As Kenyans marks the World Health Day tomorrow under the theme “universal health coverage: Everyone everywhere,” residents of counties where the Universal Health Coverage (UHC) was rolled out last year have complained of lack of coordination in service delivery.
John Mbuthia and his wife shared their frustrations after attending a prenatal clinic at a local dispensary after they were referred by a physician. Mr Mbuthia said they spent five hours waiting to see a doctor, and were later told to purchase drugs from a private chemist.
“I had my NHIF card and referral documents but was told to line up despite the medical emergency as they struggled to verify my UHC status,” he complained.
UHC is currently being piloted in Nyeri, Machakos, Isiolo and Kisumu counties.
Under the programme, the public can walk into a primary health care facility and access available services for free.
In case of a referral, including specialised treatment, UHC still caters for the patient’s bill including pharmacy and ambulance services.
Nyeri County Director of Health Service Nelson Muriu described UHC as “access to all the services available within that facility offered at no cost to the patient.”
“In an ideal situation, the patient should get the services they need at the primary health facility, however if the service is not offered in a public hospital then the patient is referred to a private facility,” he explained. A visit to the Nyeri Referral and Mukurweini Sub County Hospitals revealed that the CT scan machines were not working.
This means that patients are referred to private hospitals that charge as much as Sh7,000 for the tests. Hundreds of patients queued as their UHC status was verified.
As at March 10, a total of 697,343 people had been registered. This is 84 per cent of the county residents.
It has been four months since the programme was launched.
In a stakeholders meeting to assess UHC progress, one of the issues raised was increase in the outpatient services and decrease in the number of people paying for health insurance.
Since the roll out of UHC programme in the county, the health care facilities had registered an increase of 55 per cent in outpatient services.
In Kisumu, implementation of UHC is in jeopardy after Kenya Medical Supplies Agency (Kemsa) threatened to slash funds for the next quarter to clear a Sh77.5 million debt.
Kemsa reported that the outstanding debt which accumulated during the 2017-2018 financial year will reduce county health budget for the next quarter which begins this month. This means the county will reduce the purchase of pharmaceuticals and other medical facilities.
Kemsa Western regional sales and marketing executive Kenneth Bukachi said they are targeting the next quarter UHC allocation of Sh127.5 million to clear the debt.
Dr Bukachi noted that the agency has written demand letters and even visited the governor to deliberate on the same but nothing has been forth coming.
“We have been writing demand letters quarterly, but received no response from the county officials,” he said.
The county UHC allocation for quarter one was Sh127 million.
However, the official revealed that despite the huge debt Kemsa has continued to supply commodities worth Sh158 million.
“We supplied above the allocation which was based on their promise that they will pay on time, we did retain their orders because of the debt,” noted Bukachi. He explained that the county administration is free to make orders in the next UHC quarter but they will start by slashing the outstanding debt and then supply commodities worth the remaining balance.
Kisumu County health executive, Rosemary Obara, said Kemsa has not supplied lab reagents and items for oncology and renal facilities.
“We are working around the clock with the department of finance to ensure that the debt is cleared and does not affect UHC implementation,” Ms Obara said.
UHC plan is expected to be rolled out in the country in October and Kemsa said the initial batch of UHC money allocated in the counties will be used to settle outstanding debts. In Machakos, County executive committee member for Health Ancent Kituku said about 950,000 cards for residents who applied for the program had already been distributed across the eight sub counties, and are already in operation.
The county government had targeted to enroll up to 1.3 million residents for the pilot program. According to Dr Kituku, major infrastructural systems had been earmarked for upgrade as well as expansion of human resource capacity to deal with increasing demand for quality healthcare.
“We are upgrading six health centers to level 4 hospitals and constructing 40 community hospitals to absorb the current and future demand,” said Kituku.
The CEC noted that Machakos level 5 had been equippedwith a renal unit, four theatres, an ICU, HDU, diagnostic lab, eye unit, diabetic and ENT centres.
Governor Alfred Mutua announced plans to procure eight advanced trauma life support ambulances to respond to medical emergencies.
[Lydia Nyawira, Mactilda Mbenywe and Erastus Mulwa]