WHO: Patients in poor countries paying more for health

A new World Health Organisation (WHO) report shows that governments are spending less on health as more patients from poor countries feel the pinch of paying for health services out-of-pocket.

The report which was published on Universal Health Coverage Day shows that while health spending surged during the onset of the pandemic, domestic public spending on health per capita declined in all income groups in 2022.

"This occurred against a backdrop of rising government spending, implying that health’s share of general government spending—a measure of health priority—fell,” shows the report.

In high income countries, however, spending on health remained close to 2021 levels, but general government spending declined.

The report shows that there was an increase in the dependence on external aid for the low and lower-middle income countries. Financial help meant for health in the said countries accounted for 31 per cent of health spending compared to an average of 22 per cent spending from domestic funds.

The report shows that out-of-pocket spending remained the main source of health financing in 30 low- and lower middle-income countries.

“In 20 of these countries, more than half of total health spending in the country was paid for by patients out of their pocket, which contributes to the cycle of poverty and vulnerability,” said the WHO.

This however was not just a preserve of the poor countries; the WHO data shows that 20 per cent of health spending from the rich countries was out-of-pocket –especially from the impoverished households in rich countries.

WHO Director-General Dr Tedros Adhanom Ghebreyesus, said in a press statement that this cycle needs to stop.

While access to health services has been improving globally, using those services is driving more and more people into financial hardship or poverty. Universal Health Coverage Day is a reminder that health for all means everyone can access the health services they need, without financial hardship,” he said.

In Kenya for instance, money allocated in July this year for the health docket in the financial year 2024/2025 was slashed by Sh6billion as Health ministry officials asked the government to rethink that decision through the National Assembly.

The Health Committee at the National Assembly linked the current financial year’s budget cuts to the Finance Bill that was dropped after fiery GenZ-led protests in June this year.

An auditor’s report released in the same month showed that there was misplaced use of about Sh766 million from the same ministry with monies paid to ghost employees outside the Integrated Personnel and Payroll Database (IPPD) system.

The WHO report however shows that without prioritisation of health spending by governments, Universal Health Coverage will remain a pipe dream.

“Its deprioritization can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and 2 billion people face financial hardship due to health costs,” explains the WHO.

The report’s analysis shows that during the pandemic, government-backed health schemes worked better than social health insurance (SHI) in terms of improving domestic financing of health especially for preventive care.

This comes at a time when Kenya is only a few months into a new Social Health Authority after the defunct National Health Insurance Fund was repealed.

In the latest analysis of SHA’s scorecard by the Rural and Urban Private Hospitals Association of Kenya, the overall scorecard remains below average at 46 per cent citing stagnation on key issues needed for a smooth transition.

The report shows that almost 7 out of 10 Kenyans that took part in the survey still have a negative perception of SHA.

The WHO advises that there needs to be a rethink on financial protection for patients.

“Effective strategies to strengthen financial protection include minimizing or removing user charges for those most in need, including people with low incomes or chronic conditions, adopting legislation to protect people from impoverishing health costs and establishing health financing mechanisms through public funding to cover the full population,” the WHO experts say.

There was a positive observation on how governments are trying to pump in money to Primary Health Care which relies more on preventing diseases rather than curing them.

In October 2023, one of the Bills that was assented to by President William Ruto was the Primary Health Care Bill 2023 –now an Act, which has a fund dedicated to help in prevention of illnesses through early diagnosis of diseases, early interventions in case of an outbreak.

“Public funding needs to budget for an affordable package of essential health services – from health promotion to prevention, treatment, rehabilitation and palliative care – using a primary health care approach,” says the WHO.