Reform healthcare to achieve universal coverage

The concept of universal health coverage is to ensure all people obtain the health services they need without suffering financial hardship when paying for them.

According to the WHO, the essential pillars are: A strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies and a sufficient capacity of well-trained, motivated health workers.

In the context of the Kenyan Health Sector, an objective audit of the state of the Sector and efficiency of the system is paramount.

Devolution of health services as outlined in the fourth schedule of the Constitution means that it is a shared function between the National Government and the County governments.

More collaborative efforts between the two levels of government will be required to achieve UHC.

TERTIARY CARE

The two tertiary level facilities in the public health sector; Kenyatta National Hospital and Moi Teaching and Referral Hospital are expected to provide tertiary care to a substantive majority of the over 40 million Kenyans.

The eleven level V facilities namely Thika, Nyeri, Nakuru, Embu, Kisii, Meru, Machakos, Garissa, Coast General, Kakamega and Jaramogi Teaching and Referral Hospital currently fall under respective counties.

Upgrading them to level VI and reclassifying to Regional Teaching and Referral facilities to provide tertiary and highly specialized care to Kenyans is essential.

This would ease the burden on the two teaching and referral facilities, more health personnel will be trained to provide tertiary care in the regional blocs and counties will benefit from service provision by those undergoing training.

Kenya has no state run Emergency Medical Services System, there is need for establishment of a state run National Emergency Medical Services system in fulfilment of article 43 (2) of the constitution.

EMERGENCY MEDICAL SERVICES

It should provide emergency evacuation using ambulances by road and air for citizens in need of emergency medical services through an Emergency Medical Service (EMS) hotline. Paramedics and Emergency Medicine Physicians will be required as service providers.

Primary health care is another key area of focus, capacity building to ensure provision of quality primary health care services is urgent.

It will entail training and employing community health workers and embarking on a well coordinated and active outreach drive into the rural communities to improve coverage and prevention of common illnesses as a major strategy.

Kenya is a signatory to the Abuja declaration 2001 in which heads of state of African Union countries pledged to allocate at least 15 per cent of their annual budgets to improve the health sector.

The trend in budgetary allocation for the period 2001 to 2018 has consistently been below 8 per cent, a significant shortfall from the 15 per cent target.

BUDGETARY ALLOCATION

The budgetary allocation to health needs to increase to meet the 15 per cent target, this can be achieved through various strategies including creation of a Universal Health Fund to be funded from government revenue and other monies contributed to the fund through donor funds and an elaborate health financing strategy over the next five years outlining incremental budgetary allocation.

Plunder and misappropriation of funds as has been the norm in the sector must cease for meaningful progress to be made.

Access to essential medicines and technologies is key to the beneficiaries of a health care system, a significant majority of Kenyans today rely on out of pocket expenditure for medicines and further treatment costs. Most of these are either unemployed or in the informal sector and thus have no access to health insurance.

The National Hospital Insurance Fund (NHIF) should extend coverage to all citizens regardless of socio-economic status, as a constitutional right.

HEALTH INSURANCE

The opportunities NHIF presents are enormous in the context of social health and insurance. Indeed, Kenya has a lot to learn from the National Health Service in the UK, a well run service that provides healthcare for all UK citizens based on their need rather than their ability to pay for it.

The health workforce is severely strained due to an acute shortage of healthcare workers; the country has 31,412 healthcare workers against a required 138,266 across all cadres.

This has an overall negative impact on performance of the sector.

Meanwhile, unemployment in the sector has spiralled, employment opportunities for doctors, clinical officers, nurses and other health care workers in the public health sector have significantly dwindled in the past five years, the net effect is an increasingly strained health workforce.

The move by the government to hire 100 doctors from Cuba whilst sidelining the locally trained 2,000 doctors available for employment will prove to be counterproductive unless remedial measures are undertaken. The ultimate solution to address the challenges of the health-workforce is creation of a Health Services Commission; it will be tasked with management of the health workforce.

WORKFORCE INVESTMENT

The commission should focus on a periodic health workforce investment and recruitment plan for instance every 5 years.

An inclusive participation of all the players in the sector is mandatory. The state has to acknowledge health workers organizations and unions as key stakeholders in the sector by creating a harmonious labour environment.

Focus should be towards conflict resolution through the tripartite dialogue mechanisms set in place by the International Labour Organisation.

The utmost solution is political good will and investment in the public healthcare system to make it responsive to the needs of the populace. Healthcare needs to be viewed as a contributor to the economy as opposed to being a cost.

Dr Chibanzi Mwachonda is Deputy Secretary General Kenya Medical Practitioners, Pharmacists and Dentists Union [email protected].