When the Kisumu County government launched the Marwa Health programme in March 2021 to benefit low-income households, many residents looked forward to enjoying a period of free health care.
The health cover was launched to provide affordable and accessible services to 90,000 targeted vulnerable households, with 45,000 residents benefitting in the first phase.
The programme was unveiled in October 2020 by Governor Anyang’ Nyong’o to ensure health services are free and accessible in 48 public hospitals. It was designed to benefit the most vulnerable in the county.
Kisumu was one of four counties piloting the Universal Health Coverage (UHC) programme. It ended in December 2020, leaving the beneficiaries in these counties in limbo.
UHC had been running for two years in Kisumu, Nyeri, Machakos and Isiolo counties, benefitting 25,000 residents in each.
But it faced some challenges, such as inadequate staff and delays in supplying pharmaceutical and non-pharmaceuticals items.
The Kisumu Marwa health scheme was meant to cover outpatient, oncology, chemotherapy, radiology, kidney transplant and surgical services, among others.
Success and sustainability
In April 2021, the county in partnership with the PharmAccess Foundation paid Sh67.5 million to the National Hospital Insurance Fund (NHIF) to cover insurance premiums for households for 12 months in the first phase of the scheme.
Months later, however, Marwa, though hailed as a positive initiative that could significantly improve healthcare in the lakeside county, has come under sharp scrutiny from residents and medical experts, who are concerned about its success and sustainability.
At a past event, Governor Nyong’o reported that the programme had been rolled out in the entire county.
Most of the public hospitals in the county do not have adequate staff to attend to patients, who are expected to turn up in large numbers now that the programme is running.
Photo credit: Tonny Omondi | Nation Media Group
“I wish to inform you that Marwa is now fully rolled out to some 45,000 vulnerable households in the first phase. The number will soon be scaled up to 90,000,” he said.
However, some residents and health workers doubt the sustainability and efficiency of the health scheme.
On one hand, medical experts have raised concerns over the county's preparedness to implement the ambitious medical cover on such a scale.
On the other hand, some residents feel many deserving cases have been left out and the county government has not carried out adequate sensitisation about the programme.
Some residents are still unaware that the scheme exists, while others claim that the programme has excluded the most vulnerable families.
Ms Akinyi, a resident of Ahero, Nyando sub-county, said that many beneficiaries she knows are those who are financially stable.
She added that there had been no effort by the county to ensure that community members are well informed about the programme.
“Most of us are not even aware of the programme. The county government has not done much to sensitise the public to ensure we are well informed of the new health scheme,” she said.
Health practitioners say the county government has neither employed enough health workers nor increased hospital supplies.
In an interview with Nation.Africa, Dr Onyango Ndong'a, the secretary-general of the Nyanza chapter of doctors’ union KMPDU, said the source of funding for the project is still unclear, raising questions about its sustainability.
He also said that most of the public hospitals in the county do not have adequate staff to attend to patients, who are expected to turn up in large numbers now that the programme is running.
Health practitioners say the county government has neither employed enough health workers nor increased hospital supplies.
Photo credit: Tonny Omondi | Nation Media Group
“With the free health coverage, we are expecting more people to be visiting our hospitals. That means that our staff may end up overwhelmed due to a huge workload,” Dr Ndong’a said.
“We were only given a verbal promise by the county government that some new theatres would be put up and more doctors would be employed. However, nothing has been done yet the programme is already up and running.”
He urged the county government to first improve the health infrastructure by equipping hospitals with more specialists to limit the number of patients travelling out of the county to seek medical care.
Deregistering beneficiaries
"If nothing is done, we will have limited hospital supplies and medical personnel offering services to the patients, and that may, in turn, compromise the quality of care offered in the public hospitals,” he said.
But Health Chief Officer Dr Gregory Ganda said the programme, which has been running since February 2021, is benefiting 43,000 residents.
He added that the county government is also deregistering beneficiaries who can pay their hospital fees.
"Selecting beneficiaries is not always easy. At times we end up enrolling those who are not vulnerable," he admitted, adding that they had successfully identified and deregistered 3,000 undeserving individuals to create room for the most vulnerable.
On staffing, Dr Ganda said 200 health workers were hired when UHC was rolled out in Kisumu in 2019, although it only had 25,000 beneficiaries per county.
Marwa targets 45,000 in the first phase and the number will be raised to 90,000 in the second phase.
Dr Ganda also said that the county would provide health centres with a steady supply of pharmaceutical and non-pharmaceutical products to ensure a smooth flow of services.
