A member registering during the NHIF biometric registration. [David Gichuru, Standard]
Kenyans seek healthcare in private hospitals due to limited access to some drugs, treatment, medical expertise and resources in public facilities, according to a recent report.
Despite the high demand for healthcare, private hospitals have largely concentrated on the most profitable areas like high-cost curative services, neglecting less commercially viable services like family planning, routine child immunizations and adolescent health services.
Private hospitals are low on key vaccination services, but high on comprehensive surgical services which have higher returns.
Though the National Hospital Insurance Fund (NHIF) is a public insurer, it favours the private sector for which it may not have been established to benefit: For instance, out of Sh14 billion that NHIF spends annually on claims in Nairobi, Sh11 billion goes to private hospitals.
The privatization of healthcare in the country has also negatively impacted the roll-out of Universal Health Coverage (UHC), according to the report, Wrong Prescription- The impact of Privatizing Health Care in Kenya, by the Economic and Social Rights Centre-Hakijamii, Centre for Human Rights and Global Justice at New York University School of Law (CHRGJ).
UHC was to be fully rolled out across 47 counties by next year, but privatization of healthcare has reduced public health priorities, which reduces access to healthcare thus pushing people into poverty.
“In seeking to improve access to healthcare, Kenyan policymakers have pushed to increase the role played by for-profit private actors.
The report notes that chronic under-investment in public facilities including lack of sufficient infrastructure, staff and medicine have is also buttressed by the government whose “policymakers have explicitly embraced the private sector, providing it with public resources and undertaking favourable policy reforms.”
Though the government has not formally sold off the existing public healthcare system, policies favour privatization and sweep across large-scale contracts ranging from public-private partnerships, tax incentives, and expanded national health programs like Linda Mama, which include private health providers-effectively subsidizing private care.
In December 2017, President Uhuru Kenyatta announced improved healthcare through UHC, which was aimed at ensuring equitable access to healthcare, without risk of financial hardship.
To finance UHC, the government was to mobilize finances by increasing enrollment of the National Hospital Insurance Fund (NHIF).
Piloting was done in Isiolo, Nyeri, Kisumu and Machakos counties with a complete rollout across 47 counties by 2022. But “the planned expansion of private-sector friendly social insurance through UHC risks exacerbating these problems,” adds the report.
Two months shy to the implementation deadline, the much-hyped program has been facing bottlenecks, leaving the majority of Kenyans struggling to access basic healthcare at a high cost over lack of proper financing mechanism.
Out of10 million households enrolled under UNHIF cover, those active by May this year were only 5.6 million, according to NHIF whose CEO, Dr Peter Kamunyo, termed the UHC model of financing as ‘input financing.’
In input financing, commodities are provided for healthcare facilities as well as human resources, and registered members have access to treatment for free with depleted commodities replaced.
In a previous interview, Dr Kamunyo argued that “the only sustainable model to UHC is to have members who can pay their premiums annually do so, and those who cannot pay, like venerable groups, be identified and supported.”
But the report notes that relying on a combination of social insurance and private healthcare providers will see Kenyans continuing to experience problems associated with privatized care, high and impoverishing costs, inequality in access and unmet health needs.
The report warns that “expanding coverage through the NHIF instead of investing in a strong public health system is not a small step in the right direction—it’s a step backwards” and NHIF “now pays out far more to private providers than to the public system.”
According to the report, the public health system is best positioned to deliver on public goals, including UHC but choosing to pursue Universal Health Coverage through the NHIFrather than through the public health system—will have far-reaching consequences. It will entrench private actors and almost certainly result in more public money going to private profit.”
The report recommends the need for prioritising on health policies and expenditure, increasing public spending, besides significant improvement on the existing public health system to guarantee accessible, affordable, quality care for all Kenyans.
Private facilities also charge more for both outpatient and inpatient services: Breast cancer screening was more than four times as expensive as in public facilities while diagnostic procedures were thrice as costly.
Comparing treatment for four common Non-Communicable Diseases, the report found that private facilities charge more for screening, diagnosing, and treating them than public hospitals.
Other studies and surveys have found that private providers charge higher fees for family planning services, with 77 imposing high and burdensome fees for hypertension treatment while 78 were far less likely to have information on user fees posted in patients’ view.
Also, private health providers shun critical forms of care with low returns like post-abortion care, care for child malnutrition, tuberculosis diagnosis and treatment, HIV care and support and services for survivors of violence and sexual abuse, according to a 2018 survey.
Despite the mushrooming numbers of private hospitals, public facilities serve a higher population and in 2018 accounted for 58 per cent of outpatient visits, more than half of inpatient admissions, 260 more than for-profit, non-profit, and faith-based providers combined.
The report notes that with adequate resources and oversight, the public health system, despite many challenges, “offers far more potential for expanding access to quality healthcare than privatization has shown.”