Borrow leaf from Rwanda to make universal health care succeed

President William Ruto with his Rwandan counterpart Paul Kagame on the sidelines of COP-27 in Sharm El Sheikh, Egypt, on November 6, 2022. [PCS]

The theme of this year’s Mashujaa Day celebrations that took place in Kericho County was Universal Healthcare Coverage (UHC); one of the five priorities in the Kenya Kwanza government’s bottom-up transformation agenda.

The UHC is firmly based on the 1948 World Health Organisation (WHO) constitution which declares health as a fundamental human right and commits to ensuring the highest attainable level of health for all.

In September 2019, the United Nations General Assembly endorsed a global health and foreign resolution policy urging member countries to ensure that everyone, everywhere should easily access quality and affordable healthcare by 2030.

Kenya, which is among the 193 member states, launched the programme in 2018 and piloted it in four counties namely Machakos, Isiolo, Nyeri and Kisumu. The national roll out for all the other counties, however, never took off.

The government of Rwanda has made progress in developing and decentralising a community-based healthcare system which has greatly reduced child and maternal mortality rates while increasing life expectancy up to 69.9 years from 51.2 years in 2002, making Rwandans live at least nine years longer than the majority of other East Africans. What lessons can Kenya learn from Rwanda as far as achieving the UHC is concerned?

First, a well-motivated human resource is critical in strengthening the healthcare system in any country. According to the Kenya Medical Practitioners, Pharmacists and Dentists Union, we have a 1:17000 doctor-to-patient ratio. This is way below the 1:1000 recommended by the WHO.

Rwanda has around 45,000 community health workers who work in health centres, hospitals and in rural and remote areas. These workers are paid based on a performance contract which motivates them to work hard. They always work towards civic education, providing essential drugs and vaccines for all. Counties should embrace this model and employ enough personnel to provide health services.

Secondly, we should invest in technology. Rwanda has prioritised digital technology as a key enabler in achieving positive health outcomes, particularly in data collection, tendering processes of vital equipment, registration in their health insurance schemes etc. Kenya must embrace technology as a matter of urgency in most of our healthcare systems operations to ensure efficiency.

Third, healthcare financing. In 2001, African governments made a pledge in Abuja to allocate at least 15 per cent of their annual budgets to health sector. This was later named the Abuja Declaration.

Rwanda has met this target by devoting 17 per cent of the government resources to finance their health services. They have also come up with several laws to ensure their healthcare system is well financed.

Kenya has also tried this by introducing a bill in Parliament that has already been passed by legislators - the Facilities Improvement Financing Bill 2023. The objective is to allow the management of public health facilities to retain all the money they raise or receive for improvement of services and facilities across the country which has not been happening.

Last, fighting corruption. Kenya has hard major corruption scandals such as the Kemsa billionaires’ saga. According to a report by the Ethics and Anti-Corruption, bribery and favouritism remain the main forms of corruption witnessed in the procurement of projects in the country’s health sector.

We must benchmark from Rwanda, a country that has continuously promoted transparency, integrity and accountability within her pharmaceutical and healthcare sectors.

Let’s borrow a leaf from Rwanda and ensure we have strong political will to implement all the new laws that have been proposed recently in a bid to assist the county in achieving a better healthcare system for all citizens in line with Article 43(1a) of our Constitution.