Dr Cleopa Mailu
December 12 has now been confirmed by the United Nations as the World Universal Health Coverage Day. Here in Kenya on this date, President Uhuru Kenyatta outlined his vision for the next four years in which Universal Health Coverage (UHC) is right at the centre.
As a country we are on the cusp of a promising future. A future where no Kenyan will be denied medical care because they cannot afford it; a future where ‘harambees’ for medical expenses will be a thing of the past; a future where Kenyans would not have to sell their land to pay for hospital costs. That future is here.
We thank the President for his commitment to ensure that this becomes a reality. Granted, Kenya has made significant strides towards UHC over the last few years. The reforms at National Hospital Insurance Fund(NHIF) are now bearing fruit and even then, the best is yet to come. We have successfully expanded the number of people with NHIF cover and improved the services that NHIF members can access.
For example, Kenyans can now receive surgical operations and dialysis as well as specialised diagnostics such as CT scans. The old, the poor and vulnerable Kenyans including orphans and the severely disabled are now able to get services courtesy of these reforms.
Over the next four years, the government, through the Ministry of Health, will roll out a transformational agenda under the banner of UHC to reach 13 million principal members from the current six million. This will push the number of those under the UHC to close to 40 million because each principal member would have an average of three dependants.
To ensure equity and envisaged inclusivity, the government has targeted poor households through social protection services. To date, more than 181,000 households under the Health Insurance Subsidy Programme enjoy various health care benefits.
This is set to increase to 350,000 households by the end of 2018 and all older persons, including the one million who are more than 70 years. Additionally, we shall expand the Linda Mama programme (Free Maternity Service), which currently covers deliveries to include antenatal and postnatal care.
As a country, everyone must drum up support for enrollment for health insurance. This requires whole villages to understand that access and lack, thereof, to healthcare is a shared burden and UHC has mechanisms to cushion every single citizen.
For this, we shall require the support of village elders, administrators such as chiefs and county commissioners, church leaders as well as trade unions. The role of county governments in strengthening of devolved healthcare services comes to the fore.
Each county should ensure that essential services are accessible to all through availability of relevant infrastructure for diagnostics and medicines. Every Kenyan must be attended to by a qualified health professional and provided with necessary care. At any given time, all 40 million plus Kenyans, major pandemics notwithstanding, will be entitled to some form of care.
Critical drivers towards this include employing additional 2,400 doctors and 55,200 nurses. The number of referral institutions will be increased to 94 with each county having at least two specialised hospitals. For this to happen, the country will need additional eight medical schools and 83 mid-level colleges to train human resources for health.
The role of the private sector will be instrumental in this agenda. Privately owned healthcare facilities must be enhanced so that there is complementarity between all providers so that no one feels disenfranchised.
The private sector will play a role in improving access to quality medicines without co-payments for all Kenyans. It will be such a shame to have infrastructure which cannot complete the treatment loop due to lack of quality affordable medicines.
UHC cannot be achieved without adequate financing. At least 7 per cent of the country’s total budget should be allocated to health. Although devolution has expanded the financial envelope, much more can be done to ring-fence the budgets for health to adequately finance health related needs at the devolved units.
The government has no intention to burden the same citizens it’s cushioning against catastrophic health expenditures with heavy taxation. We shall target the reallocation of marked taxes and introduce matched contributions for health insurance as some of the sources to finance UHC. The ‘universality’ aspect in UHC is achievable in Kenya.
Already, initiatives such as Linda Mama are a testimony to the possibility of UHC. We do except that in coming years, no Kenyan will be without health insurance. We urge citizens to support their parents and relatives to ensure no one is left behind in enjoying benefits of Universal Health Coverage. The writer is Cabinet secretary Ministry of Health