For Kenya to defeat poverty, universal health coverage is a must

Tuesday, 12 December 2017 10:15 GMT

ARCHIVE PHOTO: A child is given an injection as part of a malaria vaccine trial at a clinic in the Kenya coastal town of Kilifi, November 23, 2010. REUTERS/Joseph Okanga

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Ill-health is a substantial burden on Kenyan families and on Kenya’s economy

Today is 12 December, an auspicious day that marks Kenya’s independence from colonial rule in 1963. Today is also Universal Health Coverage Day and the first anniversary of the United Nations resolution calling for affordable, quality health care to everyone, everywhere.

In Kenya, every day families are forced to sell their assets, rely on community support or see their modest life savings wiped out by medical bills. Every year, nearly one million Kenyans are pushed below the poverty line due to healthcare expenses.

Ill-health is a substantial burden on Kenyan families and on Kenya’s economy. Out-of-pocket expenses in Kenya make up a third of the country’s total health expenditure, far above the World Health Organization’s suggested 15 or 20%.

Universal health coverage should be [viewed] as a rights issue,” said Dr. Tedros Adhanom Ghebreyesus, the Director-General of WHO. “Many families are getting into poverty because they are spending their savings for health care services.”

Approximately four out of every five Kenyans lack access to medical insurance, meaning that most are just an accident or illness away from destitution. Among the poorest, only 3% have health insurance, this provided by the government’s National Hospital Insurance Fund (NHIF). This rises to 42% of the wealthiest fifth where private cover is also more common. Additionally, there are stark disparities between rural and urban populations, where rates of coverage are an average of 12% and 27% respectively.

Kenya's President Uhuru Kenyatta takes oath of office during inauguration ceremony at Kasarani Stadium in Nairobi, Kenya November 28, 2017. REUTERS/Thomas Mukoya

Towards reducing the inequalities, the Kenyan government has abolished payments for primary and maternal health services in public facilities, thus increasing utilization and improving outcomes, particularly among the poorest. President Uhuru Kenyatta at his inaugural speech emphasized, “Over the next 5 years, my Administration will target 100% Universal Healthcare coverage for all households”.

Devolution of health care to county governments should also ensure better resource distribution, accountable health services and improvements in equity that will eventually help decongest the overstretched Referral Hospitals.

Those steps notwithstanding, and as long as 33.6% of Kenyans survive on less than US$1.90 per day, millions will still not access quality healthcare.

Affordability is not the only barrier. Lack of public awareness, high loss ratios due to fraud, and reluctance among insurers to underwrite cover for the poor are also important.

Health insurance contributes only about 13% to national health expenditure, with the balance made up of out-of-pocket expenses at point of treatment, government and tax revenues, and donor funding. Such statistics undermine Kenya’s ability to achieve universal health coverage, enshrined in Kenya’s Vision 2030 and Sustainable Development Goal 3.

Technology can process claims and enable healthcare consumers and providers to interact more efficiently, while offering more customized products to people of all incomes. Efficient storage and sharing of patient data could reduce the cost of care by, for instance, tracing false claims, preventing repeat tests, or avoiding misdiagnosis.

Technology can also offer substantial savings in administration costs, which currently swallow a staggering 40% of the NHIF’s revenue, far in excess of the industry norm of 3-4%. Effective IT systems would help to reduce this disparity, as would improved governance and transparency. A lack of analytical capacity hobbles the NHIF’s ability to forecast and respond to increasing costs, hindering strategic planning and development.

However, such innovation must be accompanied by increased efficiency in health spending, through partnerships with institutions working to improving access to healthcare for the poor, and through policy dialogue between government and other stakeholders.

Ultimately, sustainability demands increased investment in preventive care and primary health. Diverting cash away from the 60% of the health budget that currently goes to curative care will pay dividends.

Launching the country’s SDG 3 Platform with the United Nations in Kenya, in New York during the UN General Assembly in 2017, Kenya’s Cabinet Secretary for Foreign Affairs Dr. Amina Mohamed remarked, “As a government we have clearly prioritized the Universal Health Coverage agenda because it is one of the ways to protect our people from the consequences of out-of-pocket health expenditure which in Kenya forms about a fifth of family spending”.

This Independence Day, let us join hands to free every Kenyan from the tyranny of poverty by achieving universal health coverage. It is a foundation for economic development and prosperity.

Siddharth Chatterjee is the United Nations Resident Coordinator in Kenya. Githinji Gitahi is the Global CEO of Amref Health Africa.

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