By 2022, all persons in Kenya are expected to have access – as and when needed – to quality and essential health services through a single unified benefit package without the risk of financial hardship. This is in line with a directive made by the President of Kenya on 12 December 2017, whereby achieving Universal Health Coverage (UHC) by 2022, is one of the top development priorities for the country alongside food security, affordable housing, and manufacturing – together popularly known, as the “Big 4 Agenda”. This has seen Kenya being lauded as a trailblazing regional leader by the WHO Director-General, Dr. Tedros Ghebreyesus during his recent visit to the country at the UHC pilot launch. This coincided with the WHO Global Management meeting on how WHO can achieve its ‘Triple Billion’ goal ( of 1 billion more people benefitting from UHC; 1 billion more people better protected from health emergencies, and 1 billion more people enjoying better health and well-being).
The current global momentum around UHC didn’t start with Dr. Tedros, as you know. UHC, at its best, can be a fundamental approach to the right to health but increasingly it’s also seen as a core factor in achieving economic progress and strengthening social and political stability. This is especially crucial in low and middle-income countries like Kenya whereby children, adolescents, and young people will be the key recipients of health gains.
Achieving this will not be a “bed of roses”, however. Significant health system challenges remain, which need to be comprehensively addressed if health for all Kenyans is to be realized by 2022. Some of these you find below.
Challenges to achieving UHC
1. An underperforming health system
Kenya is one of the countries listed by the WHO as having a critical shortage of health care workers, with only one doctor for every 10,000 people. Growing disgruntlement by health workers about their workplace environment has led to frequent strikes, the longest being 100 days in 2016/17. Frequent stock outs due to weak supply chain management and inadequately equipped health facilities are more common than they should be. Funding levels for health have decreased from 6.4% of GDP in 2010 to 5.22% in 2015 while there has been a rise in out-of-pocket payments from 28.84% of current health expenditure in 2010 to 33.36% in 2015. Poor quality of health service delivery is being showcased by an inability to perform basic infection prevention practices such as hand-washing (shown to be performed in only 2% of cases when it is indicated). In addition, issues of medical errors and hospital-acquired infections have led to increased hospital expenditure and public mistrust of public health facilities – not exactly what you want on the journey towards UHC.
These health system limitations further demonstrate the gaps that UHC reforms would need to fill, to ensure that the expansion of service coverage and financial risk protection is not undermined by shortcomings in the delivery and quality of care.
2. Weak prioritization of Primary Health Care
It’s fair to say that Kenya, like (too) many other countries, hasn’t focused enough on Primary Health Care (PHC) in the past. Over the years, investment in specialized services and construction of new facilities got priority, leaving basic primary health care on the sidelines. This has only made it harder to reach the most marginalized, in most need of healthcare. Despite the efforts made, such as free maternity care and the abolition of user fees in primary health care facilities, challenges in governance, sustainable financing, and weak regulations have all impeded PHC (till now).
Seizing the current momentum
While acknowledging these challenges, a number of opportunities exist to turn this around, and the time is ripe to do exactly that. Recognizing the urgency to improve the health and well-being of millions of Kenyans, there is a need to take advantage of the:
1. Strong political will
Recognizing that UHC reforms are an inherently political process, the directive to achieve UHC by 2022, by the President of Kenya is an opportune window for all relevant stakeholders to rally behind. After the launch of UHC in 4 pilot counties in December 2018, this year will be crucial to strengthen community participation and accountability and generate evidence to drive a stronger and more resilient health system, in preparation of the country roll-out phase scheduled for next year (2020).
2. Renewed commitment to achieving PHC
The Astana Declaration saw renewed commitment towards achieving Primary Health Care. The recognition of primary health care as the most efficient and cost-effective way to achieve UHC, as advocated by WHO, provides a driving force towards increasing efforts in this area during Kenya’s journey to UHC. This has seen Kenya sign a deal with Cuban doctors in the hope of narrowing the human resources gap and strengthening PHC, the latter an area in which Cuba excels. Of course, this has led to a fair amount of contention (but let’s keep this perhaps for another blog).
Furthermore, the increased attention towards formalization of community health workers (CHWs) as crucial members of the health workforce, is an opportunity to boost coverage and effectiveness of PHC. CHW programs have been shown to contribute to improved outcomes in child nutrition, maternal health, HIV and TB care. Strengthening the CHW system will thus be an important step on the journey towards UHC.
3. Innovation and Technology
Health innovation adds value in the form of improved effectiveness, efficiency, affordability, quality, sustainability and accountability in health systems. Kenya, a growing technology hub, has a platform to develop and strengthen technology needed to monitor and predict disease outbreaks, accelerate disease diagnosis and extend access to specialized medical knowledge among others.
Kenya’s UHC journey has started and both the national and global community have high expectations. The private sector will also be involved in UHC implementation, among others promoting innovative products, processes and funding mechanisms, increasing access to services and improving equity and quality of services. Clear regulation of the different partnership models will therefore be necessary to avoid any conflicts of interest and ensure the interest is focused on improving the health and well-being of all Kenyans. Last but not least, it will be key to ensure implementation takes a multi-sectoral and participatory governance for health approach, capitalizing on partnerships and addressing the broader determinants of health as these are all equally important to achieve UHC by 2022. Our long distance runners are well known all over the world.
Likewise, let’s hope Kenya will indeed become a regional trailblazer, causing a UHC ‘ripple effect’ in the region in the years to come.