Is healthcare for all Kenyans a pipe dream or real possibility?

This is the country I would love to live in: one that recognises health as a right by guaranteeing all Kenyans the highest attainable standard of healthcare services. In fact, this is the right guaranteed in our Constitution.

Current and previous governments have promised universal healthcare, but accountability on delivery has been lacking.

Kenya is not the only country facing challenges in implementing universal healthcare: Rwanda, Uganda, Ghana, Nigeria and the US, among many others, have committed to universal healthcare with varying degrees of success.

The World Health Organization defines UHC as a situation where all people have access to the health services they need without the risk of financial hardship when paying for them.

The Government has underlined its commitment to the health agenda by introducing free maternal health services and eliminating user charges in lower-level facilities. This is noble progress, but implementation has been challenging, with complaints from public health facilities about delays in reimbursements for services provided, which then affects ability to meet increasing demand.

Funds mismanagement

The journey towards UHC faces strong headwinds, including inefficiencies at the National Hospital Insurance Fund (NHIF), with its high administrative costs and allegations of mismanagement of funds. While donors would like to provide more structured support through NHIF, its past has created mistrust. Significant reform of the institution, or its disbandment and formation of a new organ, is imperative to regain the trust of Kenyans, development partners and other stakeholders.

Kenya has also not met its commitment to the 2001 Abuja Declaration, when member states of the African Union committed to increase government funding for health to at least 15 per cent of national income. Our devolved system of governance has introduced a new conundrum, where the overall budget allocations and spending for different sectors are not clear.

Kenya’s ability to increase its health budget is also affected by challenges in tax collection, with a significant section of the population yet to be placed under the tax net. A large informal sector also makes collection through payroll or income tax deductions challenging.

To fund UHC, we should consider selecting a viable health financing mechanism, which may include external assistance. At least 30 per cent of the health financing in Kenya is derived from development partner programmes. Harmonising this support — which is currently fragmented with different donors adopting different approaches — and directing the aid to areas where it will have substantial impact and aligned to national priorities, is critical in realising the UHC dream.

Countries such as Rwanda and Thailand have proven that UHC can be a reality, even for developing countries; what may be lacking is universal commitment and the political willpower to achieve healthcare for all.

The writer is a senior manager in management consulting with PwC Kenya. He specialises in consultancy services to the health sector.

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