What should citizens expect from universal healthcare programme?

In this interactive series, we invite readers to send in questions to selected public figures. This week, Health Cabinet Secretary Sicily Kariuki responds to your questions

1. Human resource is key in achieving Universal Health Coverage (UHC). Kenya has 2.35 surgical specialists per 100,000 population against the global target of 20. Is there a plan by the government to absorb the unemployed Kenyan doctors? Stanley Aruyaru, general surgeon, Consolata Hospital Nyeri

Globally, it is recognised that Human Resources for Health (HRH) are indeed scarce. As part of delivering on the UHC programme, the government is making investments towards increasing and retaining HRH, with a particular focus on increasing the number of specialists, including surgeons, internists and oncologists.

Surgical services are an important component of primary healthcare. In recognition of this fact, the Ministry of Health has been training and posting surgeons to counties in accordance with need. In addition, surgeons in the counties’ payroll resume duties in their respective counties after further training.

The country is moving towards combining university and collegiate methods of specialists training. The latter will ensure an increase in the numbers of surgeons and equitable distribution as the specialists are trained and retained in their respective county hospital.

2. Former Health minister Charity Ngilu tried to implement UHC programmes but failed. What lessons did the ministry learn to guarantee success this time? Joy Murile, Kisumu

Kenya’s commitment to SDGs and UHC has globally been given fresh impetus, which is the basis upon which the President is pushing for implementation. The government has over the years endeavoured in making impactful investments towards UHC including abolishment of user fees in dispensaries and health centres by the President in 2013, provision of health subsidies for the poor, free maternity services through the Linda Mama programme, and health subsidies for the elderly.

In 2006, great strides were made by the then minister Charity Ngilu. Key lessons were learnt including the need for strengthening the public health system and ensuring availability of drugs and personnel in readiness for the Social Health Insurance Programme. Key lessons we will be taking forth include strengthening Community Health Volunteers (CHV) programme and providing them with kits, scaling up of public health services by ensuring promotive and preventive services are available to all Kenyans, leveraging on partnership with the counties and the private sector, piloting interventions in selected parts of the country as part of lesson learning process and best practices documentation approach before scaling up interventions across the country.

3. The story surrounding the leased medical equipment distributed across counties after Jubilee was first elected in 2013 has often perplexed many. The governors, senators and the presidency have contradicted each other on issues touching on the project. Please expound on this? Komen Moris, Eldoret

Given that this is a new way of funding health by mobilising resources from the private sector, different people are bound to have different levels of knowledge about it. The government initiated the Managed Equipment Services (MES) Programme to address disparities in access to specialised health services as reported in 2014.

Ninety-eight hospitals countrywide were upgraded so that people have access to specialised, modern and state-of-the-art medical equipment irrespective of their locality. This was done through MES arrangement, which touches on a range of services like renal dialysis, ICU, X-ray and imaging services.

MES is an all-inclusive service whereby the contracted supplier is responsible for the supply, installation, training of users, and maintenance, repair and replacement of equipment.

The MES programme, which will run for seven years, has reduced disparities among counties in access to health services. Notably for dialysis services, citizens do not have to travel to Nairobi, as the machines are in counties.

The quipment were sourced from reputable international and original equipment manufacturers who provide spare parts and timely repair in case of breakdown. Overall, the cost of accessing medical services is now lower and Kenyans do not have to fall into poverty due to medical expenses or travel abroad for specialised healthcare.

4. What does UHC mean to the ordinary Kenyan? Okulo Andrew Guya, student at University of Nairobi

UHC will ensure that Kenyans receive quality, promotive, preventive, curative and rehabilitation health services without suffering financial hardship. The overall aspirations for UHC are that each Kenyan can access a basic health benefit package that addresses their needs, thus, everyone would be protected from potential financial catastrophe arising from seeking health services.

Some of the critical focus areas towards achieving UHC include expansion of the population covered with the identified health services and strengthening and broadening the primary healthcare system. This means increasing your access to health services, adopting a patient-centred approach meaning bringing services that are responsive to your needs, and reinforcing the referral system.

5. For UHC to be successful, it is not in dispute that it will require immense investment and mostly from employed people. Could you say how much, as a taxpayer, I will have to pay to finance UHC? Frida Mutei, Lessos

When we get to details of how much will be required to be paid, there shall be a national conversation on it at that time. We will all work together to ensure Universal Health Coverage succeeds and all Kenyans benefit.

6. Your ministry signed a memorandum with four counties, namely Kisumu, Isiolo, Nyeri and Machakos for the piloting of the Universal Health Coverage. What will be expected of the four counties? Brenda Shivachi, Kaimosi

The ministry will provide overall stewardship for UHC. Specifically, the Ministry of Health is expected to provide overall policy direction on the roll out of the programme, ensure all services provided meet quality standards, ensure all health providers have the required skills and capacity, and ensure monitoring and evaluation.

On the other hand, the county governments will provide health services. They are expected to improve existing health infrastructure, purchase medicines and related supplies, procure necessary equipment, employ human resources for health, supervise health service provision in the health facilities, provide community health servicesand providing safe water and sanitation services.

7. Regarding the universal health coverage that your ministry is proposing, to what extent will it cover pre-existing conditions which some private insurance companies are often hesitant to take up? Byron Musembi, Mtito Andei

Universal Health Coverage will involve provision of promotive, preventive, primary healthcare services as well as secondary. Kenyans with pre-existing conditions will also enjoy the services that will be provided within the Universal Health Coverage package. These will include consultations with doctors, screening, examinations, and medicines as long as the condition is one covered by the Health Benefit Package to be announced soon.

