Makueni County: For Sh500 yearly, all treatment, even surgeries are free

Kizito Mulili was knocked by a motorcycle and broke his tibia and fibula. He was hospitalised at the Makueni Level Five hospital where plates were placed on his leg. 

Even after being hospitalised for more than a month, Mulili is not worried about his costs being inflated or the inability to afford treatment.

“I only paid Sh500 for Universal Health Care which has catered for all my expenses. I paid for UHC in February and I haven’t been charged anything since,” says Mulili

It is also at this hospital, the largest in Makueni County, where Cecilia Mulewa has been nursing her husband, Daudi Mutisya, for four months now. Mutisya, 66, has been surviving on supplemental oxygen as he can’t breathe on his own. 

“He was earlier diagnosed with Tuberculosis which was treated and later got a chest infection and his stomach had an inflammation,” says Cecilia.

Oxygen is one of the expensive medical commodities and its scarcity has been worsened by the Covid-19 pandemic, but Cecilia hasn’t paid a penny in the last four months as everyone aged 65 and above gets free medical care regardless of their illness in Makueni County.

“The Kivutha Kibwana card has helped us. All laboratories fees were paid for and without it, I don’t know what I would have done. We were to be discharged but we can’t afford to buy an oxygen cylinder but my husband can get oxygen for free here at the hospital,” says Cecilia.

The Kibwana Card (named after Governor Kivutha Kibwana) is in reality the Makueni Care programme for which residents pay Sh500 annually. Makueni Care is not in competition with the NHIF card which residents are encouraged to have for accessing treatment outside Makueni, including other referral hospitals. 

Makueni Care has come in handy for residents like Muasya Muli, 65, who underwent surgery to remove inflammation on his tongue and didn’t pay a cent.

“My lab tests alone were Sh2,500 which was a lot to me and I paid nothing. We call it the governor’s card. It caters for everything,” he says, adding: “That card has been a lifesaver. Two months ago, my teeth were aching and two of them were removed, and it didn’t cost me anything. Now even if I have the slightest headache, I come to the hospital because I know it will cost me nothing.”

Makueni was one of the first counties to implement Universal Health Coverage through the Makueni Care programme.

Governor Kibwana explains: “We allocate our resources by ensuring there is no wastage and corruption and this way we can maintain the Makueni Care programme.” And Universal Health Coverage is more than just eliminating the out-of-pocket expenditure. “It is also about ensuring access to quality health care. This means that capacity in structural and resource must be increased to meet the needs of the people,” says the governor.

Makueni allocates more than 30 per cent of its budget towards boosting health care services.

“We are now formulating a policy and coming up with a law so that whoever comes after my administration knows that this financial scheme is what people have demanded. So unless there is a national system that will come and replace the Makueni Care, a governor won’t scrap it off lest they lose their position. This will ensure every person and the vulnerable continue to get care at only 500 shillings,” explains Kibwana

Dr Patrick Musyoki, the Chief Officer of Health Services, says the Makueni Care cover is to ensure residents have access to the highest standard of curative, preventive, and promotive health care, covering parents and all children under 18 or up to 24 years in case they are students.

So far Makueni Care offers free healthcare across board to residents who are also treated at local health facilities like dispensaries and sub-county hospitals which reduces overcrowding at the referral hospital.

Most Kenyans are one disease away from poverty and Makueni has helped many families evade poverty which occasioned by hefty hospital bills. In 2013, “poverty levels in Makueni were at 64 per cent as people sold their cattle, land and properties to afford hospital bills,” says Dr Musyoki adding that “we had only three theatres and now we are operating 14 theatres. We used to have very few specialists but now we have added more.”

Adelina Mwau, the Makueni Deputy Governor, says through Makueni Care, the county has brought health services closer to the people and what is more, Makueni is the only one with a gender recovery centre with the right personnel including a counseling unit in all 10 sub-county hospitals.

The genesis of Makueni care, Musyoki says, is from the roughly 200,000 households in 2016. The amount that was being collected from sub-county hospitals totaled to Sh80 million a year and “so if each household paid Sh500 we would have Sh100 million even more than what the county was collecting.”

This covers inpatient and outpatient services including surgeries, imaging or laboratories services that a patient needs and “if a patient dies or a family loses their loved ones, Makueni Care also caters for the first 10 days the body will be in the morgue” says Musyoki adding that while “previously the health-seeking behavior was very poor but now people are coming to hospitals early to seek services.” This includes more women attending antenatal clinics including all four scheduled clinics during their prenatal stage and thus boosting maternal and infant healthcare. 

“We are now getting an influx of patients from neighbouring counties,” says Musyoki. “Women are coming all over even from Nairobi to give birth in Makueni.”

Unfortunately, the insurance only applies to Makueni residents and outsiders have to pay out of pocket. 

“We are now investing heavily in the community health strategy. We have now developed a policy,” explains Musyoki. “We are also investing more in preventive services so that we scale down on our curative services then we can have a sustainable health system in Makueni County.”