Crucial factors to making the universal health care dream work after missteps

Countries that employ multisectoral approaches are better able to identify and address health issues. [iStockphoto]

Over ten years ago, Kenya adopted the principles of Universal Health Care (UHC), declaring that its citizens have a right to access affordable quality health services.

Over 44 years earlier, Kenya had also committed to the Abuja declaration, which requires countries to put in at least 15 per cent of the national budgetary allocation to health.

The highest health budget allocation the country has had to this day stands at 11.1 per cent in 2022/2023. The 2023/2024 allocation rounded off the figure to 11 per cent.

Despite these shortfalls, President William Ruto believes the country has what it takes to implement the UHC programme fully. But does it?

It is worth noting that over five years ago, the government under President Uhuru Kenyatta implemented piloted UHC in Nyeri, Machakos, Kisumu and Isiolo. The counties were selected due to the unique health needs of their populations.

Nyeri due to its high burden of non-communicable diseases, Machakos due to road traffic accidents, Kisumu due to malaria and infectious diseases, and Isiolo for high maternal mortalities.

Nyeri terminated services soon after the launch, citing financial constraints, while Kisumu was a non-starter. Machakos and Isiolo achieved an uneventful conclusion.

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In his speech after signing the UHC Act, Ruto acknowledged the flopping of these programmes but said the government will address these challenges.

"This time around, we decided to create a firmer base based on legislation," said Ruto.

A key challenge experienced during the pilot programmes was underfunding. For UHC to actualise, the government needs to allocate the recommended 15 per cent of the national budget to health, and not the four to six per cent it routinely allocates.

According to the Kenya Medical Association, resource allocation and mobilisation, oversight, and lack of accountability are the key challenges in achieving UHC in Kenya.

There also emerged a need for targeted data collection to identify and curb emerging health threats and implement local interventions like community-based surveillance.

"Development of a national health data system will enable policymakers to provide targeted healthcare budgets and services for highest impact and easy address of any emerging barriers to health equity," says Antony Mveyange, a researcher and development economist with interest in health.

"Efficient healthcare means looking at health at the community level, and not simply waiting for people to show up at the hospitals," says Dr Rose Oronje, the head of African Institute for Development Policy, Kenya.

"Countries that employ multisectoral approaches are better able to identify and address health issues," she says.

"Poor nutrition, poverty, lack of proper housing, insufficient education, environmental pollution, and poor transport all contribute to poor health outcomes. The government must also look into all sectors to make UHC successful."

Also crucial to making the dream work, citizens must be educated on their role in acquiring and updating their insurance premiums and prioritising self-care to reduce disease burden.