By Gatonye Gathura
Corruption, absent health workers, drug stock-outs and illegal payments are denying poor Kenya the benefits of universal health care.
A study carried out in Nairobi and Siaya by the Kenya Medical Research Institute (KEMRI) shows the free maternal health care, free services in primary public facilities and insurance subsidy for the poor are of little help.
“We are being made to pay or bribe,” poor residents told the researchers in the study published last month (24th June 2019) in the International Journal for Equity in Health.
As part of the ongoing Universal Health Coverage (UHC), the Jubilee Government is providing free maternity services, free care in all public primary health facilities and a Health Insurance Subsidy Programme (HISP) for the poor.
The study says the poor still pay for hospital cards, medicines, and other commodities while in many cases they are made to bribe for the supposedly free services.
However, despite these generous government initiatives the poor say they hardly receive the free services.
Many who participated in the study said they are made to bribe to skip long queues in health facilities or to get medicines at a subsidized cost.
“They ask you, how much do you have? Do you have Sh500, so that I can to give you some drugs that were reserved for someone else? Then, you tell them that you have Sh300 which they take and give you the already packed and labeled medicine,” said a respondent.
Apart from the bribes the study which sampled about 90,000 households in Makadara and Ruaraka in Nairobi, and Rarieda, Siaya, and Gem in Siaya County reports patients were still being charged in primary health facilities against government policy.
“We pay when we go to a dispensary. We pay Sh50 at the laboratory. We pay for injections, if it’s a child it’s Sh20, if someone is over five years it’s Sh50,” said a respondent in Siaya.
Delivering women, said they are made to pay for most commodities which ought to have been provided by the health facilities but they were not available.
“If you take an expectant woman to a public health facility you are made to buy gloves and even medicines. When you are discharged they send you to the cashier to go and pay,” said another respondent.
They also reported long distances to health facilities and high absenteeism of health providers from work stations.
Even beneficiaries of the loan-funded HISP reported out-of-pocket payments because refunds to facilities from the National Hospital Insurance Fund (NHIF) were often delayed.
“We were tricked; they have wasted our time by giving us invalid cards. I have to use my own money to pay for treatment, so what is the use of having the card?”
“Why should the government lie to me and my family? It is very bad. I always feel deceived when I use my own money to pay for treatment,” said a HISP cardholder.
Those with the HISP cards reported being discriminated against by health workers in private facilities who instead prefer cash-paying patients.
“Health workers perceive us as debtors or people with loans that will be paid later. They take a long time before they attend to us or they can even ignore you,” said a rural resident.
The study aptly titled: “We are called the et cetera”: Experiences of the poor with health financing reforms that target them in Kenya, suggest as currently structured UHC is not benefiting the poor.
“You know there are those who own Kenya and those who live in it, so we are called the et cetera,” a Nairobi participant told the researchers.
Notably, the lead study author, Dr Edwine Barasa, director of the KEMRI-Wellcome Trust Nairobi programme is a member of the current NHIF reform taskforce formed by Cabinet Secretary for Health Sicily Kariuki.
“We have to bring back confidence to the public health sector because that is what has been lacking especially in the lower-level facilities,” says CS Kariuki.
Kariuki at a morning TV show last week (8th July 2019) said Kenyans had lost confidence in the system for lack of drugs, health workers and even basics such as water.
The CS who singled out the shortage of health workers as a major threat to UHC said her ministry and counties will engage and train community health volunteers to take up some of the work burden.
Kariuki was, however, non-committal on when UHC will be rolled out nationally for the general population, following the end of piloting last month.
“On the approach and commencement I will confirm later but definitely within this calendar year,” she said.
2013: All fees abolished in health centers and dispensaries
2013: Free maternity introduced
2014: Health Insurance Subsidy Programme (HISP)
2018: Free UHC pilot introduced in four counties
51.6 million Kenya to be reached by UHC by 2022
100,000 community workers to be engaged
Ongoing UHC Subsidy Programme
1.79 elderlies and disabled people
1.5 million poor households
1.3 million pregnant women
3 million school children