Shaping a new era for health care financing

By  ANN MUTINDA

What you need to know:

  • The government has embarked on the Big Four Agenda whose aim is to uplift the standards of living of Kenyans.

  • One of its pillars is to provide 100 per cent Universal Health Coverage (UHC) for all households by 2022.

  • The UHC pillar mainly focuses on reconfiguring the National Hospital Insurance Fund.

Historically, Kenya’s burden of health has been more focused on communicable diseases. But recent research has shown an increase in non-communicable ailments such as cancers and cardiovascular diseases. Out-of-pocket expenditure on healthcare is still extremely high especially for the low-income earner. 

The current Constitution devolved public health care to the 47 counties. The goal was to enhance equity in resource allocation, thereby improving service delivery for Kenyans.

INADEQUATE FUNDING

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Over the recent past, we have seen challenges that have dogged the devolved health sector such as disparities in salaries, poor pay, lack of job security, inadequate medical supplies and staff in health facilities. These have led to calls by some stakeholders to reverse devolution of health care services. The challenges may be attributed to inadequate funding. The National Treasury reported a combined discretionary public budget allocation to health of 7.6 per cent which is below the 2001 Abuja declaration target of 15 per cent.

To tackle some of the challenges above, the government has embarked on the Big Four Agenda whose aim is to uplift the standards of living of Kenyans.

FINANCIAL HARDSHIP

One of its pillars is to provide 100 per cent Universal Health Coverage (UHC) for all households by 2022 thereby guaranteeing quality and affordable healthcare to all Kenyans. According to the WHO, UHC means that all individuals and communities receive the health services they need without suffering financial hardship.

The UHC pillar mainly focuses on reconfiguring the National Hospital Insurance Fund (NHIF) and reforming the governance of private insurance companies to encourage investment by private health insurers and bring the cost of cover within the reach of every Kenyan. The government also intends to continue to increase the provision of specialised medical equipment and increase the number of health facilities at the community level including mobile health services. The free maternity programme will also be expanded to mission hospitals as well as private hospitals.

GOOD GOVERNANCE

In order to implement the above prioritised programmes, in the 2018 budget policy statement, government has proposed to allocate the Health Sector Sh69.987 billion, Ksh. 72.820 billion and Ksh. 73.146 billion for the financial years 2018/2019, 2019/2020 and 2020/2021 respectively. This indicates there will be a progressive increase in allocation over the 3 years from the allocation in 2017/18. The big question is whether the 8.2 billion increase shall be sufficient to fund the initiatives that will ensure significant increase in UHC for Kenyans.

While the country may not have achieved the 15 per cent target, more effort can be put in at the county level to ring-fence the budgets allocated to adequately finance these initiatives. In addition, with the nurturing of good governance both at a national and county level, the country shall be well on its way to achieving 100 per cent UHC.

Anne Mutinda is a tax consultant at EY. Views expressed herein are not necessarily those of EY.

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