Strong health systems key to deliver UHC

Kenyatta University Hospital. [File, Standard]

It has been nine months since the launch of the pilot phase of Universal Health Coverage (UHC) in Kenya. The government took on the momentous task of providing medical care to the people of Machakos, Kisumu, Isiolo and Nyeri counties. The ultimate hope of this was to draw lessons that will inform the scale-up of the services across the remaining 43 counties by 2022. What lesson has this journey brought to fore, three months away from the proposed end of the pilot phase?

What stands out on how we have ?nanced the pilot phase? The government set aside Sh4 billion to implement the pilot phase. Some 70 per cent of the sum was dedicated to medical supplies and channeled to Kenya Medical Supplies Authority (Kemsa) while the remaining 30 per cent was given to the pilot facilities as conditional grants for improvements in readiness for service delivery. Has the money allocated been suf?cient to deliver UHC to the people? It is estimated that adequate ?nancing of health requires at least 15 per cent of the government expenditure or 5-6 per cent of the Gross Domestic Product. 

As we race towards the national scale-up, the government has allocated Sh47.8 billion to this cause for the FY 2019/20 out of Sh92.7 billion for health. This is 3.3 per cent of the total government expenditure. The allocation falls far below the recommendations hence puts the aspiration of effective scale-up of UHC at risk for the FY 2019/20.

Our reclassi?cation as a low middle-income country from a low-income country also introduces new challenges to Kenya’s health ?nancing topography. We anticipate a decline in donor funding hence pressure on domestic ?nancial resources. What then are the measures the government has put in place to expand the ?scal space for health for sustainable scale-up of UHC? How are the counties, whose constitutional mandate it is to deliver healthcare, handling this reality?

The government has the mandate of policy in health within the 2010 Constitution. It has set in place policies and structures to oversee UHC in concert with the counties. It established a task force to determine the essential services (bene?t package) to be provided under UHC. Further, it has provided a delivery structure comprising of the UHC Council, Technical Committee, and Technical Working Groups which are anchored in law vide the Executive Order No. 5 of 2019. The success of UHC implementation hinges on sound governance and political will. What has the nine months of the pilot phase revealed about our leadership and governance structures?

Successful UHC delivery demands for right numbers of quali?ed and motivated healthcare workers and in the right competence mix. What measures have we put in place to ensure a motivated, competent, well resourced and adequate human resource for the delivery of UHC?

Are medicines and other medical supplies readily available in the pilot counties? How ef?cient have planning for, procurement, storage and distribution of these products been? How has Kemsa handled the surge in demand for the past nine months? What lessons can we draw from this experience to strengthen our supply chain? An ef?cient and reliable supply chain for medical products is key for effective UHC.

Have we sidelined quality in the quest for broadened access and coverage in the UHC train? It is imperative that we re?ect on what the patient’s experience of the services is and whether they have con?dence in the system to deliver acceptable and quality care to them. A people unhappy with the quality and scope of care are unlikely to support public ?nancing of healthcare.

The scale-up of UHC across the 47 counties is to be anchored on the data from the pilot phase. Quality data is key for planning, implementation and improvement of care.

As the global family works towards leaving no one behind as far as public goods such as health are concerned, the success stories reaf?rm that UHC is not just about access, but quality and ?nancial protection as the patient experiences healthcare. These qualities, and consequently UHC, can only be tenable if there is intentional effort at strengthening the health system.

- Dr Mike Mulongo is an international health consultant. [email protected]