Focus shifts to funding, staffing as Kenya’s UHC takes root

The perennial underfunding of healthcare and shortage of human resources in Kenya could be the biggest detriment in the rolling of Universal Healthcare Coverage (UHC) in the country.

The Health ministry’s Sh90 billion allocation in the 2018/19 financial year with a recurrent budget of Sh49.1 billion gives little room for improvement of services in public hospitals.

Piloting of UHC is ongoing in Kisumu, Nyeri, Machakos and Isiolo counties and the ministry reports that patient numbers have increased by 50 percent, which is a pointer to the huge demand for healthcare.

In readiness for nationwide roll-out the government has started collapsing and onboarding some of its current flagship health programmes on the UHC plan.

Recently the Ministry of Health announced that 484,086 people aged above 70 years who enjoy free State health insurance cover will no longer seek services in private centres.

The elderly who are entitled to State-sponsored National Hospital Insurance Fund (NHIF) cover under the Inua Jamii programme will soon access free services in public hospitals.

This is in line with President Uhuru Kenyatta’s directive to collapse NHIF cover under the Inua Jamii programme, the Linda Mama and the cover for the disabled.

Principal Secretary Susan Mochache told the Health Parliamentary Committee this month that the ministry will redirect Sh3.2 billion allocated for the flagship programmes in the current financial to UHC funding.

“There are no new inclusions for insurance cover for the other programme in these counties (elderly, disabled persons and the poor) and for those who were on health insurance cover at launch of UHC programme, the covers will not be renewed upon expiry towards the end of 2019. Therefore, all insurance programmes targeting vulnerable groups will merge under the UHC programme,” she said.

Vulnerable people

Ms Mochache added that the ministry allocated Sh98 million to cater for healthcare of the 16,370 vulnerable people in the four piloting counties and that the rest of the Sh3.2 billion budget would be better spent on funding UHC.

But even as the country moves towards this milestone, the state of the public healthcare system remains in focus amid concern about poor staffing levels, inadequate infrastructure and equipment.

Health Cabinet Secretary Sicily Kariuki says that the shortage of health personnel could see them import more doctors from Cuba to add to the 100 already in the country.

That, however, is not sufficient with a recent assessment report by Kenya Institute for Public Policy Research and Analysis (KIPPRA) on healthcare delivery under the devolved system indicating that public hospitals and some regions especially those in the arid and semi-arid lands remain disadvantaged.

The Kippra data shows that in the 2015/2016 period only two counties met requirements on three workers per 10,000 people even though the average the ratio improved from 0.25 per 10,000 people in 2012 to 0.6 per 10,000 people in 2015/16.

Kenya also has a long way to go given that it heavily relies on donor funding especially in providing basic services such as vaccinations. Donor support from the Global Alliance for Vaccines and Immunisation (Gavi) for jabs against influenza, pneumonia, rotavirus and yellow fever has significantly increased this year.

Gavi data shows that support for the anti-pneumonia vaccine to Kenya increased from Sh348 million ($3.48 million) in 2018 to Sh1.5 billion ($14.41 million) this year. Under the New Vaccine Support, Gavi has approved its increased funding that amounts to $201.49 million over the last 10 years.

Co-financing model

Currently, Gavi helps Kenya procure vaccines through a co-financing model, where the government pays 10 percent of the entire budget, while Gavi foots the remaining 90 percent cost.

If Kenya were to take up the cost of funding its own vaccines, then that would mean they would still have to go back to the Ministry’s budget which is barely enough to meet the demands.

Although healthcare financing in Kenya has improved in the past five years from Sh41.7 billion in the 2013/14 financial year, a report by the United Nations SDG Partnership Platform and Aavishkaar-Intellecap Group cautioned that that is not enough given the country’s reliance on external partners for monetary support.

Kenya, the report says, has the option to finance its healthcare through levies by, for example, taxing airline tickets, air travel being a luxury service.

It also suggests the introduction of a telecoms levy for mobile phone subscribers to pay slightly more for mobile data and voice to potentially generate resources to support UHC.

Besides levies, the group says Kenya may consider Social Impact Bonds (SIBs) and Developmental Impact Bonds (DIBs) which can improve the efficiency of government healthcare spending at the county as well as national levels.

This model has proved a success in Israel, India, Mozambique and Cameroon.

These innovative financing models help to fund healthcare through contracts where private investors provide upfront flexible funding to healthcare providers and outcome funders (usually government in case of social impact bonds and development finance institutions in case of development impact bonds) repay these investors based on the healthcare outcomes achieved by those who receive the services.