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Securing Kenya’s future with health insurance for all

COMMENTARY
By Cleopa Mailu | December 27th 2017

December 12 has now been confirmed by the United Nations as the World Universal Health Coverage Day. On this date, President Uhuru Kenyatta outlined his vision for the next four years in which Universal Health Coverage (UHC) is right at the centre.

As a country we are on the cusp of a promising future where no Kenyan will be denied medical care simply because they cannot afford it.  A future where “harambees” for medical expenses will be a thing of the past, and a future where Kenyans would not have to sell their land to pay hospital fees.

Kenya has made significant strides towards UHC. The reforms at NHIF are bearing fruit but the best is yet to come. We have successfully expanded the number of people with NHIF cover and also improved the services that NHIF members can access.

Over the next four years, the Government will roll out a transformational agenda under the banner of Universal Health Coverage. We aim to reach 13 million principal members from the current 6 million, which will get us to close to 40 million Kenyans under the umbrella of UHC given that each principal member would have an average of 3 dependants.

Gains

To date, over 181,000 households under the Health Insurance Subsidy Programme enjoy various health care benefits without discrimination. This is set to increase to 350,000 households by the end of 2018 and all older persons over 70 years who are slightly above 1 million will be covered. Additionally, we shall expand the Linda Mama programme (Free Maternity Service), which currently covers deliveries to include antenatal and postnatal care.

As a country, everyone must drum up support for enrolment for health insurance. This requires whole villages to understand that access and lack thereof to healthcare is a shared burden and UHC has mechanisms to cushion every single Kenyan. For this we shall require the support of village elders, administrators such as chiefs and county commissioners, church leaders as well as trade unions.

The role of county governments in the strengthening of devolved healthcare services comes to the fore. Each county should ensure essential services are accessible to all through availability of relevant infrastructure for diagnostics, theatres, and medicines. Every single Kenyan must be attended to by a qualified health professional and provided with necessary care.

At any given time, all 40 million plus Kenyans, major pandemics notwithstanding, will be entitled to some form of care. Critical drivers towards this include employing additional 2,400 doctors and 55,200 nurses. The number of referral institutions will be increased to 94 with each county having at least 2 specialized hospitals. For this to happen, the country will need additional 8 medical schools and 83 mid-level colleges to train human resources for health.

Combined efforts

 

The role of the private sector will be instrumental in this agenda. Privately owned healthcare facilities must be enhanced so that no one feels disenfranchised. The private sector will play a role in improving access to quality medicines without co-payments for all Kenyans. It will be such a shame to have infrastructure which cannot complete the treatment loop due to lack of quality affordable medicines.

UHC cannot be achieved without adequate financing. At least 7 per cent of the country’s total budget should be allocated to health. Although devolution has expanded the financial envelope, much more can be done to ring-fence the budgets for health to adequately finance health related needs at the devolved units.

The government has no intention to burden the same citizens it’s cushioning against catastrophic health expenditures with heavy taxation. We shall target the reallocation of marked taxes and introduce matched contributions for health insurance as some of the sources to finance UHC.

The ‘universality’ aspect in UHC is achievable here in Kenya. Already, initiatives such as Linda Mama are a testimony to the possibility of UHC. We do except that in the coming months and years, no single Kenyan would be without health insurance. We urge all Kenyans to support their parents and relatives to ensure that no one is left behind and that in every village, all Kenyans will join the UHC train.

Dr Mailu is the Cabinet Secretary, Ministry of Health

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