All set for universal health, but where’s the money?

By Gatonye Gathura

On 7th April, Kenya and the world committed to providing everyone with affordable health care within the next few years.

“Universal Health Care (UHC) is not a dream for the future. It is a reality now,” says Tedros Adhanom Ghebreyesus the Director-General World Health Organisation.

In his message during the year’s World Health Day which is focusing on UHC, Tedros says the dream is achievable and affordable, using domestic resources.

While the global target is to achieve UHC by 2030 Kenya has undertaken to achieve 100 per cent coverage by 2022.

Already the government says it has made a significant start with the National Hospital Insurance Fund (NHIF) having initiated an aggressive member recruitment campaign since 2013.

By the end of last year, a report by the health sector working group says NHIF membership had grown to 6.8 million principal members.

The report published by the National Treasury in November says this translates to an overall coverage of 27.2 million Kenyans including the principal contributors and their dependents.

“This implies that approximately 50 per cent of Kenyans are covered by NHIF,” says the report which brings together the Ministry of Health and its seven affiliated parastatals.

Last year, NHIF provided medical cover for 178,186 poor families and 42,000 households with disabled persons.

During the same period, the report says 987,122 deliveries were achieved through the free maternity programme under NHIF at a cost of Sh3.54 billion.

In the current financial year NHIF plans to cover 1.2 million deliveries, 350,000 poor and vulnerable households, one million elderly and about 300,000 people with severe disabilities.

The report covering the period 2018 to 2021 says the health sector has already factored the government’s objective to achieve UHC by 2022.

“UHC programming and targets will be fast tracked to achieve universal health coverage by 2022,” says the group report.

But to achieve these objectives the ministry says it is seriously short of funding with an allocation of Sh70.36 billion against a requirement of Sh.115.86 billion in the current financial year.

Last year the then Health Principal Secretary Julius Korir said the government has problems raising the Sh 103 billion required to support a contributory universal health scheme in a year.

He said the government was only able to raise Sh 12.4 billion annually to cater for the elderly, low-income households, and citizens with disabilities.

In fact what the NHIF has achieved so far including its own reforms has largely been funded from loans and foreign grants through the World Bank.

Smartlessons, a publication of the World Bank shows funding to have come from the Rockefeller Foundation, UK Department for International Development and the Norwegian Government.

Others are Bill and Melinda Gates Foundation, the German Development Corporation (GIZ) through KfW Development Bank and the Japanese Government.

In the Treasury report the ministry lists its two biggest challenges as shortage of finances and over dependence on donors in that order.

A detailed analysis of the 2016/17 budget of the Ministry of Health by USaid showed expenditure related to UHC has been responsible for a sharp increase in foreign borrowing and donor dependence since 2014.

The main programmes linked to this development are free maternity, medical equipment leasing and subsidized health insurance for the poor and disabled.

While in 2015 the Ministry of Health had borrowed only about Sh 1.7 billion, Sh5.2 in 2016, last year borrowing jumped to Sh 6.7 billion,

The analysis shows debt at Afya House to have risen from eight per cent of the development budget in 2014/15 to about 22 per cent last year.

These loans are indicated to have gone into supporting free maternity and the now largely moribund medical equipment leasing scheme.

Despite devolution of all health services, the budget analysis shows donors to have increased their funding to Afya House from Sh19 billion in 2015/16 financial year to Sh30.7 billion last year.

But expenditure could climb further as the government moves to the next level of UHC which involves strengthening of the health infrastructure and employing more personnel.

It will also involve the engagement of 100 specialist doctors from Cuba and the training of 50 Kenyans in the Caribbean island.

“The next level involves equipping of primary healthcare facilities and recruitment of additional health workers,” says the Treasury report.

Some of the specific additional projects the government wants to put up, the report include a 2,000 bed multi-specialist hospital in Eldoret.

Six regional specialist cancer centers, a Sh 3.2 billion burns unit at Kenyatta National Hospital and the purchasing of Sh 1.4 billion office block for the National Aids Control Council in Nairobi.

This will also involve the engagement of 100,000 community health workers.

Health workers from around the countries have demanded a detailed roadmap on how the ambitious UHC is going to be funded.

At a national forum on UHC organized by the ministry in Nairobi last month the workers were assured a comprehensive universal health financing strategy was been finalized and would soon be published.

However it emerged at the meeting held at the Laico Regency, Nairobi some of the fund raising strategies on the table include raising of consumption taxes such as on sugar and tobacco.

Monies raised from such initiatives it was reported would be ring fence for use in only funding universal health care.

Health economists however say even with the current level of domestic revenues, the government can effectively afford good quality care for its entire people.

“Kenya can manage a universal, tax-funded mechanism that ensures revenues are efficiently collected and spent accountably,” say Jacob S. Kazungu and Edwine W. Barasa of the Kenya Medical Research Institute in a recent study.

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