Poor planning reason why UHC collapsed after consuming Sh4b

Lydia Wangeci is busy taking care of her ailing husband at her Majengo village home in Nyeri County.

Apart from her bedridden husband, two of their children are epileptic and need close supervision and Wangeci’s own health is also not good as she has high blood pressure.

Wangeci, 68, worked hard to hide her frustrations under a broad smile when The Standard visited her home. However, sadness is written all over her face.

She had been put on blood pressure drugs but she defaulted.

“Doctors have prescribed drugs for us but we cannot afford them. I rely on casual jobs such as weeding people’s farms and washing clothes in homes which do not fetch much. I cannot afford the drugs,” says Wangeci.

Wangeci says needs Sh700 per month for her treatment. “We don’t have this kind of money. I even stopped thinking about it.” 

Wangeci, her husband and their children are among hundreds of patients who enrolled for the Universal Health Coverage (UHC) the national government launched in 2018.

When he unveiled the initiative on December 12, President Uhuru Kenyatta declared UHC a priority and made part of his ‘Big Four Agenda’. 

Under this initiative, the government would make strategic investments to ensure Kenyans access essential health services. And the way UHC was marketed, health services would be free of charge.

The UHC concept started in the 1970s and 2000s when Southern and Western European countries introduced universal coverage. They build on previous health insurance programmes to provide health coverage for their entire populations. 

Under UHC, the central government would offer health services to everyone regardless of their ability to pay.

Wangeci says she was elated when the UHC was rolled out in Nyeri, one of the four counties the programme was piloted.

The problems her family faced, being unable to access health services for lack of money, would finally come to an end. Or so she thought! 

She was treated for the first time under UHC, a rights-based approach to healthcare, in 2019. Yet that marked the last time she received government health services under that arrangement. Patients were required to register for UHC to access services free of charge at the point of use.

The rollout of UHC in Kisumu, Nyeri, Isiolo and Machakos was meant to be representative of almost the entire country in terms of geographical location and disease burden. 

The government pumped Sh3.9 billion into the UHC pilot with a focus on strengthening health systems and basic as well as specialised medical services. Isiolo received Sh725,719,086, Kisumu got Sh876,121,279, Machakos was allocated Sh787,524,789 while Nyeri received Sh780,801,105.

The project was meant to ensure Kenyans access health services without the risk of financial hardship. The piloting, funded by the national government, was to run for one year before UHC is rolled out in other counties.

Machakos, Nyeri, Kisumu and Isiolo were, after the pilot, expected to intergrade UHC into their health systems in a model that would be adopted by the rest of the counties.

The Health ministry went ahead and integrated UHC as a goal in the Health Sector Strategy. It was believed that by achieving UHC, Kenya would eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies and reduce financial hardship linked to illness.

But more than a year later, UHC appears to have run into headwinds, leaving many poor Kenyans struggling to access basic healthcare. And there is no word from the government on the future of UHC.

Most people stopped their monthly payments to NHIF believing UHC would fully take care of their health needs. This has affected NHIF financially through which the government hoped to finance UHC. Those who defaulted can longer use their NHIF cards to pay for services.

David Munene, a community health volunteer, noted many patients are suffering in their homes. “Many people defaulted their NHIF payments after UHC was rolled out. Now, they can’t get treatment,” said Munene, who oversees Majengo and Nyeri town units. 

In Kisumu, many patients with UHC cards said the only things they don’t pay for is consultation and diagnosis.  “But we still have to buy medicine in private chemists. Most people cannot afford it,” a Kisumu resident Yvonne Ogolla said.

There is an acute shortage of medicine across public hospitals which has also compromised the goals of UHC.

Hassan Galma, from Wabera village in Isiolo, blamed the lack of medicine in local hospitals on the influx of patients from neighbouring counties. Most of these had registered for UHC.

“Our hospitals lack drugs because the demand is high. Most residents of Isiolo did not register for UHC as they thought those behind the programme were only playing politics,” said Galma.

In Isiolo, only about 190,000 people enrolled for UHC. Records at the health department show Isiolo has a maternal mortality rate of 790 deaths per 100,000 live births against 362 deaths nationally.

Health executive Wario Garma said health professionals are working with the 760 community health volunteers in Isiolo to sensitise women on the importance of antenatal clinics. “We are also encouraging women to deliver in hospitals and take up immunisation as well,” said Garma.

To enable the county to transition into UHC, the assembly has drafted a policy titled ‘Facility Improvement Fund’ expected to enable the introduction of healthcare charged through UHC.

Machakos has successfully adopted UHC into its health system. “Today, I just had an X-ray that would have cost me Sh6,000. I just presented my ID card and no one asked me to pay anything. This is the Kenya we want,” Judy Muchoki told The Standard at Machakos Level Five Hospital.

Of its Sh12 billion 2021/2022 budget, Machakos has allocated Sh4 billion to health. At least 1.2 million people were registered under UHC in Machakos. Of this, 35,000 inpatients have been treated under the initiative in addition to 3.5 million outpatients.

Health executive Ancient Kituku said increased allocation to the health docket was deliberate. “Although the national government stopped, we have sustained the programme through our budgetary allocations,” said Dr Kituku.

Ministry of Health’s report titled ‘UHC Progressive report’, says the UHC project was also meant to increase enrolment of people into health insurance.

A recent report by NHIF revealed while 10 million Kenyan households have enrolled with NHIF, only 5.6 million were active by May.

The national insurer’s CEO Peter Kamunyo said the model of financing UHC is input financing. Here, health facilities are provided with everything they need for UHC members to access free treatment.

“The best way to sustain UHC would be to have members who can pay their premiums annually do so then we identify those who cannot so they can be supported,” Dr Kamunyo said.

Kamunyo constant need for inflow of cash, under the input financing model, is a big challenge. “The alternative would be to scale up UHC so patients can have access to a network of providers, impanelled by NHIF, where they can get treated then the hospitals can claim reimbursements from the insurer.

Under the UHC piloting, the role of NHIF was to register people and provide them with cards.

In the arrangement, the government plans to raise and use Sh30 billion to support at least 20 per cent of indigents, translating into about 1.5 million Kenyans, so they can enrol in NHIF.  

“Medical insurance is important because one transfers the risks. That is why it is crucial that all Kenyans are members of NHIF; we provide social protection,” said Kamunyo. 

In a UHC progress report, Health CS Mutahi Kagwe said the attainment of UHC has remained elusive due to unequal access to healthcare services and poor distribution and use of resources. 

Efforts to get a comment from the ministry and Council of Governors were futile as officials did not respond to our phone calls and texts messages. 

mkahenda@standardmedia.co.ke