Lessons for Kenya from the UK's NHS as we implement our UHC

lnformation sign outside Lancaster Royal Hospital, UK. [iStockphoto]

"The health of the people is the foundation upon which all their happiness and all their powers as a state, depend."

These famous words were uttered by Benjamin Disraeli many years back but are just as true now as they were then. As we stand at the brink of a transformative era for healthcare in Kenya, the dream of Universal Health Coverage (UHC) beckons us with promise and urgency.

The vision of UHC is not merely about ensuring access to healthcare services for all; it is a testament to our commitment to equity, social justice, and the fundamental right to health. However, as we have witnessed, the journey towards implementing UHC has been riddled with challenges and setbacks.

In our pursuit of this noble goal, we should draw inspiration and learn from global exemplars, with the United Kingdom's National Health Service (NHS) standing out. Established in 1948, the NHS embodies the principles of providing comprehensive healthcare services to all UK residents, irrespective of their socio-economic status. This foundational ethos of equity and inclusivity has been the cornerstone of the NHS's enduring legacy, weathering challenges, and undergoing reforms, yet steadfast in its commitment to delivering quality care.

The success of the NHS can be attributed to its multifaceted approach, encompassing robust primary healthcare infrastructure, sustainable funding mechanisms, a skilled healthcare workforce, integrated health information systems, and stakeholder collaboration. NHS's foundation lies in its funding mechanism, primarily anchored in general taxation. The UK government commits a substantial portion of its budget to NHS, ensuring a pooled resource that prioritises healthcare accessibility based on need rather than financial capacity.

This tax-funded model fosters a healthcare ecosystem where quality care is universally accessible, transcending socio-economic disparities. Operationally, NHS is structured into a cohesive framework comprising primary, secondary, and tertiary care services. Primary care serves as the initial point of contact, emphasizing preventive care, health promotion, and early intervention through general practitioners and community-based services.

In contrast, secondary and tertiary care facilities cater to specialised medical interventions, acute care, and multidisciplinary treatments, ensuring comprehensive healthcare coverage tailored to individual needs. Furthermore, the NHS's governance and accountability framework underpins its effectiveness and responsiveness, ensuring transparency, quality assurance, and continuous improvement.

The Department of Health and Social Care provides strategic direction and regulatory oversight, collaborating with NHS England, NHS Improvement, and Clinical Commissioning Groups (CCGs) to drive service delivery, performance management, and community engagement. CCGs, comprising local healthcare providers and stakeholders, play a pivotal role in commissioning services, allocating resources, and addressing local healthcare priorities, tailoring services to meet community needs.

For Kenya to emulate the achievements of NHS and realise the dream of UHC, a paradigm shift is essential. Firstly, there must be a concerted effort to strengthen our primary healthcare infrastructure, ensuring that communities, particularly those in rural and underserved areas, have access to preventive care, early diagnosis, and management of chronic conditions.

Furthermore, the sustainability of UHC hinges on transparent and equitable funding mechanisms. Drawing inspiration from NHS's reliance on general taxation, Kenya must explore a harmonised approach, encompassing government allocations, health insurance contributions, and innovative public-private partnerships.

This holistic funding strategy should prioritise healthcare accessibility, affordability, and responsiveness to evolving healthcare needs. Addressing corruption within Kenya's National Health Insurance Fund (NHIF) is paramount to ensuring effective implementation and sustainability of UHC initiatives. Corruption undermines public trust, misallocates critical resources, and impedes equitable access to quality healthcare.

Reports of fraudulent activities, mismanagement of funds, and illicit practices within NHIF have eroded confidence in the healthcare system, necessitating urgent reforms and stringent oversight mechanisms. A skilled and motivated healthcare workforce is the lifeblood of any successful healthcare system. Therefore, Kenya must invest in healthcare workforce development, continuous training, competitive remuneration, and supportive working environments.

By nurturing our healthcare professionals, we can cultivate a culture of excellence, innovation and compassionate care. The adoption of integrated health information systems is paramount to optimise resource allocation, enhance care coordination, and inform evidence-based policy decisions.

Kenya must embrace digital transformation, investing in interoperable health information systems that facilitate seamless data sharing, care coordination and monitoring of UHC progress. While the vision of UHC resonates globally, we must acknowledge that several countries have grappled with implementing comprehensive healthcare reforms with varying degrees of success. The United States' attempt with the Affordable Care Act, commonly known as Obamacare, serves as a pertinent example. Despite its noble intentions to expand healthcare coverage and control escalating costs, Obamacare encountered significant challenges, including political polarisation, implementation hurdles, and contentious debates over affordability and accessibility.

These global experiences underscore complexities inherent in healthcare reform initiatives, emphasizing the need for context-specific strategies, stakeholder collaboration, and adaptive approaches to realise the vision of UHC effectively.
Finally, as Kenya addresses the challenges of implementing Universal Health Coverage, drawing inspiration and lessons from the UK's NHS is essential.

By prioritising primary healthcare infrastructure development, establishing sustainable funding mechanisms, investing in healthcare workforce development, adopting integrated health information systems, and fostering community engagement and stakeholder collaboration, Kenya can pave the way towards achieving equitable, accessible, and high-quality healthcare for all.

The journey ahead may be challenging, but with unwavering commitment, collaborative efforts and visionary leadership, we can transform our healthcare landscape, and ensure a healthier, more prosperous future for generations to come.