The six-month free universal health care piloting has just hit the half way mark as the government works out how to finance a national rollout come July.

But early indications suggest the next phase of Universal Health Coverage (UHC) will not be totally free but provided through a reformed National Hospital Insurance Fund (NHIF) scheme.

Already Health Cabinet Secretary Sicily Kariuki has appointed a special task force to prepare the NHIF for a leadership role in UHC by May.

The financing is further compounded by the high patient turnout recorded so far in three of the four UHC piloting counties.

A half way mark update by Kariuki shows huge increases of outpatients in Kisumu, Machakos and Nyeri but a modest demand in Isiolo County. Overall, the update presented at an international conference in Kampala, Uganda, last week showed demand in the four counties to have gone up by more than 50 per cent.

The six-month project was launched in the middle of December by President Uhuru Kenyatta, with expectations for a national rollout in July.

The highest increase was recorded in Kisumu where demand for out-patient care had more than doubled. A 50.4 per cent increase was recorded in Machakos, 35.7 per cent in Nyeri and 17.8 per cent in Isiolo.

None seeking services

“This shows a lot of Kenyans do not seek healthcare even when sick mainly because they cannot pay,” said Dr Gitahi Githinji, Amref Health Africa CEO, on the sidelines of the Kampala conference.

The international conference on Universal Health Care and non-communicable diseases had been organised by Novartis, the Swiss pharmaceutical giant.

The current Kenya Household Health Expenditure and Utilisation Survey by the Ministry of Health shows about 1.3 million sick Kenyans do not seek care for non-affordability.

The current piloting where patients are treated and given medicines for free is costing about Sh3.9 billion. This is being financed by the National Treasury, the World Bank and Japan and given to the counties as a conditional grant.

About 80 per cent of the money is going directly to Kenya Medical Supplies Authority (KEMSA) for the procurement of medicines.

“We have been able to deliver 99 per cent of the necessary medicines and 95 per cent of non-pharmaceutical products,” said Dr Jonah Manjari, the CEO of KEMSA.

Questioned on the possible future financing for UHC in Kenya, Dr Manjari indicated this will likely be a hybrid between free care for the vulnerable and insurance for those able to pay.

He told the Saturday Standard that data collected during the registration for UHC in the pilot counties is also informing on the households’ economic status and capacity to pay for health care.

“I think a model that shields the poor, while the rest pay through some insurance scheme, will be most sustainable,” said Dr Manjari.

Otherwise doubts have already emerged on Kenya’s ability to finance a fully free UHC such as being piloted.

“Already outpatient facilities and staff are overwhelmed by the heavy patient turnout for UHC,” said Dr Rachel Kamau, the Nyeri County Health Executive.

Dr Kamau said due to the congestion, patients have to endure long queues and long waiting hours because the county does not have resources to adequately increase workers or facilities.