Barriers impeding universal health coverage in Kenya

Research shows that 32 per cent of Kenyans’ household health budget is financed out-of-pocket. file photo | nmg 

By CAROLINE MUNENE

Summary

• The rising cost of doctor consultations, medical procedures and drugs has pushed healthcare beyond the reach of millions of Kenyans.
• Research shows that 32 per cent of Kenyans’ household health budget is financed out-of-pocket.
• Government and non-governmental actors account for 31 per cent and 32 per cent respectively.

Universal health care is one of President Kenyatta’s Big Four agenda for his second and final term in office. The political goodwill to achieve quality, affordable healthcare for all Kenyans is not in doubt. Lacking however is an appropriate framework to address multiple barriers impeding universal health care.

The right to health is entrenched in our Constitution. Article 45 states that every person has the right to the highest attainable standard of health including reproductive health, and that no one should be denied emergency medical treatment. Universal health coverage is therefore anchored in our law.

The Vision 2030, the roadmap for Kenya’s transformation into a middle-income economy, also prioritises health as a major component of the social pillar.

So, what stands in the way of universal health coverage despite being so strongly anchored in law and policy? A careful analysis of our healthcare system reveals a cocktail of challenges hindering optimal delivery of universal healthcare.

First, majority of Kenyans cannot afford the high cost of treatment and medication. The rising cost of doctor consultations, medical procedures and drugs has pushed healthcare beyond the reach of millions of Kenyans. Research shows that 32 per cent of Kenyans’ household health budget is financed out-of-pocket.

Government and non-governmental actors account for 31 per cent and 32 per cent respectively. Health insurers finance only 13 per cent.

Given that Kenyans pay directly for a larger chunk of medical expenses, the surging cost of healthcare has had a direct adverse impact on households. The high prevalence of poverty aggravates barriers to healthcare by the majority.

Second, there is lack o f a clear legal framework as to how the costs of treatment and drugs are computed.

Third, public health facilities are under-funded. Government spending on healthcare is approximately six per cent of GDP. This is low compared, for instance, to education or infrastructure. State funding for the health sector needs up-scaling.

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With health now a devolved function, inadequate funding of counties imposes further financial constraints on the public health system. Throw in recurrent strikes by health personnel and one begins to fathom the enormity of the crisis facing Kenya’s health system.

Inadequate funding compromises quality and availability of health services. Dilapidated public health facilities force many Kenyans to resort to private health facilities which are often expensive. In addition, most public hospitals suffer chronic lack of drugs forcing patients to purchase these from private pharmacies.

The rising prevalence of non-communicable diseases like cancer has further strained the health system and impoverished many families.

Realising the government’s quest for universal health care will require targeted interventions. To begin with, we must streamline the costs health care provision including consultation fees and drugs. This will ensure cost predictability and curb exploitation of patients by unscrupulous health care providers.

A well-managed cost regime also encourages health insurers to lower premiums thus enhancing coverage. This would directly reduce the burden of health care costs on households.

The government should also increase health care funding at national and county levels while expanding and modernizing our health care infrastructure. Finally, we need to create incentives for healthcare providers to tame the escalating cost of healthcare.

Caroline Munene is Group managing director, AAR Insurance.