Laikipia takes deliberate steps in quest to ensure healthcare for all

Laikipia Governor Ndiritu Muriithi [Elvis Ogina, Standard]

Kenya’s quest to stay the course of human development has had to face one big question. How do we ensure that every person has access to health services they need, when and where they need them, without financial hardship?

This is the World Health Organisation (WHO) definition of universal health coverage (UHC), and is one of President Uhuru Kenyatta’s Big Four agenda.

WHO estimates that half of the world population do not have health services they need, and that over 100 million are pushed into extreme poverty by the out-of-pocket spending on healthcare.

Health insurance is one way to overcome the financial catastrophe that is occasioned by out-of-pocket spending. In Laikipia, for instance, we have put in a lot of effort to ensure families have health insurance. More than 63 per cent of our population is now covered by National Hospital Insurance Fund (NHIF). This includes 103,000 self-employed who are paying for themselves, and 91,000 paid for by private companies.

However, and although other insurers cover a little bit more, it still means that over 30 per cent of the population still has no cover, posing a significant challenge to our goal of attaining UHC.

To get to 63 per cent of the population has been some heavy lifting, particularly by community health volunteers (CHVs). I shall return to the central role of CHVs in attaining UHC presently.

On insurance our CHVs have gone home to home encouraging people to join NHIF. Armed with a mobile app, they have made it possible to join instantly, eliminating the time and cost involved if the client is to go physically to an NHIF office.

We made news this week in Laikipia because of our innovative ‘goat for delivery’ programme. The first ladies of Kisumu, Nyamira, Makueni, and Baringo joined with our first lady midweek to award 400 goats to traditional birth companions (TBCs) at Kimanjo, in Laikipia North. This was an incentive to the TBCs to encourage our joint clients–that is expectant mothers–to use health facilities for safer delivery and to attend both pre- and post-natal clinics.

As an added benefit to the traditional birth companions, they are also getting formal education through an adult literacy programme.

The ‘goat for delivery’ innovation was necessitated by the fact that traditional birth attendants among communities in Laikipia North get a goat from the family when they assist a woman to deliver.

In order to align, we negotiated with the communities to continue with the traditional token, but also accept the one from government, in return for encouraging pregnant woman to attend clinics and deliver at health facilities.

The Hongera Mama kit gives the new mother a care package that includes all the provisions she needs after giving birth. We are giving it to mothers who have attended the clinics and who then deliver at a health facility. This has provided us with a unique opportunity to capture health data on all pregnant mothers. So far 7,000 Hongera Mama kits have been distributed.

As delivery facilities increase, we are making great strides in eliminating mother-to-child HIV transmission. Our target is for all babies to be born free of HIV by 2023. All these innovations are intended to improve access to health services.

And the early results are encouraging. The fourth ante-natal clinic (ANC) attendance improved from 44 per cent to 69 per cent between 2017 and 2020, and is projected to hit 75 per cent this year.

Another recent innovation is sample referral. Instead of sending the patient to a laboratory, we take samples at the point of care and send them to the lab ourselves, saving the clients time and money. The results are then transmitted electronically to the point of care.

In addition, we are improving the diagnostic capability at every service point. And as we do so, we are finding that the traditional Kenya Essential Package for Health (KEPH) classification of facilities from level 2 to 6 rather limiting. This is because the services available at level 2 are limited, clients prefer to seek services at high level facilities directly, without waiting to be referred. This makes it harder to run a referral system. Yet there is nothing stopping a level 2 facility from having at least a basic laboratory.

In fact, to eliminate artificial demarcations, we have organised ourselves into one service–the Laikipia Health Service. Our clients can therefore expect the same quality of care at all our 84 service outlets. We have uniform branding, and all our outlets are expected to provide the same customer experience.

To make the referral system work better, we have grouped our outlets into clusters. Sample referrals happen within those clusters. Human resources are also managed at the cluster level.

Managing the duty roster at a cluster level has enabled us to open all our facilities, including those previously classified as level 2, for 7 days a week.

Further, we have mapped out the concentrations of our clients who attend medical clinics for diabetes, hypertension and so on. Now, instead of the clients going to the level 4 or level 5 facility to be attended to by the specialists, the doctors are going out to where the clients are, saving them time and money.

Throughout the system, we are streamlining the service flow. Growth of facilities tends to be organic. They start small, and service are added over time. As a result, the placing of services creates a zigzag flow.

For instance, records, billing, NHIF and triage are now being placed at the same service area to eliminate the back and forth that clients have previously faced.

CHVs are central to preventive and promotive health. And because they visit households, they provide a unique opportunity for NHIF. The fund should adopt them as its agents to assist in recruiting members and in collecting premiums.

In addition, the volunteers’ work means less sickness and therefore fewer claims, which is good for the fund.

Mr Muriithi is the governor, Laikipia County