8. As the ministry pilots UHC programme, some counties like Makueni and Kitui already have similar initiatives. How will the ministry harmonise the national programme with those already in counties? Paul Gesimba, Nairobi

The first phase of UHC will involve learning lessons. These lessons will be compared with those from other programmes that have been implemented in the country such as the free maternity, free treatment for HIV/TB/malaria, health insurance subsidies for the elderly and initiatives such as those in Makueni and Kitui counties.

9. Nakuru Level 5 Hospital has been overwhelmed for years, what is your ministry doing to support the capacities of all such hospitals? Dan Murugu, Nakuru

There are 11 gazetted Level 5 hospitals, Nakuru’s being one of them. To enable them offer referral services to patients from other counties, all the 11 hospitals are given conditional grants. In the financial year 2018/19, a grant of Sh4.19 billion was issued to all the hospitals. Counties may apply for these funds to improve infrastructure including acquiring specialised equipment.

Regarding acquisition and maintenance of equipment, the ministry is implementing MES under which 98 hospitals have been fitted with essential equipment. The equipment are for theatre, ICU, renal dialysis, central sterilisation and radiology. The equipment have a seven-year service level contract. In addition, most of the Level 5 hospitals have been equipped with CT Scans and MRI equipment.

Going forward, the government is implementing UHC. Under the adopted approach, all public hospitals will be drawing their medicines and other supplies from KEMSA using additional resources availed by the national government.

10. What is the gap in salaries between the Cuban medical specialists and our own specialists with equal qualifications? Githuku Mungai, Nairobi

What they are paid is not at the entry level but at a higher scale enjoyed also by our own specialists. Specialist doctors’ entry point is at Job Group ‘P’ and they are promoted by virtue of qualification and experience up to Job group ‘U’. The Cuban doctors were placed at Job Group ‘S’ based on their expertise. Taking into consideration that they are working in a foreign country.

11. Madam CS, are you proud of the Cuban doctors and the services they are rendering? Komen Moris, Eldoret

Yes, l am proud of the plan, and l can also assure Kenyans that their presence is worthwhile. For example, the long waiting lists of speciality treatments at teaching referral hospitals have tremendously reduced. Preventive healthservices have also improved as family medicine specialists work within the community with families. These are just a few positive gains that have been realised among many.

12. Cancer has become a major health concern in the country. What is the ministry doing to alleviate the situation and what happened to the pledge by the Indian Prime Minister to set up a cancer treatment centre in Kenya? Paul Gesimba, Nairobi

The Ministry is implementing the National Cancer Control Strategy 2017-2022. This strategy has identified key areas to work on to improve the cancer situation in the country.

In the area of treatment, the government will establish four comprehensive cancer centres through a public-private partnership. These centres will be in Mombasa, Nakuru, Kisii and Nyeri. The full funding for Kisii Cancer Centre has been identified and a memorandum of understanding signed with the National Treasury. Construction work should begin any time.

The other three centres have started giving limited cancer services. Mombasa has a cancer centre that offers chemotherapy as well surgical services. The Ministry has also renovated Nyeri Cancer Centre and provided equipment to offer chemotherapy services. Nakuru County has established a cancer centre and the ministry has supported them with chemotherapy chairs to improve service delivery. Patients from these and nearby counties can therefore receive chemotherapy services and only need to be referred for radiotherapy services. Eventually, radiotherapy equipment will be provided in these centres. Apart from the comprehensive cancer centres, the Ministry has established other chemotherapy centres in the former provincial general hospitals to improve access to cancer care at the county level.

The Ministry has provided chemotherapy mixing hoods and chairs to Garissa, Bomet, Meru, Embu, Kisumu, Kakamega, and Vihiga. These centres can now offer cancer treatment services and only need to refer to KNH for radiotherapy. The Ministry is working with Kemsa to stock chemotherapy drugs so that Counties can order from a central store to maintain quality. The Indian government pledged to provide radiotherapy equipment for Mombasa Cancer Centre and follow up discussions are ongoing.

13. What is your ministry doing to deal with county pronouncements that health is taking the bulk of their budgets and there are health workers feeling counties are mistreating them? Josphat Kinoti, Meru

On the overall, these issues are before the Council of Governors and proposals that they will make will be shared for a national debate around it.

14. Is the ministry aware of pending backlash between medical laboratory officers and pharmacy and pharmaceutical personnel over the control and regulation of blood and blood products transferred from control of Kenya Medical Laboratory Technicians and Technologists Board to Pharmacy and Poisons Board in the bill passed recently and now awaiting presidential assent? Josphat Kinoti, Meru

Formulation of laws and regulations is a progressive thing and there is room for improvement, especially now as we focus on UHC. To improve the management of medical services and products and other related services, the government is fast-tracking the formation of the Kenya Food and Drug Authority (KFDA) to regulate medical, veterinary, agricultural services, as per requirement of the Health Bill 2017 part 7 section 62. Once functional KFDA will resolve the outstanding issues between the regulatory bodies.

A consultative meeting with CS for Agriculture has been held to fast-track the establishment and operationalisation of KFDA. The baseline is to do away with structures that complicate the way we do business as a country and that is what we must focus on.