Why Kenya is inching closer to universal health coverage

Nyamira governor John Nyagarama (left) and county director of medical services Jack Magara (centre) when they received medical equipment worth Sh150 million donated to the county hospital early this year. PHOTO | BENSON MOMANYI 

By CLEOPA MAILU

In Summary

• Equipping county and referral hospitals is easing disease burden.

Health is inseparable from human development. The development of a nation depends on the health and well-being of its people.

Many international declarations and commitments attest to this as is well amplified in the United Nations millennium development goals which Kenya has undertaken to achieve.

The great health challenges of today — among them infant, child, and maternal mortality, malaria, HIV and non-communicable diseases — all impact on the capacity of people to survive and thrive.

Advancing better health is a gateway to development. And development is a gateway to improving health.

Since independence, Kenya has steadily worked to improve the health of its 40 million plus people, more than half of whom live in rural areas.

However, the economic crisis of the 1980s coupled with the HIV/Aids pandemic in the 90s aggravated the limitations Kenya faced in providing quality care across the population.

These limitations included providing healthcare services to geographically dispersed populations, ensuring access to healthcare providers in critical regions and securing appropriate financing to sustain and increase the healthcare infrastructure at the national and county levels.

Along with tackling persistently high levels of infectious diseases, such as tuberculosis, HIV/Aids, and malaria, Kenya has seen an increased prevalence of chronic illnesses such as diabetes, cancer and cardiovascular diseases.

In 1994, the government produced the Kenya Health Policy Framework paper, which set forth a vision of providing “Quality healthcare that is acceptable, affordable and accessible to all” by 2010.

Our healthcare system has evolved with the changing needs of the population. The health policy, the Constitution and Vision 2030 serve as our roadmap towards increased access, quality and affordable healthcare for all Kenyans.

To reduce the disease burden and eliminate geographic and financial barriers to accessing health services, the Treasury has increased funding for the sector to support innovative projects which are currently transforming lives in the 47 counties.

Through the health policy the government is committed to the principle of universal health coverage by diversifying financing options that include progressive elimination of out of pocket expenditure, especially for marginalised and indigent populations and providing essential basic health services to its citizenry.

Our healthcare financing system, comprising subsidies, elimination of user fee in primary health facilities, the free maternity services and the managed equipment service project, has helped keep healthcare affordable, especially for the lower and middle income Kenyan, while ensuring sustainability.

Through the Sh38 billion managed equipment service project (Tiba Mashinani), Kenyans are enjoying access to uninterrupted, quality specialised health services in 47 counties and four national referral hospitals.

To date, we have installed 144 digital anaesthetic machines in 85 hospitals, 129 digital sterilisation machines in 95 hospitals,55 intensive care unit beds in three public hospitals, 28 high dependency unit beds, 94 digital X-ray systems in 94 public hospitals and 48 digital mammography units in addition to 174 dialysis machines in 26 hospitals.

The dialysis capacity has been enhanced by 522 sessions per day countrywide. Indeed, specialised diagnostic and treatment services have been devolved closer to the wananchi and in the near future, Kenyans will no longer need to travel abroad for specialised treatment.

To increase human resources for health the Kenya Medical Training College (KMTC) has developed 56 new campuses in 37 counties up from 31 campuses in 25 counties, raising student enrolment to 40 per cent.

This is a major step in empowering young people acquire clinical skills as well as promote equity in access to medical education opportunities. We endeavour to have KMTC footprints in every county.

These efforts to improve healthcare since 2013 have also contributed to major improvements in child and maternal health indicators. Deaths of children below five years have declined from 74 to 52 per 1000 live births and infant deaths from 52 to 39 per 1000 live births.

Doubled deliveries

In addition, maternal deaths have come down from 488 to 362 deaths per 100,000 live births translating to 2,000 mothers saved from pregnancy and child birth related death annually.

Through the free maternity services programme, we have doubled deliveries in health facilities from 600,323 in 2013 to 1.2 million in 2016 and increased primary healthcare utilisation from 69 per cent in the financial year 2013/2014 to 77 per cent in 2015/2016 as a result of foregone user fees. Similar improvements have been made in HIV/Aids that is currently stabilising at below six per cent.

Because of distribution of 14 million arthemether — combination therapy doses, and 12.6 million long lasting insecticide treated mosquito nets, the number of households owning treated bed nets has increased to 63 per cent from 44 per cent, cutting malaria prevalence from 14 per cent in 2010 to eight per cent in 2015.

Through the National Hospital Insurance Fund (NHIF), we endeavour to reduce spending and increase access to health services to previously marginalised population.

Through the health insurance subsidy programme for the poor and the health insurance subsidy for older persons and persons with severe disabilities many Kenyan’s now have access to inpatient and outpatient covers.

Whereas there is still ground to be covered, the government is making good its health promise to Kenyans and is committed to achieving universal health coverage as well as other targets.

The ultimate goal of achieving high quality of care will require strong partnerships between the national and county governments, development partners and the private sector.

Dr Mailu is the Health secretary.