Why initial health benefits package was shelved

In June, Health Cabinet Secretary Sicily Kariuki constituted the Universal Health Coverage Benefits Package Advisory Panel.

The panel was meant to design an affordable and responsive health benefits package, outlining the services Kenyans would get for free in public hospitals.

In detail, the team was to come up with a list of medical services, procedures, drugs, supplies, products and health technologies — broken down into their cost — based on realistic projections of current and future supply and demand for health services.

They were also to consider emerging health technologies, provided that their cost-effectiveness and benefits to Kenyans could be justified.

The panel had their work cut out for them, and Kenyans were riding on the promise of affordable healthcare at last.

BENEFITS

Their report, which was presented to Ms Kariuki, recommended that all health services from dispensaries to referral hospitals (level five) be provided free of charge, while medical bills for services in national referral hospitals like Kenyatta National Hospital (Nairobi) and Moi Teaching and Referral Hospital (Eldoret), be footed by the government through a health fund.

However, investigations by the Nation have found that what the President launched as UHC is different from the promise of affordable healthcare that was riding on a defined health benefits package.

A health benefits package refers to a set of health services, including medicines, procedures, diagnostics and health technologies, which are guaranteed to those who are entitled to receive them.

Under the benefits package, Kenyans visiting any health facility, from a dispensary (level one) to a national referral hospital (level six) were to get all medicines, diagnostic tests and other treatments required for the complete management of any disease or condition.

TREATMENT

Under the package, meant to ensure that Kenyans are not driven into poverty by high medical bills, county health facilities were to offer medical emergency services and evacuation of injured patients, basic and advanced life support, blood transfusion, emergency surgery and trauma care and management of gender-based violence and sexual assault, free of charge.

The committee recommended that all vaccinations, including yellow fever, HPV (human papilloma virus), tetanus and rabies, be provided free of charge.

Kenyans were also to get free treatment for sexually transmitted infections and gynaecological conditions, as well as free treatment for infectious diseases such as malaria, tuberculosis and HIV/AIDS.

Non-communicable diseases were not left out. Kenyans with sickle cell anaemia, heart disease, hypertension, diabetes, asthma and cancers would get free treatment including surgery.

The panel also recommended free emergency treatment for children and free management of common conditions such as diarrhoea, malaria, acute malnutrition, meningitis, respiratory tract infections, ear, nose and throat diseases, skin diseases, heart conditions and mental health disorders.

CHARGES

However, after receiving the recommendations, the Cabinet secretary recommended a second opinion since the model was expensive.

In an interview with the Nation last week, Ms Kariuki said that not all healthcare would be free. “What we are offering is not what we had anticipated, but with time the benefits will change,” she said.

The model had two limitations: The state of the 6,000 facilities was wanting and NHIF, which was to handle UHC, was not in the best state to deliver and reimburse the monies to hospitals.

“We agreed that NHIF must be reformed and looked at. We also needed to separate the confusion on the roles that the insurer currently plays. It is the insurer that purchases the packages and decides what to settle and when to settle,” she said.