Road to UHC: What it will take to achieve health for all

As Kenya gears up to achieve universal health coverage by 2022, some say that the country is well on its way, while others point out gaps that have to be addressed to avoid derailing the train.

Universal health coverage (UHC) means every person irrespective of where they live and their socioeconomic status, has access to good quality health services without having to go through any financial hardship.

It has three key elements, namely: equity in access to healthcare in terms of geographic coverage and the range of available health services; high quality health services; and financial protection against any hardship to users of health services which may be arise from out-of-pocket payments.

Last Thursday during the Nation Leadership Forum dubbed Our health, Our future, Healthy Nation caught up with thought leaders in the health space, who shared their views on what it would take to make the UHC dream a reality.

What will it take achieve the much touted universal health coverage by 2022? Experts weigh in.

Dr Mwachonda Chibanzi

Deputy Secretary General, Kenya Medical Practitioners, Pharmacists And Dentists’ Union

What do we need to do to make UHC work in our context?

The essential pillars defined by the World Health Organisation are very straightforward: an efficient healthcare system, a financing strategy, a well-motivated, well-trained and efficient workforce, and access to essential medicines, vaccines and technologies.

If we focus on these pillars and involve all stakeholders and implement them, we can achieve UHC.

How can the government creatively raise the funds to drive UHC?

Financing has to come from government revenue first before we even consider tapping into resources from other stakeholders. If anything is to happen, the government must be at the frontline.

With the conflict between doctors and government, can you work together to make UHC a reality?

If there is a harmonised labour environment where we can soberly discuss issues with government, the unions can play a key role in sectoral reforms.

We are asking the government is to hear us out through the tripartite dialogue forum to reduce any conflict.

Sicily Kariuki

Cabinet Secretary For Health

What is this UHC that the government is promising us?

Universal health coverage does not mean that every service is accessible to everyone immediately. We have to make choices on where to start and add to that over time.

There is a set of guaranteed health services referred to as a Health Benefits Package. The selection of the package will take into account the best available evidence of what works, and how much it costs, with a focus on protecting vulnerable Kenyans and reducing healthcare disparities.

The Health Benefits Package Advisory Panel that was set up recently will work with my Ministry, county governments, and the public, to define the Health Benefits Package which will form the starting point of our UHC journey.

Kenya has many policies on health on paper, but they have not been implemented. Will the UHC push be one of those?

UHC has to work and you can take that to the bank. It has to work because we are implementing a constitutional right.

Moreover, there is reassuring political commitment from the national and county governments and partners who are working tirelessly to ensure that Kenyans have access to affordable and quality healthcare.

Thirdly, we are benchmarking with countries, such as Rwanda and Ethiopia, that have succeeded. We are not going to fail. We have experts on board and we must make it work. I have established a delivery unit to do nothing else but coordinate, support and facilitate all UHC-related work.

How will it work?

After the advisory panel completes its work, we will pilot UHC in Kisumu, Isiolo, Nyeri and Machakos.

The Ministry will diligently monitor the responsiveness of the chosen benefits package to the needs of Kenyans. This will inform scale-up of UHC to the rest of the country.

Dr Githinji Gitahi.

Group CEO Amref Health Africa and Co-Chair Of The UHC2030 Steering Committee

Why is UHC so important?

UHC is about justice. It is about ensuring that there is equity in health. We need to allocate the resources that will give us certainty to achieve universal health coverage, but allocation of resources is an area where Kenya’s light bulb is yet to turn on.

When we under-allocate resource to health services, we continue to delay our economic development, because health costs impoverish people. And if people are sick, they cannot earn; and if children are sick and therefore cannot learn, the cycle of poverty continues.

Yet, we cannot go on this way because economic development cannot be achieved unless a country has a healthy population. The country’s current budgetary allocation for healthcare is way below the Abuja Declaration of 15 per cent.

Contrary to the current allocation of Sh4,000 per person, to achieve universal health coverage, we estimate that we need to allocate Sh9,000 per person annually. That means the government must step up its game.

We need to prioritise financing for healthcare if the country is to grow and not wait for the country grow then allocate money to healthcare.

Do we have the money?

It is not a question of whether there is money or not, because it is there. The issue is what we do with the money we have.

