Lower health budget undermines bid to attain universal healthcare

Cesarean section women with their babies at the Makueni Mother and child hospital on August 10, 2021. [Boniface Okendo, Standard]

Kenya's commitment towards ensuring access to health for all is enshrined in the Constitution. Article 43 provides that every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.

To actualise the constitutional commitment, several policies, institutional and legislative frameworks have been established as well as significant budgetary allocations over the years. However, in this year's budget, the Ministry of Health was allocated Sh141.2 billion, which is 11 per cent of the total amount of budget, but is down from Sh146.8 billion allocated in 2022/23.

Kenya has departed for the first time from the 2018 commitment by East African Community (EAC) heads of state on health priorities, committing to gradually increase health sector funding by 10 per cent annually, following extensive national and regional consultations.

This situation not only calls into question the integrity of the EAC treaty but also poses a serious threat to the lives of Kenya's already vulnerable population. The meagre allocation of just one per cent of gross domestic product puts Kenya's ability to meet the African Union's 2030 domestic health financing targets at risk.

When health systems fail to provide adequate services, the financial burden falls on people, especially those who live below the poverty line and do not have resources to meet basic needs such as health. Every year, nearly one million Kenyans fall below the poverty line because of health coverage related-expenditures.

Several initiatives have been put into place to guarantee Kenyans' access to quality healthcare at an affordable price and to lower their out-of-pocket expenses.

To further reduce out-of-pocket expenditures in Kenya, it is critical to address the role of the private sector such as through the inclusion of more health facilities under the National Hospital Insurance Fund arrangement and coverage of pharmaceuticals. The National Health Insurance Fund is the primary implementing institution for UHC in Kenya.

Even though the goal to achieve UHC across the 47 counties by 2022 has not been achieved, considerable progress has been made in the health sector. This is seen in Kenya's ranking on the Global Health Security Index 2021 where it is ranked first in the East African Community region and 84th globally out of 195 countries.

Across the six categories used in the index, Kenya ranked 27th globally at early detection and reporting epidemics of potential international concern. Under the category that measures a country's commitments to improving national capacity, financing plans to address gaps and adherence to global norms, Kenya ranked 35th globally. These scores indicate positive change towards providing access to health for all.

The investment in social health protection has seen Kenya close gender gaps. It is no surprise that Kenya was honoured at the African Union summit 2023 held in Addis Ababa for the country's approach to improving reproductive, maternal, new born child and adolescent health.

The global gender gap index uses two indicators to score a country's health and survival index. That is, sex ratio at birth and healthy life expectancy.

Despite using only two indicators, Kenya's performance of 97.5 per cent highlights the milestone achieved in closing the gaps within the indicators. Kenya had closed 98 per cent of the gender gap in health and survival in three consecutive years, 2020, 2019, and 2018. The sustained performance slightly drops to 97.5 per cent in 2021.

There is need to take care of the health workforce and streamline the governance aspect of healthcare to ensure the progress is sustained and universal health coverage is achieved.