a right to quality and affordable health care, and recognizes the role of the government in removing barriers to access. This was recently affirmed in Sessional Paper No. 7 of 2012 on Universal Health Care. The Kenya government’s commitment to providing health care for all of its citizens is clearly moving in the right direction, an inherited challenging health system and dissatisfied workforce notwithstanding.

The Kenyan Constitution states that every Kenyan has a right to quality and affordable health care.

The question now turns to what Universal Health Coverage looks like for Kenya. The focus of the Jubilee government is framed aroundfree primary healthcare for all Kenyans, starting with women, expectant and breastfeeding mothers and persons with disabilities, by increasing health financing from 6% to 15%. An important qualifier here is that the health services proposed may be free to the client, but the proposed increased financing, which is very welcome, will have to come from somewhere. Our current healthcare financing is a veritable Gordian knot of tax revenues, donor funds and NHIF contributions. Thus the first step is to map out a viable financing system that defined by the local context, and is efficient and equitable in terms of both revenue-raising and service delivery mechanisms.

The next step is the government leading an objective process of priority setting that enables us to rationalize our decisions around which combination of investments to make—be they facilities, technologies, drugs, and human resources—and against which services – for child, maternal, primary or chronic care. This process will undoubtedly confront us with difficult decisions around value for money and health investment options. These go to the heart of addressing our inequalities around who has access to which services. Without a process such as this, we will continue to be responding to the wrong pressures and we will not have a clear trajectory of progress in health outputs that we are getting from our pipeline of significant health investments. Indeed, all of this must be achieved within an admittedly delicate balance of political promises, fiscal austerity and quality service aspirations. However, with Kenya as a country that has come into her own at 50 years, as evidenced by commitments that have led to a stronger judiciary and constitutional reform, Universal Health Coverage in this country is an implementable idea whose time has unreservedly come.