Lessons State must learn from the UHC pilot programme

President William Ruto during the signing of Universal Health Care Bills, State House, Nairobi. [PCS]

The date was December 13, 2018.

Excitement and high expectations hung in the air as then President, Uhuru Kenyatta officially launched the long-awaited national Universal Health Coverage pilot programme.

The colourful luncheon held in Kisumu City brought hope to Kenya where delivery of primary health was facing major drawbacks. The ambitious programme was to be experimented in Kisumu, Isiolo, Nyeri and Machakos. If it succeeded, the model was to be rolled out in all 47 counties.

His face beaming with confidence, President Kenyatta declared: "Today marks Kenya's commitment to the actualisation of SDG 3 on ensuring healthy lives and promoting well-being for all. Kenya joins the rest of the world in aligning with primary healthcare approach."

He said that access to primary healthcare can address over 80 per cent of people's health needs throughout their life cycle focusing on preventive care and promotive health interventions.

Sadly, a few months after the launch, the UHC programme quickly flew into headwinds.

The enthusiasm slowly died out. Things were not working out as planned. Governors who were implementing the pilot stage worked hard to save the situation.

Today, five years down the line, experts say the pilot programme remains an important case study. They say, that implementers of Rutocare, which was launched on Mashujaa Day, must draw lessons from the Pilot scheme.

"The Rutocare will not meet its objectives if they don't draw lessons from the pilot UHC and improve on the loopholes," says Mr Joab Ndire of the National Health Alliance.

According to Dr Gregory Ganda, an Obstetrician-Gynaecologist and Kisumu's Executive Committee Member for Medical Services, the UHC pilot was a mixed bag of successes and shortfalls.

He identifies some of the challenges as - c in level 4, level 5 hospitals, and the under-utilisation of level 2 and 3 hospitals, human resources issues such as the overworking of staff, Lack of efficient information systems, interruption of the Linda Mama programme and delays in the supply of essential medicine.

Other challenges included delays in the transfer of funds from the national government to county governments. He says most of the funds had not been received by the end of the pilot.

To strengthen the UHC pilot study, the Kisumu County government introduced Marwa- a Health Insurance Scheme targeting the poor. This helps increase the number of those seeking services in public hospitals.

Kisumu Governor, Prof Peter Anyang' Nyong'o who is a former Minister for Medical Services and a former Chairman of the Health Committee at the Council of Governors, says primary health is the engine for universal healthcare and must be funded well.

"Health financing arrangements provide the fuel for primary health care as an engine for achieving good health and universal health coverage," says Nyong'o

While praising President Ruto for the launch of the countrywide Universal Health Care scheme, Prof Nyong'o said: "In trying to achieve UHC, we are faced with the twin task of offering quality care while at the same time managing costs."

He adds: "This calls for health to be managed as a business, using business intelligence to improve efficiency and minimise or eliminate wastage in the system. We must invest heavily in the digitisation of the health services"

To help Rutocare succeed, Prof Nyong'o says: "We must never lose sight of the real reasons why we are pushing for and implementing UHC. Digital solutions and innovations must never be so complex and so involving so as to increase barriers and facilitate inequities which we are working to reduce."

He says both County and National governments must pay special attention to the Community Health promoters. "These are the people who will make the UHC succeed or fail. Let us pay, kit and give them a sense of belonging."

Some experts however say that the UHC Pilot registered a number of successes.

A study published in the Rwanda Journal of Medicine and Health Sciences in 2021 says the UHC programme specifically in Kisumu led to an increase of patients in hospitals and the availability of medicine than ever before, though inadequate.

Dr Ganda said despite the challenges, the pilot also recorded successes that can be borrowed from the new UHC project.

He says there was a 30 per cent increase in the number of patients visiting health services.

To ensure the success of the new UHC scheme there was a need to strengthen the monitoring and evaluation health management system to both expand and improve the quality of data collected and evidence-based service provision.

However, as spelt out in the Ministry of Health UHC policy 2020-2030, sustained political goodwill, good management systems, functionality, efficiency, and accountability will form the pillars of Rutocare.