When President Uhuru Kenyatta announced his Big Four Agenda, I was very happy that manufacturing and health had made it to the highest policy platform.
Health insurance was a key plank of my own campaign to be governor of Laikipia. Supporting small businesses had become part of my DNA.
Most of my professional life had been about providing business development service to small enterprises. In Kibaki’s second term, I was assistant minister for Industrialisation!
We would differ later with his technocrats on the best way to achieve Universal Health Coverage (UHC) and to stimulate domestic manufacturing.
To be honest, I still differ, for instance, with the Health Cabinet Secretary, who wants to extend the Managed Equipment Service for three years, to the chagrin of most governors, but I digress. Is universal health care achievable? Unequivocally, YES! And here is how.
The first big question is how to pay for it. For most families, hospitalisation of a member is financially catastrophic, hence the many harambees to settle hospital bills. Globally, the best answer is health insurance.
In the early days of implementing UHC, there was intense debate on the financing question. The then CS and other technocrats favoured a special tax to cover insurance, arguing that NHIF was in dire straits. And they carried the day and proceeded with a pilot phase in four counties. Well, it did not work.
In Laikipia, 63 per cent of the residents are now on national hospital insurance. This includes the extremely poor, who are supported by both levels of government. This is key, considering that more than 16 per cent of Kenyans live in extreme poverty (US$ 1.90 per day).
Extreme poverty has prompted one political formation to promise an extension of social protection, which was started in the Kibaki administration and intensified under the Uhuru administration. It covers the elderly and those living with disabilities. These groups receive a monthly stipend of US$1.90 per day, which works out to about Sh6,000 monthly per household.
In Laikipia, we deployed community health volunteers. Armed with smart phones with an app integrated into the NHIF, the volunteers would register a household on the spot during a visit. This also helped us to collect household asset data that we used to identify the extremely poor with a high degree of precision.
The next big question is the health service itself. Universal health care implies that all citizens are covered and can get the service they need when they need it.
The traditional categorisation of health facilities creates rigidity of mindset. For instance, level two facilities (dispensaries) are not expected to have laboratory services, yet there is no reason why they should not.
A novel idea of the Laikipia Health Service is the sample referral. If a facility does not have the immediate ability to conduct a particular test, they refer the sample and not the client to a higher-level facility. This saves both time and money. In Laikipia, we are keen to grow the facilities from 84 to 90.
