Universal health plan too ambitious, Senate now says

A committee of the Senate has cast doubt on the capacity of the national government to implement the Universal Health Care (UHC) under its ambitious Big Four agenda.

The Committee on Finance and Budget says the health sector has not been given adequate resources to enable implementation of the project.

“There is a significant resource gap in the sector as a result of the proposed ceiling in the 2019/20 financial year and over the medium term considering the government intention to actualise the UHC by 2022 as one of its Big Four plan,” says the Committee in its report on the 2019 Budget Policy Statement (BPS).

In the 2019/20 budget projections contained in the BPS, the Treasury has allocated Health ministry Sh93 billion, which is just about 43 percent of its projected 2019/20 budget.

Of the amount, Sh56.3 billion will cater for recurrent budget while Sh36.6 billion will go into development projects.

The committee notes that proposed budget ceiling for the health sector for the 2019/20 financial year is significantly less compared to the resource requirements for the sector which stand at Sh218.4 billion.

Members of the committee expressed reservations with the phased model that the government has adopted to implement the UHC programme, noting that little will come out of it.

“The adopted UHC pilot is not unique since a similar model was tried during the initial phases of free maternity programme (Linda Mama Programme) and did not deliver the desired results which necessitated the shift of financing to NHIF-based reimbursement model,” the report states.

Further the committee is concerned about a proposal in the BPS that suggests that county governments will have to match the national contribution, arguing it’s unsustainable and will burden the devolved units.

The committee concludes that the Health ministry is “over ambitious” in its target of rolling out the UHC in all the 47 counties by July 2019 “since this requires significant resources which have not been adequately provided for in the 2019 BPS.”

“There is ambiguity in targeting 100 per cent county coverage and not the actual number of population accessing specific health care services for free.

“Free and affordable health care for all Kenyans by July 2019 is not achievable,” the committee says, suggesting that the process should be thought through since funding for UHC in all 47 counties is based on revenue that the government does not have.

While in the BPS the government envisages to equip 6,200 health facilities in the next financial year with what it describes as basic clinical equipment, the committee further doubts this.

It instead wants the government to provide clear guidelines on what constitutes basic clinical equipment and what the modalities will be used to equip these facilities considering that most of them are under the purview of the county governments.

The committee further wants the national government to clarify whether the programme to equip the health facilities with basic equipment is a new programme or an expanded version of the controversial Equipment Managed Services (EMS).