How Kenya can achieve universal health care for all


The question of health provision to Kenyans of all walks of life has been at the center of public discourse for more than a year.

Recently however, the focus has shifted to raising taxes to fund the National Hospital Insurance Fund at the rate of a maximum of Sh2,000 person per month. The jury is still out on this one as the courts have halted its implementation.

As Kenyans wait for the newly elected government to take office, there is no doubt that most people are waiting with bated breath for the common man’s issues to be addressed — and they are myriad. Healthcare, particularly for every citizen, remains a sticking point. 

The Ministry of Medical Services has drafted a policy document outlining a strategy towards achieving universal health care coverage in Kenya.

Known officially as Sessional Paper number 7 of 2012, the document is designed to rectify the errors of the National Health Insurance Act of 1998 and strengthen the funding of the National Hospital Insurance Fund as a way of ensuring access to health for the poor.

This is in itself a noble gesture and the government must be commended for taking steps to address the issue of providing universal health care to all citizens.

Even as we make these baby steps towards providing universal healthcare, we need to draw lessons from other countries that have successfully to see what can work for us. One of them, an interesting case study, is Israel, which went through an evolutionary consultative process of developing a universal healthcare scheme that now works.

Modeled on the principle of inclusivity, the process of giving Israel universal healthcare started as far back as 1929 when it was occupied as a British Mandate. The Israeli scheme was later changed in 1995 after the National Health Insurance Law came into effect — making membership in one of the four existing Health Maintenance Organisations compulsory for all the citizens.

It also guaranteed a minimum set of benefits for all members. But the most important points were that Israel went on to develop a graduated system of publicly funding the Health Management Organisations and overseen by the state and at the same time instituted a raft of measures to attract back the immigrant doctors and nurses to the country. By 2010, there were 25,542 doctors in Israel — 3.36 doctors for every 1,000 people.

It is my considered opinion therefore that in focusing only on strengthening funding the National Hospital Insurance Fund the Sessional paper misses the point. To achieve universal healthcare coverage in Kenya the government must adopt a multipronged approach to addressing it. There are three primary pillars that form universal coverage — affordability, accessibility and quality.

From a policy perspective the healthcare system should look at all three arms simultaneously.

Affordability has to take care of taxation where the citizens feel they can afford to fund the national health fund and equally, those who access the services must see them as priced affordably.

Accessibility has been addressed in the sense that by and large the government has ensured that there is a public hospital in virtually all counties.

Drive costs down

Ultimately, the biggest drawback that our national healthcare system faces is quality. Most of the government hospitals, if not all, lack good quality medicine, have a biting shortage of doctors and nurses, have a negative customer care culture and fall short on sufficient medical equipment. It is no wonder even public servants who are supposed to use them prefer to visit private hospitals whenever they need medical services.

Now, even though the plan to fund the national healthcare scheme focuses on taxation, it appears to me that the government did not consider all options available for it.

For instance, the concept of public private partnerships can be applied very effectively to the health sector.

In this case, the government would get the private sector to participate in construction and equipping of the hospitals including developing incentives for doctors and nurses to reverse the brain drain and boost training of additional ones and ensure that we match the growth of facilities with manpower.

To take it further, medical insurers and private sector investors are prepared to work with the government to develop minimum service quality standards that define the standards of healthcare.

Medical care costs money and it is important (even for Kenyans who will be taxed to fund the scheme) to ensure that a person who goes in for treatment at a public hospital actually gets well because if he or she doesn’t, then it is a waste of valuable financial resources.

As long as there is a minimum guarantee on treatment quality, we are likely to see a shift in the preferences from private to public hospitals, eventually driving down the cost of medical care.

The way I see it, the sessional paper is not tackling all the issues that contribute to a universal healthcare scheme than can be drawn from contributions by multiple stakeholders in a consultative forum. And since the Constitution requires that citizens participate in policy development, the Ministry of Medical Services may have to consider taking this route to avoid developing a half-baked scheme.

The writer is the Head of Medical Division at UAP.


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