Under UDA, even the poorest and most vulnerable will have access to high quality medical services

If one were to express Kenya’s economic character in the form of a graphic design, a triangular pyramid would emerge.

It would be divided into three portions. The top comprises a very small percentage of Kenyans who can access cheap credit at rock-bottom negotiated rates, say 10 per cent per annum. They access the best healthcare services.

The middle slim portion comprises the middle class, who get credit at the market rates. They have medical insurance covers to meet their health needs.

At the bottom are millions of Kenyans who cannot qualify for credit. They have no medical insurance and depend on fundraisers whenever some medical emergency arises.

Good plans

UDA has laid out good plans for these Kenyans at the bottom on matters of healthcare.

Health systems models in the world can be categorised into three forms: single-payer, socialised, and privatised-regulated.

In a single-payer system, the government provides universal insurance but the actual care is by private practitioners and hospitals.

The socialised system is one where the government both provides insurance and runs the hospitals. The United Kingdom's health system is a version of this model.

The privatised but regulated healthcare systems within the EU are exemplified by Germany.

Citizens earning below a threshold must take health insurance and their unemployed spouses and dependents are also covered without any extra cost.

Above this threshold, employees may buy private insurance. In Switzerland and the Netherlands, health insurance is mandatory and provided exclusively by private providers.

The government subsidises the premiums through taxes, making it possible for even low-earning citizens to afford health insurance.

The problem of under-investment in health is not uniquely Kenyan. Sub-Saharan Africa has 13 per cent of the world’s population but shoulders a fourth of the world’s disease burden.

The region accounts for only one per cent of global health expenditure.

A majority of Africans have a per capita income of below $2 a day. Private spending accounts for 60 per cent of all payments on healthcare.

However, half of the private healthcare expenditure is taken up by private providers, and 40 per cent of the lowest-income people in Africa pay for care from for-profit providers.

In Rwanda, national health insurance covers more than 90 per cent of the population, whereas less than nine per cent are covered in other African countries.

Ghana has a National Health Insurance Scheme (NHIS) and built a public-private partnership network to reach areas that lack public health services. Funded through taxation, the NHIS covers most common diseases.

All residents must enrol and pay an annual premium, in return for free care. About a quarter lack any insurance, however.

Almost 70 per cent of those insured do not have to pay premiums. In Kenya, we have a similar national health insurance programme.

However, NHIF premiums make this cover inaccessible to most citizens.

Enrol more families

To strengthen NHIF, UDA, through our leader Deputy President William Ruto, has pledged to set aside funds to enrol more families into NHIF.

Under UDA’s proposals, counties and the national government will set aside funds for this scheme.

If a county government sets aside funds to enrol poor families into NHIF, it can always claim back the sums invested once the public seeks healthcare services in its facilities.

The actuarial reasoning underpinning this model is sound, as the NHIF pool is large because this is a national fund.

The public hospitals are incentivised to improve their efficiencies as they are competing with the private sector to serve patients under the NHIF model.

The poor and vulnerable under the segment funded by the government can access specialised expensive care under this model.

This system is more sustainable as compared to the single-payer healthcare model practised by Makueni County or piloted by the government in 2018-2020 in four counties.

The single-payer model is hinged on the efficiency of the government. This is an unrealistic goal in Kenya.

The number of public hospital attendees shot up during the trial runs.

The range of medical services available to patients under this model is limited.

Services rendered under this model are usually only to those available in the public sector. Makueni medical card, for example, cannot work outside Makueni.

However, there is room for improvement notwithstanding the merits of the proposed NHIF model as proposed by UDA.

NHIF Information Technology systems and corporate governance systems need to be strengthened. NHIF still requires that claims be processed through manual forms.

The NHIF board needs to consist of very qualified policymakers with a diversified skillset.

Procedures for recruitment of vulnerable families to be supported by the government needs to be transparent and open.

The NHIF needs to enhance its benefits, including introducing a pharmacy benefit scheme to hedge against the lack of essential medicines in public hospitals.

But with UDA, it is possible to achieve 100 per cent NHIF coverage in Kenya.

Dr Kang’ata teaches law at the Catholic University of Eastern Africa and is the Murang’a senator. He is a former Senate Chief Whip.