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Universal health coverage is a journey, not a destination

Sunday February 10 2019

The ongoing nurses’ strike challenges us to think deeper about where Kenya’s starting point in the pursuit of universal health coverage should be. Many have misunderstood universal health coverage to only mean accessibility to healthcare services. This is either through private insurance policies or NHIF. However, the World Health Organisation explains that it revolves around equity, meaning that healthcare services should not only be uniform but should also be available to everyone, including those who are unable pay.

Universal health coverage is one of the four pillars in President Uhuru Kenyatta's Big Four agenda. According to Dr Jacqueline Kitulu, the chairperson of KMA, UHC should be viewed progressive in nature and not bound to be achieved in 2022.

Rwanda is one of the few developing countries progressing well towards universal health coverage. Eighty five per cent of its population accesses healthcare from public health centres and are covered by the community-based insurance programme. Each district has a policy trimmed to suit its needs. This has also ensured that the rich and poor access equal healthcare services.

Kenya can borrow from Rwanda. According to KIPPRA, the total membership of NHIF at the end of 2016/17 financial year was 6.8 million. When you include dependents, the number rises to about 27.2 million. This is slightly above 50 per cent. If we have to achieve the over 70 per cent coverage target by 2022, we need to do more. We should consider following Rwanda’s example by aligning the NHIF to suit the individual needs of every county. For example, the people in Kisumu are more prone to malaria than those in Nairobi or Kiambu. Therefore, the package offered in Kisumu County should be more affordable and favourable with regard to preventive and curative services of malaria.

We also need to ensure that members of the public are actively involved in making health policies. Previous experience has shown that ideas are with the people, the impoverished included.

We cannot be effective if we do not acknowledge the role that community-based organisations and saccos have to play in all this. If both the national and county governments empower these, then we will be halfway there. These organisations can also be used to champion disease prevention measures, right from the community level.

We are still in the journey towards universal health coverage. If we are to reach the destination, then we have to align NHIF to suit the needs of every community/county, increase public participation from the county level and empower CBOs.

FANON KIHU, Nairobi.