President Uhuru Kenyatta’s Big Four agenda train seems to be gathering steam and the universal healthcare coverage wagon is full.
Last month saw two high level gatherings bring together stakeholders from the industry to deliberate on the same. Arguably and most befitting was the Makueni event given the trail blazing trend Governor Kivutha Kibwana has made in matters health.
Now that the subject matter is coalescing, my biggest reservations on the pledges by the government are in measuring the results of our efforts. A Health ministry communication indicates a 100 day Rapid Results Initiative (RRI) has been rolled out. The achievables in the document are great if hit but will most likely not be met. One target states that by December 2018, 10 million members to have been enrolled in the National Hospital Insurance Fund (NHIF) scheme.
Broken down, the formal sector should add 3.8 million, 4.7 million from the informal sector, one million elderly people and about 350,000 vulnerable indigents.
The last two groups have already been enrolled in previous efforts under several pilots funded by external donors. The schemes suffered the usual malady of discontinuation and late disbursements. The most positive news for me is the proposed new governance structure at the NHIF. The lack of expertise among technical and management members of the boards is perplexing.
More health system managers are needed there to cut administrative costs. The best approach is to tap them from the private sector, supported by partners to cushion against political interference. On enlisting 100,000 community health volunteers (CHVs) for each to recruit 20 households, the question is where the resources will come from. Currently CHVs are demotivated and do not receive even travel allowances in their work.
These funds should also not just be for enrolling new members. What happens in the villages when contributors are late in paying? How will the CHVs follow them up?
Counties need to upgrade public health facilities. Here partnerships and collaborations with private sector players are important.
Nobody will pay for NHIF if the quality of care is as it is; understaffed, lacking drugs and referrals for over 50 per cent of diagnostic service.
The weakest link in all this though has always been the sustainability of our funding plans. The communique highlights the government’s plan and commitment to increase the allocation for healthcare as well as earmark and ring-fence certain revenues for healthcare financing.
Given previous pledges, I am skeptical on this issue. In the last five years pledges delivered slightly above 47 per cent of commitments made from external evaluators.
However, without easily verifiable sources we are likely to be given cooked up numbers. The best way would be to ensure that after six months we can assess whether set targets have been met.
To succeed, the president should put in place a professionally appointed and managed NHIF devoid of political intrigue.