Counties carry heavy burden as UHC pilot phase comes to an end

Wednesday March 25 2020

The entrance to the Nyeri County Referral Hospital. Nyeri, Machakos, Kisumu and Isiolo counties piloted the universal health coverage programme. FILE PHOTO | NATION MEDIA GROUP


Counties piloting the universal health coverage (UHC) scheme will now be forced to use their own budgets to support the medical plan as the project’s extension period comes to an end.

Patients will soon start paying for medical care in public health facilities.

As one of the pillars of President Uhuru Kenyatta’s Big Four Agenda, UHC is expected to herald a transformation of the health sector and benefit those hitherto unable to access healthcare or lack medical insurance.

However, silence on the way forward from the national government has left counties overstretched in terms of drugs, workforce and non-pharmaceuticals due to lack of funds.

Machakos, Nyeri, Kisumu and Isiolo piloted UHC, which is part of President Kenyatta’s legacy projects. Other flagship projects are food security, affordable housing and manufacturing.

The four were selected as they represent unique characteristics: Isiolo is a frontier county with mainly nomadic and semi-nomadic population; Kisumu has a high burden of infectious diseases; Machakos has high burden of road accidents, and Nyeri has a high burden of non-communicable diseases.


“Lack of direction from the Ministry of Health is making the patients suffer because counties are now only providing the basics,” said Nyeri Health executive Rachael Kamau.

Since the roll-out last year, counties have grappled with underfunding and shortage of personnel against a huge number of patients due to the availability of free services.

The Nyeri health department received just about 50 per cent of the UHC budgetary allocation.

Nyeri was to receive Sh359 million to facilitate the programme but the county only got Sh159 million by the end of the pilot phase on December 13 last year.

The four counties were given three more months until March 13 with no extra resources.

“Due to stretched service demand as a result of removal of medial fee on patients visiting our facilities, counties ended up using their allocation before the end of the last financial year,” said a source in the health department.

“We are not sure of what will happen, particularly now that we are battling Covid-19 since we have no information on the UHC nationwide roll-out; this means counties are exposed.”

Counties are mainly stretched in the laboratories since they were forced to procure from the Mission for Essential Drugs (MED) — a faith-based organisation — using county funds. So far, services have been affected because of non-availability of crucial commodities and diagnostic services.

During the UHC pilot project, all commodities were to be drawn from the Kenya Medical Supplies Authority (Kemsa) but it could only cater for 70 per cent of the demand.

More than 40 counties have signed the Intergovernmental Participation Agreement (IPA) as the national government plans to roll-out the programme countrywide.

Sources in the Health ministry said counties that have signed the agreement will receive between Sh100 million and Sh300 million to run the project.