BWIRE: Why Universal Health Coverage will remain a pipe dream

By Victor Bwire

While the intent to provide health care to Kenyans is evident, things on the ground are different; the current state of policy confusion, especially on how the focus on the private sector to provide the greater bulk of resources for Universal Health Coverage (UHC) and haggle over the management of public resources for health services between the national and county government persists.

The responsibility of providing quality and accessible healthcare for all lies on the national and county governments with the national government being responsible for policy formulation and managing referral hospitals while county governments are charged with managing health facilities within their jurisdiction.

Unfortunately, this is not what is happening, and Kenyans’ pursuit to access health is frustrated, thus the realization of UHC in the near future might be a pipe dream.

While the insurance model where the private sector is a major player seems the model being favoured (Kenyatta National Hospital running a private wing and with plans to put up another private hospital), investment by the public sector into primary health care is the model that can help Kenya realize UHC and not the latter.

The provision to affordable and quality health requires a right based and public good approach with the primary responsibility lying on governments and not a market forces approach, where the for profit private players dominate.

The financing, human resource, and governance together with the rising burden of Non-Communicable Diseases (NCDs) remain a big challenge to the constitutional promise of the right to health.

The Government has committed itself to rolling out and achieving Universal Health Care by 2022.

The inclusion of health as one of the key pillars anchored in Kenya’s Vision 2030, in the president’s legacy projects, especially the “Big Four Agenda,” and strategic placement of the National Health Insurance Fund (NHIF) underline the stated commitment by the government to improve healthcare and to steer the country towards achieving Universal Health Coverage (UHC).

This obviously follows the Constitutional requirement, Kenya Health Act 2014 and Kenya Health Policy 2014-30. In addition, Kenya has ascribed to the Sustainable Development Goals (SDGs), including SDG No 3,that commits governments to provide quality healthcare for all.

Over the last six years, the health sector in Kenya has exhibited significant developments, including the introduction of the Linda Mama (free maternity) initiative, the Beyond Zero campaign, efforts to revamp the National Hospital Insurance Fund (NHIF), as well as a multi-million dollar Medical Equipment Leasing scheme aimed at bringing advanced medical equipment closer to citizens across the 47 counties and in key referral facilities.

The inclusion of health in the president’s legacy priorities (Big Four Agenda) underlined this stated commitment to improving healthcare.

Kisumu County Governor Prof. Anyang Nyong’o recently expressed what many experts in the health sector have noted; we need to invest more in human resources in the sector more than in buildings and equipment.

However much we invest in putting up buildings, installing equipment and other medical supplies, with adequate investment in stabilising the human resources factor in the sector, and reduce the out of pocket charges/user fees at the hospital facilities, the realization of UHC in Kenya will still remain problematic.

Suffice to note that attempts by the Government at free health services for Kenya are not new, and initially had a lot of success, which the current efforts can tap into. Kenya’s 1965/66-1969/70 development plan saw all outpatients and children provided with government-guaranteed free healthcare services.

The scheme suffered later with the introduction of the IMF and World Bank led SAPS that restricted hiring in the sector, introduced user fees and welcomed the private players to the selling of healthcare. This approach should inform current intervention.

It’s possible with structured interventions and increased pubic investment and good governance to the achieve UHC using the rights based approach to health rather than the current commercial driven approach where health services have been left to the market forces, with private players reaping profits at the expense of quality accessible services to Kenyans.

While the role of the private actors in health financing and the provision of goods and services is inevitable and has risen given the existing resource gaps and supplies deficiencies in the sector, caution should not be thrown through the window, to allow the private sector to be the major influencer and player in the health sector.

These are for profit making ventures, and quality, access, affordability will eventually set in, denying Kenyans right to health. Health just like other sectors including security, telecommunication, education, ports and others must be protected from the jaws of the market forces.

In addition, to streamlining the management of public resources by both national and county governments, the government should increase the budget allocation to the sector to the Abuja Declaration stated of 15% of the national budget.

More importantly, where there are arrangements for public private partnerships in health or initiatives supported by development partners or non state actors, such interventions and joint efforts must be transparent, people driven and detailed information shared.

The author is the Programmes Manager at the Media Council of Kenya

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