Do you see Kenya achieving UHC by 2022?

This is very possible as long as we define UHC and design a realistic package which the country can afford. The problem is that everyone expects UHC to be everything; it can’t be.

We must ask ourselves, what do the youth, women, girls, migrants, pastoralists ... the most vulnerable want? What affects them the most?

From this we can define what they really need, then allocate money to meet this need progressively. We need better financing and better utilisation of the system.

There is no need to go to KNH for a cough; start with primary healthcare and be referred up if necessary.

Kivutha Kibwana

MakueniGovernor

Everyone is singing the praises of Makueni’s health system. How were you able to achieve this feat?

It was very simple. During a public participation process, the people of Makueni said that the most difficult challenge they faced was access to health services.

They said it was expensive, especially hospital admissions. So we sat down and looked at how much money families were paying to access health and realised that if each household of the 63,000 households paid Sh500, and we added the county’s contribution, we would get the money needed to cater for their health services.

When we rolled out the pilot for the elderly in May 2016, we saw that it works. So we decided to expand it to the whole county. Now, after a household pays the Sh500, their treatment, from outpatient, inpatient and even surgery is catered for.

This money covers the principal member, a spouse and children under 18 years or 24 years if the child is still in school. Sh500 is not much and the people have found it easy to pay it because they find it more affordable than NHIF.

The only thing we are not able to offer is specialised treatments like dialysis or dental implants.

Dr Kahaki Kimani

Ophthalmologist and senior lecturer, University Of Nairobi

Which pillars will help Kenya achieve UHC?

Human resource for health – these are the people we need to help us realise the agenda. We also need the infrastructure and community participation, because no matter how excellent health facilities are, if people do not access services from them, then UHC will not work.

What financing model can we explore to achieve UHC?

I believe Kenya can afford and is capable of giving quality healthcare to every Kenyan, but only if we deploy and use our resources wisely. The National Health Insurance Fund (NHIF) is a key pillar in driving universal coverage.

What should we focus on?

On areas that give the best return on investment such as immunisation and antenatal care. We also need to invest more in prevention and even enforce some aspects of disease prevention.

Kenyans have to own their health and take responsibility. Maybe people should be penalised for neglecting their health, for instance by paying higher NHIF premiums, if it is within their power to do better.

Do we really have a shortage of doctors?

There are enough doctors to cover every county even if the doctor to population ratio is not ideal. With task-shifting (delegating tasks to less specialised health workers) and improving the efficiency of how health facilities are run, we can manage.

Health workers need to be accountable for the use of resources including time. It is not a must for every hospital to have specialists permanently posted there.

Specialists can cover different hospitals on a rotational basis and teaching hospitals can be supported to offer specialist services in form of outreach.

Rate Kenya’s health system on a scale of 1 to 10 (with 10 as excellent)

I’ll give it a 5. We have an excellent primary healthcare system which we allowed to be run down.

Eritrea and Rwanda borrowed our template and are doing wonders with it. We need to revitalise our primary healthcare (health centres and dispensaries).

We are short on human resource for health, but we could do so much more if we were to cut down on wastefulness and ensure the workers remain motivated.

Also, so many of our facilities are underutilised. Just compare what mission hospitals deliver with fewer resources than government health facilities!

When politicians start seeking healthcare from government facilities, I’ll give our health system a rating of 9 out of 10.

Do you see Kenya achieving UHC?

UHC is not optional, it is a constitutional right. It is upon the government to find the quickest, cheapest and most efficient route to achieve it.

If the government consults the right people, this is achievable and painless, but only if the sticky fingers can be kept out of the UHC pot.

Suchitra Durai

High Commissioner Of India to Kenya

Many Kenyans go to India for healthcare. What is India doing right?

Both India and Kenya are developing countries, but in India we have an advantage in the sense that our doctors have been dealing with huge numbers of patients from all over the world, so they have attained a level of expertise.

Medicine is also extremely cheap because we make generic drugs of very high quality.

What can Kenya do differently to make healthcare affordable?

Upgrade and strengthen public hospitals to the level of private hospitals, because not everyone can afford the latter.

Kenya should strive to make its health system so good, that it becomes a destination for medical tourism in the region.