Experts say health budgets are not serving Kenyans

Millicent Mandera, 23, remembers feeling dizzy and feverish while teaching four months ago. She stepped out of the school to go to the nearest medical facility for treatment. It was a Level 4 hospital in Kitale.

“I was so weak when I got to the hospital. I suspected I had malaria but I let the medical worker take the tests first. There was no doctor at the facility, not even a clinical officer, but there was a nurse. She insisted that I had to take a pregnancy test, so I complied. It turned out negative and so I took another test and it was confirmed that I had malaria,” Ms Mandera said yesterday.

“After the test, I was told there were no drugs but I was given the prescription and told to go to a chemist in town,” she added.

While Millicent is one of the lucky Kenyans who may have some money to buy medicine, many Kenyans miss out on treatment in such instances. 

The Kenya Primary Health Care Strategic Framework (2019-2024) wants to ensure Kenyans are spared from out-of-pocket spending when accessing health services.

“There should be an increased uptake of health insurance, establishment of a sustainable mechanism for resource mobilisation and alignment of existing health insurances to primary health care and Universal Health Coverage (UHC) needs,” states the framework.

However, data from the Health Ministry shows that UHC as well as free primary health care get only 5.9 per cent of the Health budget. It is the least financed in the health sector. The eight semi-autonomous government agencies under the ministry receive the bulk of financing (61.9 per cent) as per the 2020/2021 financial year.

Lack of funds

Sabina Ombwayo, who works as a community health volunteer in Korogocho, Nairobi, said lack of funds is wrecking their efforts in offering primary health care to residents with no pay.

“I manage about 100 households, all of which I have to visit every month. Ever since I started working as a community health volunteer, this is the first year that I have received payment of Sh3,500,” she said. Her job also puts her health at risk.

“Sometimes, we go to areas where we need protective gear but we do not have money to buy even something as basic as gloves. Our security is also at stake, especially in slum areas, but we keep doing this to save lives,” she explained.

Dr Rose Oronje, the Director of Public Policy and Translation, who is also in charge of Kenya’s African Institute for Development Policy office, told the Nation that despite the Health budget rising steadily over the years, the country is still not meeting its commitments.

“If we have a goal to improve the country’s Health sector, a huge chunk of the money should go to primary health care. Instead of waiting for people to go to the hospital for treatment, we should invest in engaging them in preventive measures,” she said.

The country’s Health budget in the current financial year is about 11.1 per cent of the total, which is below the 15 per cent recommended more than 20 years ago in the Abuja Declaration. 

With health being a devolved function, counties are allocating about 28 per cent of their budgets to health.

“Health devolution is great, but the planning can be improved. So far, we have only devolved the power but we have not increased the money. This should have been done progressively so that we can learn lessons from other people,” she said.

She added: “Devolution is good for primary health care because services are brought closer. At the moment, most experts in counties do not understand health financing, and training ought to have been done. Data is also an important aspect that can inform decision making.” 

For the devolution of health to work, Dr Oronje believes that ramping up healthcare at level 1, 2 and 3 facilities is critical. “We can only get value for money by investing in things that give a better return to our overall health in our country,” she said.