Ideas & Debate

Let’s put patient at the heart of universal health

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Picture a scenario where accessing affordable health care was as ‘easy as pie’ – simple and pleasant with patients not having to shuttle from one medical facility to another or enduring unbearable financial strain in paying for treatment.

You are essentially referring to Universal Health Coverage. According to the World Health Organization, Universal Health Coverage (UHC) means individuals, families and communities receive the health services they need without suffering financial hardship. This covers the full spectrum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.

Achieving UHC is one of the goals set by the international community when unveiling the Sustainable Development Goals in 2015. Universal health is seen as a way of cushioning people from poverty by not having to pay for health expenses out-of-pocket, especially in cases of sudden illness that could easily wipe out their financial assets.

Available data reveals that owing to low insurance penetration, about 25 percent of all health bills in Kenya are paid out-of-pocket. UHC is one way of reducing the financial risk to families due to disease.

Given its hugely transformative impact, UHC cannot be left to the government alone. It requires support from communities, civic society, development partners and the private sector. As they say, it ‘takes a village to raise a child’ and for UHC to work, everyone must be involved. Fortunately, our Constitution entrenches public participation as a core tenet of decision-making at both national and local levels.

Following previous unsuccessful attempts, UHC finally took off in Kenya in 2018 with a pilot in the four counties of Machakos, Nyeri, Isiolo and Kisumu. The pilot phase focused on access to basic and specialized services with inputs like health products and medical technologies (HPTs), human resources for health (HRH), basic equipment and community health services.

With the completion of the pilot phase, UHC has since June 2020 been expanded to other counties. In addition to the main components in the pilot phase, the expanded version also includes primary care networks. In 2021, the UHC Insurance Scheme will come into effect, managed by the National Health Insurance Fund.

The envisaged universal insurance scheme will also cover poor, vulnerable Kenyans. National and County governments will identify the vulnerable Kenyan households to be covered through the contributions made through the eligible contributors.

Expanding universal health coverage in Kenya is timely given the disruption Covid-19 has inflicted on the health system. As the rising numbers of Covid-19 patients continue stretching out health facilities, there is a worrying trend of people avoiding hospitals for fear of contracting the virus.

And even for those who seek treatment, it is a long wait for hospital beds especially in ICU. A Covid-19 diagnosis means a protracted affair with patients having to be seen by chest specialists and radiographers, receive critical or home-based care, and even counselling. The financial and emotional burden on families is onerous.

The silver lining in the gloom of the pandemic is in how it has amplified the role of technology in health care. Specifically, the use of a blended model combining brick-and-mortar with technology so that where one is not able to visit a health facility, treatment is done remotely.

As we roll out the UHC programme, we need to integrate innovative approaches like blended care in expanding coverage to vulnerable groups, particularly those with chronic conditions requiring prolonged management.

UHC could not have come at a better time. But to succeed and deliver universal benefits, it needs to be patient-centered in order to meet and surpass patients’ expectations. The people seeking medical care have to be involved in designing health services that suit them. Besides better treatment outcomes, such a patient-led approach translates to value for patients as they pay only for what they need.

Technology is crucial, for instance, use of electronic medical records that support automation, enable real-time information exchange among doctors, and help track the patient’s progress. Telemedicine is in vogue driven by digital disruption of the healthcare ecosystem. Patients can now consult their physicians and order for medicine to be delivered to their doorstep online.

As the government scales up UHC, it needs to partner with the private sector in ensuring communities have access to quality, affordable health care. Creating an enabling environment for the private sector players to provide quality services affordably is key to considering they provide 48 per cent of health services in Kenya.

Such support includes timely and accurate certification processes that are tied to quality improvements. There is also a need for NHIF accreditation that allows every citizen to access services in a facility of their choice. Timely settlement by NHIF of payments billed by private health providers is crucial to their financial sustainability.

In a nutshell, UHC is fundamentally about every citizen being able to walk to a health facility of their choice and access medical services affordably.