The evolving history of Universal Health Coverage in Kenya

The launch of the Universal Healthcare Coverage (UHC) in Kenya in Kericho on Friday will mark the latest attempt by the government to avail accessible and affordable health care to the masses. 

The last attempt to have Kenyans access this was during the second term of President Uhuru Kenyatta’s government which did not work as envisioned.

The pomp and colour that followed the launch of the country’s first-ever attempt to provide accessible and affordable healthcare to her citizens in 2018 perhaps provided much hope and enthusiasm for those who previously found it hard to get healthcare when they needed it.

UHC was piloted in four counties, with the larger plan being a rollout to the other 45 counties, once the programme had taken root. 

Kisumu, Isiolo, Machakos and Nyeri were the four counties chosen as guinea pigs for the ambitious project. 

Each of the four counties was picked for a unique reason; Isiolo County for high maternal mortality rates, Kisumu due to its high prevalence of HIV and Malaria, and Machakos for high cases of road accidents.

“Nyeri was picked because of its high number of cases of non-communicable diseases,” Governor Mutahi Kahiga said at the launch.

The UHC programme was anchored on a two-phase medium-term approach. The first phase aimed to abolish all user fees at the local health centres and the county referral hospitals.

The second phase was meant to have seen the rollout of a Social Health Insurance Scheme through the National Health Insurance Fund (NHIF).

The rollout in the four counties indeed showed the need for the coverage, with the government increasing the number of community health volunteers and workers, and revamping community health units, visits to health care centres by the residents increased with the Ministry of Health putting the number of visits to 3.2 million in just one year.

“In one instance we had organized a clinic under the UHC, we had 13,000 people showing up, we could not handle that,” Kahiga said at the time.

 The UHC programme did not leave to see its second birthday, in nearly all the four pilot counties, only Isiolo and Machakos limped to its’ uneventful conclusion.

Kisumu was a non-start from the beginning and Nyeri eventually terminated the pilot due to financial constraints.

“The national government did not seem to have a clear roadmap on its implementation, it was doomed to fail from the start,” Kahiga noted.

Then KMPDC CEO and now Machakos Health CECM Daniel Yumbya added: “As soon as that money was given, the county expected the money to continuously come, there were projects that were started, some have stalled, there are facilities that were started ...once the support was stopped or discontinued, shortages hit the counties that were involved.

Indeed, the pilot counties decried the lack of funds as the key reason why the project failed, which alongside the lack of accountability in the governance of the programme also contributed to its’ short life. The current government says it has learnt from the past and is keen to get it right this time round.

“Based on the past three attempts by the national government and it has failed, we have learned important lessons, first one is legislation, they were trying to do it outside the law, so we have brought four bills,” Health Cabinet Secretary Susan Nakhumicha said.

The legislative framework under the new dispensation of the UHC will amongst other things, anchor the legal and institutional framework for healthcare in Kenya by repealing the current National Health Insurance Fund and establishing in its place the Primary Healthcare Fund; Social Health Insurance Fund; and Emergency, Chronic and Critical Illness Fund, effectively addressing the pitfall that was financing the UHC.

“That’s what we are doing to ensure that the UHC does not fail, I have instructions from the President that it does not fail, I have planned myself as a minister it will not fail, I want to assure Kenyans that it will not fail,” stated Nakhumicha.

But aside from the legal backing, the counties, learning from the past say the national government must increase its budgetary allocation to health docket and ensure the funds are devolved as the function, increase the human resources and streamline the referral systems, especially from county to national level hospitals.