In the post-2015 development agenda, the world has committed to universal health coverage (UHC) and achievement of Sustainable Development Goal 3 – to ensure healthy lives and promote well-being for all at all ages.
This means that everyone everywhere should have access to basic health services irrespective of geographical location or economic status. In addition, the Kenya Government has committed to meeting constitutional requirements on health and implementing the health strategy contained in Vision 2030.
To achieve these goals, investment in a strong primary healthcare (PHC) system is necessary. Indeed, under financing of the health sector is one of the causes of its many problems.
It is notable that Government funding for the health sector currently accounts for 30 percent of total expenditure, yet 80 percent of the country’s population depends on this for their healthcare needs. Private insurance and out-of-pocket payments account for 36 percent of health expenditure, but these benefit only 20 percent of the population. The contribution of organizations such as Amref Health Africa, bilateral partners and other international donors, amounting to 30 percent of overall health expenditure, aims to fill the funding gap in the sector.
Yet this still does not fully meet the deficit in provision of UHC. In addition to chronic challenges, the recent events in the health sector are disrupting the desired health change. While we support devolution of health services, we note that the handing over of the services from the national to county governments has not been smooth, and that counties have had teething problems in taking over this responsibility.
Further, there is concern about the turbulence that human resource management in the health sector has faced, leading to recurrent health worker strikes both at county and national levels.
Most distressing, 80 per cent of Kenyans who depend on the public sector for health services currently have limited access to care due to the doctors’ strike.
This is especially being felt in poor, hard-to-reach and marginalised communities with no resources to access services in the private health sector. In consideration of the foregoing, an impartial multi-sectoral committee needs to be set up to mediate the current impasse between doctors and the Government to prevent more lives from being lost. For the sake of suffering Kenyans, both parties should have a level of flexibility in discussing a collective bargaining agreement.
The county governments, in conjunction with the national government, should conduct a thorough gap analysis at all levels to understand current use of existing human resources in the health sector.
The analysis should take into account all cadres of health workers – including community health workers, nurses and doctors –given the important role they all play in achieving UHC. Although Kenya prides itself in having a high number of skilled health workers, these may, however, not be available to those who need them most.
There is need for a revamped human resources policy that ensures equitable distribution, effective deployment, motivation and retention of health workers in the public health sector.
An audit of healthcare management capacity in the country should be done to identify managerial causes of the problems in the sector and develop an implementation plan to curb recurrence.
From our work across Africa, we have realised a critical need for Leadership, Management and Governance training for healthcare professionals to improve the quality of leadership within the sector and efficient use of resources.
The Government should accelerate discussions and implementation of public-private partnership initiatives for creation of sustainable models for healthcare financing to achieve UHC.
This should include using National Health Insurance as well as giving healthcare professionals, private sector players, community groups and investors opportunities to invest in healthcare and reduce reliance on the public sector.
Mechanisms for financial protection for the poor and vulnerable should also be put in place. Amref Health Africa is ready to support the Ministry of Health in any way necessary to get the health sector back on course.