OPINION: Address inefficiencies in Kenyas health sector for quality and affordable healthcare

The government insists that the country is facing a tight limited fiscal space to meet the doctors’ demands as per the 2017 Collective Bargaining Agreement (CBA).

Such narratives shed light on the challenging intersection of quality healthcare and financial constraints. They underscore the broader systemic issues within the healthcare system in the country, where economic barriers exacerbate health-related crises, plunging families into a state of destitution. 

Over the past few years, there has been a dedicated focus on achieving Universal Health Coverage (UHC) as a prominent goal in the country’s national development agenda. This commitment has been renewed, especially, in the current regime with the passing of four UHC laws: Social Health Insurance Fund (SHIF), Facility Improvement Financing, Digital Health and Primary Health Care. A move that breathes life into the sector. 

The proposed paradigm shift in the country’s health financing couldn’t have come at a better time. Evidence suggests that donors are moving away from the country following its change in status from a low-income to a low-middle income country. 

Though graduating from foreign aid is a commendable achievement, if not handled well, this transition could result in a reversal of gains made in the health sector. 

Analysis by the African Institute for Development Policy (AFIDEP) indicates that the 2.75% deductions from employed Kenyans through the SHIF could potentially double the total contributions from the more than Ksh. 60 billion collected by National Health Insurance Fund (NHIF) annually to Ksh. 125 billion. 

Nonetheless, if inefficiencies are not addressed, increased domestic resource mobilisation or more money for health may not ensure access to affordable healthcare by all. As per the World Health Organization, improving efficiency in healthcare systems has the potential to save 20 to 40 percent of current health spending. 

Loss of public healthcare resources, for example through false claims, should be addressed. Recently, Cabinet Secretary for Health Susan Nakhumicha admitted that tax payers could have lost Ksh. 20 billion through fraudulent NHIF claims in 2023. This is not an isolated case of misuse of public funds in the Ministry of Health. 

Other factors causing inefficiencies in the sector are higher than necessary prices for medicines, medical errors, fragmentation, sub-optimal quality of care, overuse of commodities, supply of sub-standard commodities, and medical errors.  

The roll-out of the Community Health Promoters (CHP) programme is commendable in efforts to realise UHC. However, focusing on enhancing their competencies and skillsets is essential over merely increasing their numbers. 

While a sufficient workforce is paramount, the quality of healthcare delivery hinges significantly on the proficiency of the individuals providing the services. Investing in continuous training and professional development ensures that healthcare workers stay abreast of evolving medical practices and technologies. 

CHPs should be provided with sufficiently stocked kits and also adequately and timely remunerated for their services. A good performance monitoring and review framework should also be in place to ensure that they effectively deliver on their responsibilities. 

Additionally, there is a pressing need for closer integration of health initiatives provided by different stakeholders to foster synergies, streamline resource allocation, and enhance the overall efficiency and health outcomes. 

This approach will minimise duplication of efforts and resources, and create a more cohesive and streamlined framework by avoiding overlapping activities and contributing to reduced administrative costs, leading to a more resilient healthcare infrastructure.

Finally, there is need to evaluate and adapt health programmes to ensure optimal functionality. Regular assessments and strategic adjustments are pivotal to maintaining a dynamic and responsive approach to public health challenges, ultimately fostering more resilient and adaptive healthcare systems.

In conclusion, the ongoing healthcare workers strike has exposed the dark underbelly of our healthcare system. The country should shift towards building a resilient and responsive healthcare system that guarantees citizens value for money through efficient services. 

With the sector currently in limbo, there is a need to commit to tangible actions that will ensure health for all remains more than just a lofty aspiration. 

The Author, Derick Ngaira is a Communications Officer at the African Institute for Development Policy (AFIDEP).