Waking Up to Universal Health Coverage in Kenya

Waking Up to Universal Health Coverage in Kenya

 {Photo credit: Anteneh Tesfaye Lemma/MSH.}Kenyan Cabinet Secretary for Health James Macharia (left) and MSH President Jonathan D. Quick (right) sign the canvas pledge.Photo credit: Anteneh Tesfaye Lemma/MSH.

I felt like I had traded my mother’s health for my children’s schooling. It was a tough choice, and I cried every day.

This emotional remark was made by Lucy Njoki, a Kenyan mother and grandmother, at the Health for All Campaign Launch Event on April 28, 2014, in Nairobi. She had been forced to choose between paying for her children’s education or her mother’s urgently needed medical treatment. She could not afford both. Affordable and accessible health care remain an unrealized dream for many Kenyan citizens.  

Unfortunately, Lucy’s story is not uncommon. Lucy represents millions of people who are pushed into poverty due to catastrophic health expenditures in Kenya. The Health for All: Campaign for Universal Health Coverage in Africa is building awareness and advocating for universal health coverage (UHC) in Nigeria, Ethiopia, and Kenya. Implemented effectively, UHC ensures that all people have access to the quality services they need, without suffering financial hardship.

Kenya Launches Health for All Campaign for UHC

As Lucy narrated how her mother suffered from ovarian cancer and had major surgery, only after attaining health insurance through the National Health Insurance Fund (NHIF), there wasn’t a dry eye in the room.

She wouldn’t have made it if it was not for the delayed, but still valuable, support from NHIF.

But, we need outpatient coverage. Often by the time you are admitted, it can be too late.

The Cabinet Secretary for Health, Mr. James Macharia, responded to Lucy by reaffirming the Ministry of Health’s commitment to achieving UHC. He warmly acknowledged Health for All as a timely and welcome campaign to push the government’s initiative forward.

Hiwot Emishaw, regional director of the Health for All Campaign, stressed the need for partnership among government entities, the private sector, and civil society to make sure that people like Lucy have access to affordable health care services.

Professor Wainaina Gituro, the director general for Vision 2030 (Kenya’s development plan to become a middle-income country by the year 2030), said that every three minutes a mother in Kenya is dying. “This is unacceptable.” He acknowledged the campaign as “a great milestone.”

[(Left to right) Dr. Omar Omar (MSH Kenya), Dr. Gandham Ramana (World Bank), Dr. John Masasabi (Kenya Ministry of Health), Dr. Jonathan D. Quick (MSH), Dr. Elizabeth Ogaja (Kisumu County), Professor Kibwage (University of Nairobi), Dr. Daraus Bukenya (MSH Kenya).] {Photo credit: Chelsey Canavan/MSH.}(Left to right) Dr. Omar Omar (MSH Kenya), Dr. Gandham Ramana (World Bank), Dr. John Masasabi (Kenya Ministry of Health), Dr. Jonathan D. Quick (MSH), Dr. Elizabeth Ogaja (Kisumu County), Professor Kibwage (University of Nairobi), Dr. Daraus Bukenya (MSH Kenya).Photo credit: Chelsey Canavan/MSH.

Health for All is led by Management Sciences for Health (MSH) with support from the Rockefeller Foundation. The campaign has been able to bring together more than 20 partners in Kenya. “This is a partnership campaign, not an MSH campaign,” explained Emishaw. Mr. CD Glin, associate director for the Africa Region at the Rockefeller Foundation, said they are supporting Health for All because UHC is a culmination: “it’s the future.”

Speaking at the event, MSH President and CEO, Dr. Jonathan D. Quick, encouraged interest groups in all areas—such as HIV, chronic diseases, and maternal and child health—to ensure that UHC works for them. It’s not just about having an insurance card. UHC can transform health systems to provide everyone with the services they need. And to ensure that progress is being made, Quick stressed:

UHC should be measured by health impact.

The launch event concluded with a discussion session among attendees, followed by declarations of support through a pledge canvas signing. The canvas read “I support Health for All in Kenya.” The first signatory was the Cabinet Secretary for Health.

Delving Deeper in UHC: MSH-Hosted Symposium

Later in the day, MSH hosted a symposium called Achieving Universal Health Coverage through Stronger Health Systems to delve deeper into the issues of UHC in Kenya. The symposium was attended by various stakeholders representing development partners, national and county government officials, private sector organizations, NGOs, civil society organizations, and academia.

Said the Director of Policy, Planning and Healthcare Financing at the Ministry of Health, Dr. Masasabi Wekesa:

Of five flagship initiatives of the Kenyan government, UHC is number one.

The government has committed to increasing the number of people with health insurance from 4.6 million to 24 million over the next two years--a laudable target.

The symposium covered a range of topics that will be central to successfully expanding health coverage: access and service delivery, health care financing, and human resources for health. The role of counties in improving access to health care in Kenya’s devolved health system cannot be overstated, as Quick pointed out.

Dr. Elizabeth Ominde-Ogaja underscored this point. Ogaja is the Minister for Health for Kisumu County. She talked about the role of UHC in ensuring access to essential medicines. To this end, she noted, other areas of UHC, including financing, service delivery, human resources, governance, and infrastructure will all need to be addressed, with accountability at the county level.

Also central to UHC, is health financing. Dr. Gandham Ramana, lead health sector specialist with the World Bank, said financial protection aimed at ensuring equity should be combined with a basic service package that can be expanded over time. He noted the need to increase the tax base, including through the use of so-called “sin taxes” (i.e. taxes on items such as tobacco, alcohol, and soda).

A primary challenge for Kenya is human resources for health. Professor Isaack Kibwage, principal of the College of Health Sciences at the University of Nairobi, highlighted that inadequate numbers and skills of health workers in Kenya are exacerbated by issues of retention. Furthermore, overstressed health workers are ill- equipped to handle the challenges of leadership and management.

Although there are many challenges in Kenya, they are not insurmountable. UHC sets in motion a course of reform that can ultimately reshape the system to provide everyone with the health services they need. While it will not happen all at once, important steps have already been taken in forming the vision for UHC, and making a commitment to achieve it. Some initiatives aimed at UHC are already underway, such as a voucher program for the very poor, and the elimination of maternity fees in public facilities.

Awareness and partnership are two additional, essential components. With help from the MSH symposium and the Health for All Campaign, Kenya has now begun taking these steps, too. And if the momentum continues, the dream of affordable, accessible health care just might start becoming a reality for millions of Kenyans.