Bold commitment to Kenya’s healthcare equity and growth

Kenya’s pursuit of Universal Health Coverage (UHC) has been a transformative journey, marked by a steadfast commitment to equitable healthcare access for all Kenyans.

The current framework—rooted in the Bottom-Up Economic Transformation Agenda (Beta)—represents a significant paradigm shift that recognises health as central to socioeconomic progress. While some criticisms of elements like the Social Health Insurance Fund (SHIF) have emerged, it's crucial to appreciate these reforms’ broader vision.

Kenya's dedication to UHC dates back to the early 2000s during the administration of President Mwai Kibaki. It, however, took a serious turn in the late 2010s when the country rolled out pilot programmes in several counties, including Nyeri, Kisumu, Machakos, Tharaka Nithi, and Isiolo. These pilot projects revealed the multifaceted challenges of establishing UHC in a diverse nation.

Key lessons underscored the need to bolster primary healthcare, address workforce shortages, and ensure sustainable funding mechanisms. They exposed systemic gaps, such as underfunded facilities and fragmented service delivery. Yet, they also established a solid groundwork for future administrations to refine and expand UHC initiatives, which have informed current efforts undertaken by the government.

Prioritising equity

Under the leadership of President William Ruto, the Beta framework has revitalised the pursuit of UHC, integrating healthcare reform with economic development. This approach acknowledges that a healthy population is fundamental to economic growth, prioritising equity, inclusivity, and sustainability to ensure that no Kenyan is left behind.

The Community Health Promoter Services (CHPS) model is at the heart of this strategy. This visionary initiative reinforces primary healthcare by recruiting, training, and deploying community health promoters to provide essential services, including preventive care and maternal and child health support.

The model, anchored on 100,000 CHPs, is the cornerstone of Kenya’s healthcare pyramid, effectively connecting community care to higher service delivery tiers. When primary care needs are met, patients can access level-2 and -3 health facilities for specialised treatment, while level-4 and -5 hospitals cater to more complex cases.

This structured model not only ensures efficient service delivery but is also cost-effective; prioritising primary care alleviates the burden on higher-level facilities, optimising resource allocation. Furthermore, it empowers communities to prioritise their health, leading to a reduction in preventable diseases and enhancing overall well-being.

Critics of the Social Health Insurance Fund (SHIF) have consistently expressed concerns about its financial implications and unclear implementation. Although these points deserve consideration, they often miss the larger vision and potential that SHIF holds within the UHC framework.

Pooling resources

SHIF is more than just a financing tool; it embodies social equity. By pooling resources, it ensures that wealthier individuals effectively subsidise care for vulnerable populations, reinforcing societal solidarity. The proposed reforms also aim to address previous inefficiencies that excluded the most susceptible.

Rather than focusing solely on immediate challenges, we must recognise the long-term advantages of SHIF. A well-funded health system not only saves lives but also enhances productivity, alleviates poverty, and catalyses economic growth.

The healthcare reforms initiated by Dr Ruto represent a pivotal shift. These are not just policy adjustments—they are investments in Kenya’s future. A healthier population correlates with a more productive workforce, lower household healthcare costs, and a heightened capacity to withstand health crises. These reforms have far-reaching economic benefits. By reducing out-of-pocket healthcare expenditures, families can allocate more resources towards education, entrepreneurship, and development.

Enhanced health outcomes also attract foreign investment, as businesses recognize the potential of a stable and robust healthcare system.

Additionally, Kenya’s UHC journey sets a precedent for other nations striving for equitable healthcare. Our emphasis on primary care, community health integration, and innovative financing distinguishes us as a global health leader.

The road to fully implementing UHC is fraught with challenges, including resource limitations, resistance to change, and the essential demand for sustained political commitment. These are surmountable.

 The writer is a former Cabinet Secretary for Health.