Achieving Universal Health Care

For many years Kenya has relied on external resources at the expense of generating local resources to fund the health care. The external resources can no longer sustain support on health. Global fund is still supporting health financing because of the burden on Malaria, HIV/AIDS and other diseases. However, Kenya was recently rebased from low income country to lower middle-income company which therefore means that the county will now be purchasing medicine at the market price. Do we have the resources to buy the drugs at the market price?

Kenya’s health financing envelope is progressing gradually but falls short of the 2001 Abuja Declaration, in which nations committed to allocating 15 per cent of their national budget to the health sector. In fact, Kenya was outperformed by some of its neighbours in the national budget allocation to health sector. In fiscal year 2016/17, Uganda allocated eight per cent of its national budget to the health sector compared to Kenya’s four per cent.

The new Kenyan constitution devolved responsibility for primary and secondary healthcare services to the newly demarcated 47 counties, leaving the national government to focus on policy and research. National allocation to Kenya’s 47 counties is based on a resource allocation formula that takes seven factors into account, including population, poverty, land share, and others. County allocations are given as block grants and counties determine the share to be allocated to health. County governments also collect some of their own revenue which are included as part of the county budgets before allocation to different sectors. In the Financial Year 2014/15, 38 of the 47 counties allocated at least 15% of their budget to health.

The challenges confronting the health sector range from the spread of non-communicable diseases to inadequate funding of health interventions. The devolution of healthcare services, coupled with the Bill of Rights, elicits huge funding demands, making the sustainability of gains made so far in the sector more complex. In 2015, the international community formally enshrined UHC in Agenda 2030, the Sustainable Development Goals, which will guide development efforts through 2030.

Universal Health Care

Universal health coverage (UHC) refers to access to needed health services and financial risk protection within a health system. UHC remains one of the key global health community commitments whose goal is to ensure all people obtain the health services they need without suffering financial hardship when paying for them. The drive for UHC is evidence-based: global evidence suggests that that well-functioning and inclusive health systems contribute to social cohesion, equity and stability as well as holding societies together thereby helping reduce social tensions. The opposite is true: catastrophic health expenditures can drive families and communities into poverty.

Among many policy options, UHC is one of the most powerful social equalisers available to overcome challenges of access to health care. Yet, achieving UHC is not a walk in the park. Available evidence shows that most countries are struggling to make progress perhaps because UHC requires a strong, efficient, well-run health system, an investment that most countries are unable or unwilling to make.

The Constitution of Kenya (COK, 2010) through the Bill of Rights recognises health as a primary right and tasks the health sector with the responsibility to realise this right. The right to health is also captured in other policy documents such as Vision 2030 and the Kenya Health Policy 2015 – 2030, which aim to provide equitable and affordable health care of the highest standards to Kenyans. These legal and policy documents, among others, signal the government’s commitment to ensure that Kenyans have access to quality, affordable health care. Yet, despite these commitments, significant disparities in access to care persist mainly driven by residence (urban vs rural), wealth index (rich vs poor), sex (male vs female) and regional variations.

Universal health care goes hand-in-hand with social justice, health equity and the nation‘s responsibility to uphold two basic human rights, the right to health and the right to social security as enshrined in our constitution. The first key issue the government should consider is how to balance the goal of health improvement and financial risk protection, this is because with the need for health improvement, the people of Kenya can face financial catastrophe to the extreme. The second issue the government should address is whether to have a universal approach where everyone is included or target certain disadvantaged groups for care. Although there have been health programmes targeted at certain populations, most of the services at both public and private health facilities do not

openly‘ discriminate between the better off and the disadvantaged groups, what matters is your ability to pay for the service.

To fully gain from devolution and the devolution of health services, county governments should continue to increase their allocations to health. But investments alone cannot fix the population’s healthcare needs or achieve the SDGs and universal health coverage. Counties will also need to focus on efficiency improvements, redirect personnel expenditures to free funds for priority interventions, and partner with public- and private-sector partners to avoid duplication and competition and relieve catastrophic health spending. Only then can Kenya achieve universal health coverage for its people and contribute the achievement of the SDGs.