Reality of inadequacies hits ministry ahead of nationwide UHC rollout

Massive staff shortages and inadequate medical specialists are just some of the challenges the government will have to grapple with in the countrywide rollout of the Universal Health Coverage (UHC).

A recent national audit of health workers’ skills by the Human Resource Development Unit of the Health Ministry showed the country to have less than a quarter of the doctors and nurses it needs to actualise the much awaited UHC.

Of the 138,266 health workers the country requires for UHC to succeed it only has 31,412 in the private and public health sectors. Only 15 per cent of the required specialist skills are available in public and private facilities and almost all are based in major urban areas.

In the brief, ‘Human Resources for Health; Gaps and opportunities for strengthening,’ the ministry says Kenya risks missing the UHC and other health targets due to huge health worker shortages.

“The acute shortage and mal-distribution of healthcare workers has been contributory to the long-term decline of care, and now stands in the way of achieving crucial targets.”

Consequently, the ministry has suggested redistribution of health workers from areas of high density to underserved communities.

The ministry blames inadequate infrastructure, bad working conditions and low salaries for the poor retention of health workers in the public sector.

In the brief, the ministry says a third of public health employees reported not being satisfied with their current employers. The main causes for disillusionment include low, delayed and rarely reviewed salaries and lack of or delayed promotions and few training and development opportunities.

But the promise to employ more workers and improve pay packets may be a tall order considering most counties are yet to comply with the current Collective Bargaining Agreements (CBAs) for health workers.

But Health Cabinet Secretary Sicily Kariuki says the government is planning major staff redistribution and rationalisation to cope with demands of the UHC programme.

Ms Kariuki has promised three major changes in the next phase of UHC that include health staff rationalisation, price controls for essential medicines and a contributory scheme through the National Hospital Insurance Fund.

Last Tuesday Kariuki said the UHC piloting phase which ends this month had ‘spurred unprecedented demand for medical services rising by 40 per cent.”

The four piloting counties, she said had only managed to cope with the influx through the filtering of patients through the referral systems and increasing delivery of medical products.

But to cope with a similar demand in the planned national UHC scale up, CS Kariuki said a well "articulated and resourced health provider master plan will be required."

“The plan will involve rationalisation and redistribution of healthcare workers to balance delivery of health services,” said Kariuki.

Kariuki was presenting, ‘Kenya’s Statement at the 72nd World Health Assembly’ last Tuesday in Geneva, Switzerland.

Her statement, the first such public disclosure on the ongoing UHC piloting was well received at the highly packed UN plenary session.

Kariuki said for effective scale-up of UHC the counties must provide for adequate and well-resourced healthcare providers.

In a meeting between the ministry and governors held in Naivasha in April it was agreed that due to the huge demand created by free health services there was need to increase the number of health workers.

It has been suggested that recruitment and distribution of highly specialised health workers be centralised such that they could be managed from a shared pool with their skills distributed as and where required. 

The CS said the staff rationalisation will address both geographic distribution and the case of emerging non-communicable diseases. She also gave the first glimpse into how the next phase of UHC will be financed.

The current UHC phase is being financed through donor grants and loans amounting to about Sh5.1 billion mainly from the World Bank, Japan and Denmark.

Unlike in the piloting where all patients get free care, the next phase will be financed through contributions to the NHIF with the government subsidising for maternity care, the poorest and disabled persons.

However, Kariuki hinted that this will be a transitional arrangement as the government moves to a fully tax funded UHC in future.

“The NHIF is being reformed, and it is anticipated Kenya will adopt a mixed health financing model while transiting to a tax financed social insurance fund,” Kariuki told the UN. The CS also said her ministry is in the process of implementing the Health Act 2017 which, provides for the established of a single regulatory body for all medicines and health technologies.

The law, which has met strong opposition from various interest groups, provides guidelines on the pricing, procurement and distribution of medicines.

“The Act outlines a new regulatory framework to propel UHC and access to essential medicines through managed and harmonised product pricing within a transparent framework,” said Kariuki.