Road to UHC - Universal Health Coverage isn’t free healthcare
UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
What you need to know:
- Kenya’s progress towards UHC was marked by the enactment of four acts.
- The healthcare reforms are meant to set Kenya on a path to Universal Health Coverage.
Most Kenyans heard that they would access healthcare services for free following the unveiling of Universal health coverage in October 2023.
A resounding commitment from the President as he assented to four health bills.
Then began the whispers of contribution payment with 2.75 per cent deductions from salaried employees.
The confusion set in when it was confirmed that contributions would not only be from those in formal employment, but those employed in the informal sector. For the latter group, the contributory process wasn’t clear.
It was apparent that Universal Health Coverage (UHC) would not be free, certainly not in the way most Kenyans had come to believe.
But what is UHC? Is it a vision, a mission or simply a campaign promise?
As always in such cases, it is useful to start with a comparison with a country geographically not very far from ours, which has already succeeded in what we are now attempting. In this case, Botswana.
In sub-Saharan Africa, Botswana is a country that has attained Universal Health Coverage. Healthcare services are available at almost no cost to citizens.
Botswana’s health system remains dominated by the public sector with most services being rendered in public healthcare facilities.
The healthcare system is based on a primary healthcare model and according to Botswana’s Ministry of Health, health posts and clinics make up approximately 95 per cent of government health facilities.
Despite most of its population living in rural areas, people have access to public care. According to Unicef, an estimated 84 per cent of Botswana’s population lives within 5 kilometres of a health facility, while 95 per cent reside within a 15-kilometre radius of the nearest health facility.
According to a 2016 Health Policy Project funded by USAID, Botswana’s government funds the majority (57 per cent) of health expenditure with 54 per cent of government spending coming from domestic sources.
Therefore, reliance on donor funding isn’t as extensive, serving as both on and off-budget support.
Direct donor support is perhaps directed to program-specific initiatives such as HIV, TB and Malaria.
Healthcare infrastructure
While healthcare expenditure is also pooled through private healthcare insurance schemes, it was estimated to account for 39 per cent of the expenditure according to the report.
This means the out-of-pocket expenditure on health is minimal, estimated at less than 4 per cent. A stark contrast to Kenya’s healthcare expenditure breakdown where the majority is out-of-pocket.
Therefore, the country’s commitment to advancing healthcare is seen in its allocation of a significant portion of its budget to healthcare infrastructure.
According to the World Health Organisation, Botswana’s success can be seen in the establishment of an extensive network of primary healthcare facilities, focusing on preventive measures and ensuring essential services are readily available, including community outreaches.
Additionally, Botswana has made strong efforts to extend coverage under the public system to rural areas through mobile services. The current system of tax-financed health services has been successful in pooling risk, contributing to reductions in catastrophic expenditure and promotion of equity in health.
Botswana doesn’t have free healthcare, some services might be free, but most aren’t.
But the citizens enjoy healthcare services without having to sell parcels of land or travelling day and night to get care, as most do here in Kenya.
This brings us back to what is Universal health coverage (UHC)? As per the WHO definition, UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.
It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
Kenya’s progress towards UHC was marked by the enactment of four acts. These include the Primary Healthcare Act, Digital Health Act, Facility Improvement Financing Act and Social Health Insurance Act.
These ambitious healthcare reforms are meant to set Kenya on a path to Universal Health Coverage.
However, the regulation, operations and implementation processes remain to be the elephants in the room.
In this column, we seek to answer some of the questions on Kenyans’ minds and ask some of our own on this road to universal health coverage.
Follow more UHC conversations weekly on one health lens podcast: https://nation.africa/kenya/audio
Dr Wangari is a medical doctor; [email protected]
