Kenya’s Universal Health Coverage piloting ends but what’s the way forward

 

By Gatonye Gathura

The six-month piloting period for Kenya’s Universal Health Coverage (UHC) has ended but there is no word yet from the government on the way forward.

On 13th December, President Uhuru Kenyatta launched the project, to cover Kisumu, Nyeri, Isiolo and Machakos counties for a six-month period.

After the piloting, presumably ending on Sunday (30th June 2019) the Ministry of Health (MoH) had promised a national rollout but without publishing any timelines or details.

The MOH has, however, indicated the next phase of UHC involving all the 47 counties will be driven by a reformed National Hospital Insurance Fund (NHIF) supported by the Kenya Medical Supplies Authority (KEMSA).

But there are indications the three: county units, NHIF and KEMSA are not ready for the national rollout.

In June for example, all members of the County Executive Committee in charge of health demanded the MOH  provide a  comprehensive UHC policy framework before the scheme is scaled up to the other 43 counties.

“The MOH should brief governors adequately about the financial implications of UHC its sustainability and tenability mechanisms in place,” demanded the health committee.

Also measures to reform NHIF are still a long way off the mark with a task force formed for the purpose scheduled to present its report last month.

The report was though just the beginning of what could be another long government bureaucratic process that will require developing new policies, legislations, public participation all which could take many months if not years.

Among the deliverables expected from the task force is a report on governance, legal and regulatory detailing proposals for draft Bill(s) draft rules, orders and legislative amendments required to operationalize any changes.

The six-month piloting has also exposed serious challenges in drug and medical supplies distribution.

A March 2019 update of the pilot showed demand for health services to have risen by about 40 per cent for outpatient care in all the four participating counties.

To cope with the demand the Health Cabinet Secretary Sicily Kariuki said they had to significantly increase the delivery of medical products.

This has however had unintended consequences in the distribution of medical supplies to the other countries.

At a meeting of county governors held in Naivasha in April, several complained that intense concentration of supplies to the piloting counties had led to shortages in some non-piloting counties.

This in essence may indicate KEMSA does not have capacity to meet the expected service demand from a national UHC rollout.

Reforms at KEMSA may also be derailed as governors have threatened to move to court over a legal amendment making the Authority a mandatory supplier to the counties.

Currently, most county health units are facing challenges including workers strikes, poor quality care, shortages of workers and erratic disbursement of funds.

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