Consider this: every year, nearly 1 million Kenyans are pushed below the poverty line as a result of unaffordable health care expenses.
For many Kenyan families, the cost of health care is as distressing as the onset of illness and access to treatment. A majority of the population at risk can hardly afford the costs associated with basic health care and when faced with life threatening conditions, it is a double tragedy-inability to access health care and lack of resources to pay for the services.
According to the World Health Organisation, a large percentage of poor households in Kenya cannot afford health care without serious financial constraints as most are dependent on out of pocket payments to pay for services. Nearly four out of every five Kenyans have no access to medical insurance, thus a large part of the population is excluded from quality health care services.
In 2015, UN Member States endorsed the 17 Sustainable Development Goals (SDGs), expected to guide the development agenda through 2030. The endorsement of the SDG 3 ― Good health and wellbeing; formally enshrined Universal Health Coverage (UHC) as a development priority for all countries.
UHC has the potential to transform the lives of millions of Kenyans—guaranteeing access to lifesaving health services while helping individuals and families avoid crippling health expenses and the poverty trap.
The situation is not unique to Kenya, but also a case in point for many other developing countries. As a result, UHC has been identified as a key development goal for enhancing countries’ health systems globally. It is an all-encompassing development issue, including as it does, the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation as well as palliative care.
Protecting people from the consequences of out-of-pocket health expenditure, which in Kenya forms about a fifth of family spending, is critical. It reduces the risk of people using up their life savings, selling of assets, or borrowing, threatening the financial future of their families as out of pocket health expenditure is also the most inequitable and inefficient.
However, achieving UHC is a formidable challenge because Africa as a continent requires about 50 percent more doctors to achieve UHC, compared to Europe which needs only about 3 percent more. The continent still lags far behind the rest of the world in provision of basic health care services such as immunisation, water and sanitation as well as family planning.
Much of the problem lies with the low prioritisation of health. Less than ten countries in Sub-Saharan Africa have met the Abuja declaration committing to allocate 15 percent of their annual government spending on provision of health care.
Kenya is one of the countries that is yet to reach the Abuja threshold, but several indicators show that the country can be an inspiration for the rest of the continent in achieving UHC by 2030.
One of the steps in the right direction is the government’s move to eliminate payments for primary and maternal health services in public facilities. This has led to tangible improvements in maternal and child health, with maternal mortality ratio falling from 488 to 362 deaths per 100,000 live births between 2008 and 2014.
With consensus that maternal health is a major driver of overall health and economic development, the Government of Kenya in partnership with the United Nations family and the World Bank, with strong support from the governments of the United States of America, United Kingdom, Japan, Germany, Denmark and Norway who have focussed on counties with the highest maternal and child deaths. Significant gains have also been made as a result of the First Lady of Kenya’s Beyond Zero campaign.
Arnaud Bernaert, Head of Global Health and Health Care at the World Economic Forum, remarked that, “Kenya’s efforts has led to an innovative public-private partnership mechanism that has the potential of building business models that will offer the best of both public and private sector in scaling-up the delivery public health services in low-resource settings.”
Another positive direction is the devolution of health ― a constitutional change that shifted responsibility for healthcare provision to county governments. This seeks to achieve universal coverage by bringing health decisions closer to citizens, ensuring efficient and equitable resource distribution, thereby improving access to health facilities as well as services.
Recent changes to the National Health Insurance Fund (NHIF) has expanded the coverage for formal sector employees by adding outpatient care and a new initiative specially targeting informal sector has recently been introduced. The new national scheme offers a comprehensive family cover for US$ 60 (6000 Kenyan Shillings) covering both outpatient and inpatient services. New initiatives such as health insurance subsidies for the poor, severely disabled and elderly will help to bring more vulnerable people under comprehensive health insurance cover.
Kenya is already a leader in technological innovation. This is a capability that must be harnessed to improve health systems to help bring down costs of delivering health care services through telemedicine, reducing inefficiencies in provider payment systems and generating better data.
These improvements could significantly help ameliorate the financial stress that is currently the most significant barrier to achievement of UHC. Some studies have shown that technical efficiency is a big flaw in Kenya’s health facilities, with one reporting that public dispensaries are operating at only 47 percent efficiency.
Kenya is part of various initiatives for developing sustainable financing for health services such as the Global Financing Facility, a partnership that will catalyse greater investments in health services, with a particular focus on women, adolescents and children.
The momentum is already with the country and in keeping with the spirit of the SDGs, Kenya must lead in the moral imperative of ensuring that none of the people who cannot pay for health care are left behind.
Kenya can undoubtedly lead the way in achieving universal health care.