NHIF reforms plan will help deliver universal health coverage better

Health care is a unique service where compassion, altruism and economics combine in a single cause. By saving lives and fighting morbidity, we not only do something morally right but also help build more prosperous, productive communities.

Universal Health Coverage (UHC) is therefore a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities for shared prosperity of any nation.

It is based on the principle that all individuals and communities should have access to quality, essential health services without suffering financial hardship. On our journey towards UHC we aspire that every Kenyan will enjoy access to preventive, promotive, curative, rehabilitative and palliative health services at minimum financial burden.

The government has prioritised the achievement of UHC, christened “Afya Care”, as part of its Big Four Agenda. The UHC pilot phase is now on course, having been launched by President Uhuru Kenyatta on December 13, 2018 in Kisumu.

Other counties where the UHC pilot programme is being implemented are Machakos, Nyeri and Isiolo.

The Ministry of Health’s approach to achieving UHC is through removal of user fees at all public facilities, including levels 4 and 5 facilities, and ensuring commodity security through the Kenya Medical Supplies Authority (Kemsa).

The ministry is providing conditional grants to the four UHC pilot counties for health system strengthening and primary health care interventions.

With these additional resources, counties will be able to strengthen their primary health care networks, with a focus on preventative and promotive interventions.

The pilot phase is closely monitored in collaboration with the four counties. Notably, utilisation of health services has on average increased up to 39 per cent, which means that many people who were limited by their inability to pay can now access the services.

The proposed next steps in the pilot phase of UHC will include: increasing the uptake and utilisation of community health volunteers’ (CHVs) services; investing in standardisation of diagnostics; prioritising the National Integrated Identity Management System (NIIMS) programme for biometric registration of patients; strengthening the monitoring of health facilities under the UHC pilot phase; strengthening health systems in the 43 non-pilot counties; and ensuring efficient and appropriate use of health funds.

While the goals of UHC are straightforward, implementing and realising it will be a far more complex process — and although we may easily recognise the “why” of UHC, we must also address the “how” of UHC.

When people have to pay out of pocket, the poor are often unable to obtain essential health services and even the rich are exposed to financial hardship when faced with severe or long-term illness.

Pooling health funds through taxes, compulsory insurance contributions and voluntary health schemes helps to minimise the financial risk of illness across a population.

In other words, pooling health resources creates a safety net to ensure everyone can access essential health services, regardless of their socioeconomic status, and gives citizens greater financial independence.

Countries that have made significant progress towards UHC, such as such as Rwanda, Thailand and Japan, have leveraged the power of national social health insurance programmes to reach vast populations with equitable, quality health care.

In order to achieve UHC in Kenya, institutional reforms are paramount.

I have therefore instituted an expert panel to guide these reforms, and to ultimately strengthen the capacity of the NHIF to deliver UHC in an efficient, accountable and transparent manner.

Reforms will focus on improving the efficiency of the fund, ensuring financial sustainability and transparency, and enhancing equity to ensure that all Kenyans, regardless of their ability to pay, can enjoy social health security.

Similarly Kemsa will be reformed and repositioned to ensure the uninterrupted supply of quality, affordable medicines and to build its technological and operational capacity to forecast needs and manage logistics.

Moreover, UHC is not a journey we take in isolation. We are grateful for the support of the governments of Cuba and Thailand.

We look forward to maintaining our strong partnerships with the development partners community, partners from civil society and faith-based organisations.

And through the SDG Partnership Platform we look forward to exploring how we can bring private sector better along for the financing and delivery of UHC, especially primary health care.

While the government remains committed to delivering on this critical agenda, it is important to reiterate that it is the responsibility of every citizen to live a healthy lifestyle; educate yourself on good health practices and practise habits that prevent illness and promote well-being, such as handwashing and compliance to medical treatment; and timely seek health check-ups and health care services whenever necessary.

Ms Kariuki is the Cabinet Secretary for Health