Delivering the health promise to Kenyans

Most people agree we should have access to health services and not suffer financial hardship as a consequence of health-care costs. Universal health coverage (UHC), the concept that encompasses these goals, has gained wide attention and support in recent years.

The goals of universal health coverage (UHC) are to ensure that all people can access quality health services, to safeguard all from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for healthcare or loss of income when a household member falls sick.

Countries as diverse as Brazil, France, Japan, Thailand and Turkey that have achieved UHC are showing how these programmes can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability.

Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low-income and middle-income countries.

Four years ago the Government of Kenya focused public attention on the need for health system reform - to improve access to health facilities, increase the number of facilities and equipment, provide free maternity services, combat and manage major causes of illness in mothers and children, utilise ICT to enhance health service delivery and accelerate attainment of Universal Health Coverage (UHC) through reforms in NHIF.

To reduce the disease burden and eliminate geographic and financial barriers to accessing health services by Kenyans, the national government has consistently increased funding for the health sector to support innovative projects that are currently transforming lives across the 47 counties.

The true success of the Managed Service Equipment (MES), the Free Maternity Service, the elimination of user fee in primary health care facilities, the Beyond Zero innovations and public private partnership for health are the cornerstones of UHC in Kenya.

A key feature of UHC is the NHIF - the Health Insurance Subsidy Programme for the Poor (HISP) - and the Health Insurance Subsidy for Older Persons & Persons with Severe Disabilities and the Chronic Illness Care Package, covering hypertension, CT scan, Renal Dialysis, MRI, cancer, diabetes and Rehabilitation. Currently, 21.3 million Kenyans are now enjoying access to inpatient and outpatient covers and quality services up from 14 million.

Growing evidence shows the Government's focus on strengthening health systems has made a positive impact on access and uptake of some services and Kenya is making efforts to achieve UHC.

Kenyans now have access to increasingly innovative and specialised care, including improved diagnosis and treatment options that were not available in the past.

The evidence is the drop in death rate to 7/1000 population. More people are living longer, free of disability and disease. According to the latest WHO data published in 2015, life expectancy in Kenya is: Male 61.1, female 65.8 and total life expectancy is 63.4 which gives Kenya a World Life Expectancy ranking of 145.

The country has made great strides in improving the nutritional status of children. Kenya is the only country that has met 4 out 5 WHO nutritional goals. Stunting reduced from 35 to 26 per cent, while exclusive breastfeeding improved from 32 to 61 per cent.

The under-five mortality has declined from 115 to 52 per cent, translating to 30,000 children’s lives saved. Neonatal mortality has also declined from 33 to 22 per 1,000 live births over the same period. Vaccination coverage for fully immunised child has gone up to 76 from 68 per cent in 2013/14.

Maternal mortality has also dropped from 488 to 362/100,000. This represents 2,000 mothers lives saved. Primary healthcare utilisation has increased from 69 in the financial year 2013 to 77 per cent in 2016 as a result of foregone user fees.

Similar improvements have been made in HIV/AIDS, currently stabilising at below 6 per cent. Malaria prevalence has dropped from 14 per cent in 2010 to 8 per cent in 2015, TB treatment rate is 90 and 80 per cent in multi-drug-resistant TB.

The ability of these programmes to help achieve the country’s ultimate goal of UHC depends on the ability of the programmes to be scaled up and their long-term sustainability. We contend that UHC in Kenya can be achieved by addressing both supply and demand-side constraints simultaneously.

The solution must also include building on existing public and private institutions and informal networks, leveraging existing capital, and empowering clients and local communities.

The innovative models such as the Managed Equipment Service could be replicated in the planned cancer centres of excellence to achieve health-care and financial protection for all.