The Ministry of Health is in the final stages of developing policies to guide the rollout of universal health coverage (UHC) in the country, which has been impeded by financing gaps, inadequate structural reforms and challenges in the medical supply chain.
Ms Susan Mochache, the Principal Secretary at the ministry, said Friday that the string of policy reforms is aimed at strengthening the National Health Insurance Fund (NHIF) to take centre stage in the financial administration of the programme, weeding out cartels from the supply chain at the Kenya Medical Supplies Agency (Kemsa), building capacity in the counties, and developing a robust information technology framework to capture, store and manage data.
“The dream of UHC is not dead,” she told a team of senior ministry officials and editors at a workshop in Malindi.
“If anything, it is more alive than it ever was and we are in the final stages of rolling out a comprehensive medical care programme.”
Her statement came in the wake of concerns that Kenya’s dream of achieving universal health coverage could be impeded by lack of clarity on policy changes and a huge financing deficit.
Recent brain drain at the ministry as doctors and nurses sought better-paying jobs abroad also threatened to derail the plans.
Ms Mochache said that among the policy changes are guidelines to govern who among the medical cadres would be allowed to take up job offers abroad.
Already, the government is not allowing specialist nurses, among them those who work in intensive care and paediatric units, to take up foreign job offers.
It is, however, a raft of changes at NHIF that are poised to disrupt the country’s public and private health ecosystem. The Fund is being viewed among government circles as the biggest enabler of the UHC dream as it will act as both a social protection and insurance firm.
Changes here include the revision of laws to give it more impetus to recruit new members, as well as amendments to the amount of money paid to hospitals for treating member patients.
Private hospitals have protested the move to revise fees, saying lesser fees would greatly reduce their profit margins and render their partnership with NHIF untenable, but Ms Mochache says the government will adopt a “take-it-or-leave-it” policy if it is to bring down the cost of medical care.
“We have asked a task force to advise and guide on the best pricing,” she said, accusing some private sector entrepreneurs of seeking to profiteer from the enterprise.
The proposed changes at NHIF also aim to identify vulnerable Kenyan homes that need to be covered, revise the benefits package, expand statutory and voluntary contributor bases, and incorporate such State-sponsored programmes as Linda Mama and health insurance subsidies targeted at the orphaned, the physically challenged and other vulnerable groups.
Dr Peter Kamunyo, the NHIF chief executive officer, said on Thursday this week that the policy governing the Fund’s administration of UHC was ready ahead of rollout by President Uhuru Kenyatta, perhaps in the coming weeks. Other supporting policies, including one on health financing strategy and another on essential health benefits, have also been approved, he said.
Health is a devolved function
Criticism against UHC has centred around its financing dilemma; how accessible –both physically and financially- it will be to the millions of Kenyans who have no medical insurance; and the monopolisation of the supply chain by Kemsa, to the chagrin of governors, who argue that health is a devolved function and the government has no business nationalising the procurement and distribution of essential medical supplies.
Of these, financial barriers pose the biggest obstacle, and while a mix of public, private, and donor resources supports Kenya's health sector, the funding is not enough to support President Kenyatta’s dream of lowering the cost of medical care and making primary health care more accessible.
For instance, between 2009 and 2013, donor financing fell from 34.5 percent to 25.6 percent of Kenya’s health budget, while financing from public sources rose from 28.8 to 33.5 percent.
Conversely, private financing for health increased from 36.7 per cent to 39.8 per cent over the same period.
This is worrying because a huge part of private funding is in the form of out-of-pocket payment, which rose as a proportion of total health spending from 25 percent in 2009 to 29 percent in 2013 and 32 percent in 2018, according to data by various institutions.
Lack of equipment and infrastructural support
The high out-of-pocket expenditure denies the vulnerable access to healthcare, while many are forced to sell assets to offset hospital bills, thereby impoverishing them further. It is estimated that healthcare puts 1.5 per cent of households in Kenya below the poverty line every year.
To effectively roll out the programme, the government will also have to deal with the fact that most public health facilities across the country lack the capacity to manage certain ailments, and the lack of equipment and infrastructural support – such as water and electricity connection – that impedes the provision of adequate medical care across the country.
Dr Mercy Mwangangi, the health Chief Administrative Secretary, noted earlier that other than the development of a policy framework to manage UHC, the government is also improving the support infrastructure, including upgrading roads, connecting rural hospitals to the national electricity grid, and setting up an information technology directorate at the ministry headquarters.
