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Amid UHC pomp, germane questions linger

Monday April 22 2019

Universal Health Coverage.

Universal Health Coverage. PHOTO| FILE| NATION MEDIA 

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As President Kenyatta’s final term stutters towards an increasingly closer 2022 expiry, one of his flagship legacy projects is the much-touted Universal Health Coverage (UHC) programme.

Expectedly, it chugs along, egged on by a hopeful public keen for relief from astronomical healthcare costs.

UHC was launched to counter the runaway costs of access to health that have been sending poor Kenyans with treatable ailments to an early grave, and consigning thousands of families to poverty every year. More precisely, the programme aims to provide safe, timely, effective, efficient, equitable and patient-centred health services to all, irrespective of financial circumstances or economic well-being.

Currently being piloted in Kisumu, Isiolo, Machakos and Nyeri counties, the programme is noble and timely, but its architects must come out clearly on some key issues that have arisen from the experience in the pilot counties.


First, and perhaps the biggest elephant in the (cabinet) room, is just how sustainable the programme is. Haven’t we been told that the government is broke? Isn’t the Salaries and Remuneration Commission looking to chop civil service packages because Big Brother is unable to pay public workers’ (the same people expected to implement UHC, mind) house and commuter allowances?

Healthcare is not cheap; just how does government plan to raise a few hundred billion shillings per year to provide healthcare to some 50 million Kenyans?

Again, haven’t we been here before? Wasn’t the idea of free health services dropped in the late 1980s with the introduction of co-payments in hospitals because free healthcare services were unsustainable?


Kenya produces some of the world’s best innovators, sportsmen and, of course, teachers. We also produce the most cunning public property looters, whom we later reward with some of the most lucrative offices on earth. But for all our industry and wisdom, we obstinately refuse to learn from history.

Second, how are UHC and NHIF integrated? Why would people continue paying premiums to NHIF when they can access the same services for free? And where do faith-based hospitals come in? Additionally, UHC promises to cover the ‘full range of essential health services including chronic care.’ Does this include dialysis, transplants and cancer treatment costs?

Finally, it has been claimed that about 70 per cent of UHC funds will go towards procuring health products and technology.


However, commodities represent just one pillar in the expansive healthcare system. For these drugs to be deployed effectively, we need adequate clinicians to prescribe them. For them to be adequately managed, stored and dispensed, we require pharmacists at every level of healthcare as well as an effective Commodity Information Management System.

Healthcare provision is not just about procuring medicine and dumping it in health facilities.

Government must, of necessity, employ more healthcare workers and deploy requisite systems and infrastructure. These are key issues that need ironing out if the dream of universal quality, affordable healthcare is to be actualised.

Dr Louis Kibathi is a pharmacist. [email protected]