The move by the government to implement Universal Health Coverage initiative is noble and long overdue. Yet, unless a sober approach is adopted to finance its risk, the attempt will prove futile.
To realise the full benefits of UHC, which includes enabling every Kenyan an ability to obtain essential health services (thereby alleviating poverty and increasing mortality rates), the government should review how the National Health Insurance Fund (NHIF) operates.
This is because the social insurer still remains the optimal platform to fund financial risks against illness and accident, especially for the poor. If well harnessed, and if its entire operation matrix is revamped, NHIF will provide the best gateway to actualise this goal.
For the fiscal year 2016/17 Kenya dedicated Sh73.6 billion, about seven per cent of its national budget, for healthcare compared to the 15 per cent recommended during the 2001 Abuja Declaration. About 10 per cent of the health budget was utilised by NHIF.
Gladly, for the past year, the Fund improved its services and rebates, even offering coverage against health complications such as diabetes, cancer and specialised surgeries.
Presently, it has 6.5 million beneficiaries, and the government seeks to double the figure within four years under the UHC programme. The coverage is expected to net about 40 million Kenyans if the principal member is approximated to have at least three dependants.
For NHIF, salaried employees remit mandatory premiums of up to Sh1, 700 monthly while there is a Sh500 voluntary scheme for the self-employed on a monthly basis. This is discriminatory to the poor who cannot afford the monthly premiums.
It is not lost that this premium collection model is basic and is no longer sustainable. A complete actuarial evaluation has to be undertaken in order to ascertain a more viable model that will sustain the social health insurer under the ambitious UHC initiative.
For example, a recent study by Kenbright Actuaries and Financial Services found out that Sh86.3 billion was needed if NHIF was to include HIV treatment in its portfolio.
This presents an opportunity for the management to seek smarter ways to pool more money. This includes introducing more ‘socially-acceptable’ health-related covers, and investing heavily on technology.
NHIF should borrow a leaf from local insurance technology (insurtech) startups that have developed products with premiums as low as Sh500 per year. With the right actuarial input, I am sure it can roll out micro-insurance covers that can hasten coverage across the country.
In fact, NHIF can be at the forefront in championing insurance coverage acceleration in the country that still stands at three per cent of the country’s GDP.
AN ACCEPTABLE MIX
Apart from a well-managed and a crisis-free NHIF, Kenya needs to put in place a health system that is efficient and strong. This includes an acceptable mix of responsibilities between the National and County governments when it comes to health matters.
The National Government cannot continue ignoring the primary and secondary responsibilities of healthcare, despite the roles having been relegated to the counties. This has caused considerable confusion among the stakeholders especially in better part of 2017 when the industry was grounded due to doctors and nurses strike.
Apart from its function of policy, research and regulation of the sector, the National Government is also responsible for Level Six hospitals — the National Spinal Injury Hospital in Nairobi, Moi Teaching and Referral Hospital in Eldoret and the Kenyatta National Hospital. Level 1 to 5 hospitals have been left to the responsibilities of the county governments.
For UHC to be fruitful, the government should also consider adopting bolder policy and leadership changes. This includes genuine political commitment and serious approach in addressing human resources gaps.
According to the Office of the Cabinet Secretary in charge of health, the country will need an additional 2,400 doctors and 55,200 nurses to plug this deficit. Also, 94 further referral hospitals are needed.
Lastly, the government should rope in the private sector. Some of the remarkable Public-Private partnerships (PPPs) in the past include a seven-year Managed Equipment Services Partnership (MES) with General Electric to provide Kenyans access to teleradiology services across 98 hospitals in all the counties, and the initiative with Philips and the United Nations to improve access to primary healthcare.
Through UHC, which is part of Sustainable Development Goals, every Kenyan is expected to obtain health services they need whether rich or poor. Presently, in some parts of the country, some of basic health care services such as family planning and infant immunisation are available.
Still, because four out five Kenyans do not have any form of medical insurance, most of them have to pay for these services out of their pockets, sometimes exceeding 10 per cent of their household income.
To accelerate UHC, to increase the rate of financial protection and to realise a drop in poverty due to affordable healthcare, the government should take a new approach on how NHIF runs its operations, and strengthen its capability in long-term financial risks management.