Uhuru Kenyatta’s ‘golden baby’ UHC still struggling to crawl

In December last year, while on his death-bed, Dr Stephen Mogusu managed to contact the Nation. 

In a long message, he left behind a grim, yet detailed picture of what President Uhuru Kenyatta’s ‘golden baby’ -- the Universal Health Coverage (UHC) programme -- had become. 

All the gallant frontline warrior wanted was for things to be better for many Kenyans as well as the doctors seeking affordable health services, but eight months after his death, things seem to have gone from bad to worse.

“I contracted the virus ... sasa niko (I am in) self-isolation ... I have never seen death this close in my life…” were some of the last sentences he could piece together before the virus overpowered his body.

The young doctor died before he could earn his first salary.

Dr Mogusu was one of the 200 medical doctors deployed to counties in July 2020 under the UHC programme to serve in county Covid-19 isolation wards.

Like his colleagues then, he had not received his salary for the five months he served at his duty station in Machakos.

The father of one also did not have medical insurance, despite working in a high-risk centre, which predisposed him to infection with the very virus he was fighting. And when he tested positive for Covid-19, there was no bed for him there.

Big Four agenda

In 2018, the country adopted UHC, one of the Big Four agenda for empowering the nation.

Four pilot counties, namely Isiolo, Kisumu, Machakos, and Nyeri were selected because, according to the government, they are characterised by a high incidence of both communicable and non-communicable diseases, maternal mortality, and road traffic injuries.

In 2019, then-Health Cabinet CS Sicily Kariuki said the programme had expanded health services to 3.2 million Kenyans in a period of 12 months.

Mr Kenyatta stated that his aspiration was to ensure Kenyans become able to use the essential services they need for their health and wellbeing through a single unified benefit package, minus the risk of a financial catastrophe, by 2022.

This was to be done in pursuance of the human right to health as guided by the 58th World Health Organization (WHO) World Health Assembly held in 2005, which urged member countries to aim to provide universally accessible health care to all members of the population based on the principles of equity and solidarity.

The human right to health as enshrined in Kenya’s Constitution 2010 is part of the development agenda outlined in Vision 2030.

The model adopted is a two-phase medium-term approach, which, in the first phase, is expected to abolish all user fees at the primary level (local health centres) and the secondary level (county referral) hospitals.

The second phase is the rollout of a social health insurance scheme.

The funding comes primarily from the central government budget, which from the word go, set aside between Sh4.4 billion and Sh4.9 billion for UHC.

The government considered various sources of funding, such as taxes and reallocation of funding from other budget areas.

Health system

Kenya also sources funding for certain elements of the health system, like monitoring and evaluation from partner organisations such as the World Bank.

Unfortunately, UHC is nothing to write home about, according to doctors, nurses, counsellors and administrators. 

“UHC is a flop, this is not even debatable. If you look at those of us deployed to county hospitals under this programme, they lack basic things, basic lab tests. The common people are forced to go buy drugs, and sometimes syringes, so that we are able to attend to them. Healthcare is just too expensive and that only shows you that UHC is as dead as a dodo,” a doctor in charge of a Covid-19 Isolation centre in one of the county hospitals explained.

The doctor further added that contracting issues between national government, counties and other partners when it comes to recruitment of doctors and nurses is plagued by trust issues.

“They took people on renewable contracts for six months, when the contract elapses they take over three months to renew it, which means you remain out of work. Some of my friends employed in counties tell me they have gone for three months without pay,” he said.

Dr Davji Bhimji Atellah, the national secretary general & CEO at Kenya Medical Practitioners, Pharmacists and Dentists' Union (KMPDU), blames the failure of the UHC on what he describes as ‘overall confusion’.

“There’s a lot of confusion in the roles counties are playing as well as the roles the Ministry of Health is playing. As a solution, we suggest they come up with a centralised unit, so that, for example if Machakos County needs 200 doctors, it is the body that delivers, takes charge and manages the programme so that this way, we will have effective management and accountability.

“Governors know that there is a lot of money in healthcare to pay doctors and healthcare workers but they cling to it as much as they cannot deliver and this is where the kickbacks and cartels come in,” he added.

The union official believes President Kenyatta had a good vision but his team has terribly failed him.

“The technical team that was tasked to execute the implementation has failed him. If you compare to what Nairobi Metropolitan Services (NMS) has achieved in only a year, they can’t match.

“Dr Ouma Oluga and his team have birthed more than 24 new centres that are fully operational in Nairobi and have employed over 200 doctors,” the doctor highlights.

Budgetary allocations

Dr Collins Kizito Matemba, the CEC for Health in Kakamega County, believes the national government has trust issues.

“The national government delays on budgetary allocations and therefore, things get tricky. The government does not trust counties to manage the programme, while they take on an advisory role because health is a devolved function, which is why we have two factions of health workers under UHC, those on national government payroll and those on county payrolls, and there’s a lot of confusion there,” he explained to the Nation in a telephone interview on Monday.

But according to Dr Andrew Mulwa, the director for Medical Services, Preventive and Promotive Health at the Ministry of Health, if people understand the ‘dummy’ pilots they can then rate the scorecard.

“After 100 per cent testing in the four counties, we took lessons and scaled up with input financing. All 47 counties have 11,000 healthcare workers that are already on board as part of health strengthening, community volunteers where we have trained 90 per cent of them. We probably lost a lot of visibility when we moved to the third phase which is output financing.

“In third phase, it means you get the services and I pay for the services that have been offered and this we have done through National Hospital Insurance Fund (NHIF) registering a million low income households between October last year and now,” Dr Mulwa, who is the creator of the UHC programme, told the Nation.

“At the moment, we are moving to automate incident registration, which is what we call biometric registration. So far, out of the one million that registered, 800,000 have accessed services using NHIF, but our target is to register at least 10 million Kenyans under the UHC programme,” he added.

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