Funding, political goodwill key to achieving universal health coverage

What you need to know:

  • The government is seeking to have a gradual implementation of the plan and avoid the pitfalls seen in other countries that have struggled to maintain the noble idea.

  • Last month, Health Cabinet Secretary Sicily Kariuki appointed an advisory panel made up of 15 professionals that will be responsible for the “the design of UHC."

  • Its main tasks will be to develop criteria for assessing the inclusion and exclusion of services, drugs, and commodities in the Kenya Universal Health Coverage.

When President Uhuru Kenyatta laid out his four-point agenda for his second term, the component of affordable healthcare rang a bell for most Kenyans, because it is the one that will have the greatest impact on virtually every household. This is because about one  million Kenyans fall into poverty every year due to catastrophic health expenditures.

Only 36 per cent of Kenyans have a form of health insurance offering financial protection. Increased healthcare financing and political goodwill, therefore, will be required to ensure all Kenyans benefit from universal health care.

The government is seeking to have a gradual implementation of the plan and avoid the pitfalls seen in other countries that have struggled to maintain the noble idea.

15 PROFESSIONALS

Last month, Health Cabinet Secretary Sicily Kariuki appointed an advisory panel made up of 15 professionals that will be responsible for the the design of an affordable, responsive health benefit package for the delivery of Universal Health Coverage.

The panel, chaired by Prof Gilbert Kokwaro, will be in office for two years and it will be presenting periodic reports on conferred assignments at the request of the Cabinet Secretary as per the Gazette notice.

Its main tasks will be to develop criteria for assessing the inclusion and exclusion of services, drugs, and commodities in the Kenya Universal Health Coverage.

It will also assess the unit cost of the package of services and determine the cost and premiums for the essential health benefit package as well as propose the benefit package and provider payment rates for gazettement by the Cabinet Secretary, among others.

LESSONS LEARNT

Ms Kariuki, in an exclusive interview with the Sunday Nation, said the panel is made up of professionals from various fields and they will be independent and its advice will inform the ministry on the rollout of universal health care.

“We do not want to start what we will not afford. The implementation will be gradual. Thailand is one country that 15 years ago was where we are now and they got it right. We will learn from them and get lessons from other countries on how not to roll out Universal Health Care,” she said.

She admitted that attempts in the past to roll out universal health care have hit the wall because of lack of political will and a legal framework.

Past Health ministers Charity Ngilu and Prof Anyang’ Nyong’o have all failed to deliver the promise of universal health care.

SPECIALISED CARE

“We have the President and all 47 governors committed to this noble idea. In fact it is the President’s plan. And previously access to health was not [a constitutional right], now it is. More importantly, access to health is part of the United Nation’s Sustainable Development Goals,” she said.

The government is still formulating the policy document that should drive the universal health care agenda but a working draft seen by the Sunday Nation shows that the health sector is under-financed compared with other international benchmarks.

Moreover, Kenya has only been able to fill in 15 per cent of the approved positions in all health facilities. It has been noted that there is inequity in the distribution of the workforce: urban–rural, regions with high and low socio-economic development. Specialised medical care is mostly available in urban areas.

Delayed promotions, issues around non-practice and call allowance, unpaid salaries, non-payment of school fees, and non-remittance of NHIF salary deductions resulting in salary discrepancies, especially between former local government and Ministry of Health staff, together are the major challenges in managing human resources.

DIGITISE RECORDS

“These challenges are causing industrial unrest in some counties. There is a high level of absenteeism ... as shown by recent studies, which show a high efficiency gap,” reads the working draft that will be used to roll out universal health care.

Ms Kariuki hinted at major changes at the National Health Insurance Fund, where already there are efforts to digitise most of their services as part of the reforms.

“NHIF is a critical institution for us to achieve our vision. We will have to reform it to some extent. We have a situation where they do accreditation, purchase services from hospitals, access claims then pay, all these duties may need to be separated,” she said.

Research has shown that in health infrastructure, the average population living within five kilometres of a health facility (the norm) is about 62 per cent. Kenya had 14 doctors per 100,000 people and only 42 nurses per 100,000 in 2016.

Some counties have also started to work on motivation and retention mechanisms. For example, Garissa County has upgraded health workers’ salaries by two job groups and developed a retention package for its workers.

UPGRADE CLINICS

“In infrastructure, the Managed Equipment Supply (MES) programme helped to embark on a comprehensive programme to upgrade 98 hospitals, two in each of the 47 counties and in the four national hospitals.

“There is also an effort to upgrade slum clinics. Counties have started to improve their infrastructure as can be seen throughout the country,” reads the document.

The Kenya Medical Supplies Agency (Kemsa), which will be a key cog in delivering the President’s agenda, has in the past few years improved on its delivery.

It has been training over 3,000 health workers on the Logistics Management Information System (LMIS) and that, in turn, has improved turnaround time of medical commodities by reducing from 12 days in 2013/14 and 10 days in 2014/15 to nine days in 2015/16. The development and functioning of the LMIS and the use of WhatsApp to follow up on stock levels have helped to monitor and reduce stock-outs, the working documents point out.

Kemsa is expected to play a critical role in realising the affordable health agenda and already plans are under way to expand current capacity for access to all health commodities whereby it will get Sh3.22bn required as a one-off seed fund to achieve this objective.

EXPANDED COVERAGE

The ministry also intends to ensure all health commodities in the country are of good quality (intensify combating of counterfeits and poor quality commodities) to support the health agenda.

The Ministry of Health will oversee the expansion of the 200 per cent of the population under universal health insurance coverage by 2022.

Those targeted to achieve the ambitious expansion include 12 million in the informal sector, the main target for the expanded coverage; 1.79 million elderly (70+ years) and people with severe disabilities on government subsidies; 1.5 million poor households (the indigents); and all public secondary school children.

The ministry is also seeking to digitise the NHIF for both registration and claims processing, whose funds have been factored into the 2018/2019 budget.

EQUIPMENT USERS

The ministry is also upbeat about the much touted Managed Equipment Services Project.

To date, 94 hospitals have been equipped, with a further 21 to be equipped this year. The private sector has been contracted to service equipment, and train equipment users and medical engineers for seven years.

“As a result of this programme, there are considerably larger numbers of patients visiting hospitals and a rise in the use of different types of radiology services (x-rays, ultrasound and mammograms).

For example, the installation of the latest digital mammography has enabled more than 30 pc of Level 5 hospitals (regional centres providing specialised care including intensive care, life support and specialist consultations) to offer in-house mammography exams for the first time, increasing capacity for breast cancer screening, a leading cancer killer in Kenya,” reads the policy document.