How to make healthcare cheap for all Kenyans

Kenya has made significant strides towards attaining universal healthcare in recent years. A fundamental pillar is the Constitution, which asserts every Kenyan's right to quality and affordable healthcare. Various Government policies like Sessional Paper No. 12 of 2012 on Universal Health Care have sought to enhance access to healthcare by all.

Political commitment to attaining universal health coverage - defined as provision of quality, affordable healthcare across the population - is not in doubt. What is however lacking is an appropriate framework to tackle multiple barriers to universal healthcare. Overcoming these policy and institutional hurdles is critical in ensuring that every Kenyan can access quality and affordable healthcare.

First, Kenya's health sector is highly under-funded. Although the State has committed 15 per cent of the annual national budget to the health sector, the actual funding has stagnated at around 6 per cent for the last five years.

The implication of this is that the burden of funding primary healthcare has tended to lean heavily on the private sector accounting for about 36 per cent of total funding compared to 30 per cent each for government and donors.

Under-funding of the health sector has resulted in dilapidated health facilities across the country. Inadequate supply of essential drugs and non-pharmaceuticals coupled with old equipment prone to frequent breakdowns has severely constrained the public healthcare delivery system.

Second, corruption, poor management and insufficient skilled manpower have created inefficiencies in the health sector as evidenced by high levels of waste and inability to reach out to the most vulnerable segments of the population. It was expected that devolution would address some of this issues. Unfortunately, things have worsened with counties blaming the national government for not providing sufficient funding.

Third, there is the issue of rising cost of healthcare. Like the public sector, private-sector driven healthcare has its own challenges. These include high service charges, provider-induced utilisation of services, and over-servicing of patients on a fee-for-service basis. Insured patients are often subjected to and billed for unnecessary medical procedures thus increasing the overall cost of service delivery.

Consequently, medical insurance firms have been forced to hike premiums in order to remain financially viable. And where premium hikes become untenable, they resort to decreasing members' benefits. This has resulted in an increasing number of members exhausting their benefits way before the end of the year. The situation is worsened by fraud and exorbitant non-health-related administrator fees. All these factors have conspired to hamper uptake of medical insurance in Kenya.

To address these challenges, government needs to partner with private sector and other stakeholders in formulating a coherent framework for universal health care delivery. Obviously, heavy investment in the health sector is required to improve facilities and supply of essential inputs like drugs.

This will entail increasing budgetary allocation to the health sector to $52 per capita as recommended by the World Health Organisation.

Tackling corruption affecting public health procurement and service delivery is crucial to enhancing efficiency and accountability. Tougher penalties for fraudsters will help stump out malpractices in the industry and reduce the cost of healthcare thus improving uptake of medical insurance. Enactment of the Health Bill 2015 will also help in smoothing the path to universal health coverage.

Among the raft of reforms proposed by the Bill is the creation of integrated national health insurance system including provisions of social health protection.

Overall, there is need for public-private partnerships that address the challenges outlined above.

Such partnerships will help drive policy reform and collaboration in identifying and implementing health sector priorities.