By Gatonye Gathura
President Uhuru Kenyatta says the Universal Health Coverage (UHC) project is now being rolled out to all 47 counties.
In a commentary appearing in the Financial Times of London, Uhuru says the rollout of Afya Care to all counties started in September.
“In December 2018, Kenya launched the pilot phase of “Afya Care” — our brand of universal health coverage — in four of the forty-seven counties …… The full-scale expansion of Afya Care to the remaining forty-three counties, and, by extension, to every Kenyan, began last month,” wrote Uhuru. https://www.ft.com/content/33f5fd0a-db8f-11e9-8f9b-77216ebe1f17
But the reality on the ground shows the UHC piloting is still stuck in the initial four counties with no timeline for a national rollout.
Initially, the piloting was meant to take six months but a year on it is still being tried in Kisumu, Nyeri, Isiolo, and Machakos.
Modalities for the national rollout with county governments and even the mode of financing are yet to be worked out.
On Wednesday the Council of Governors refused to sign an MoU with the Ministry of Health for the national rollout before some pertinent issues are agreed on.
The Council of Governors want a requirement that they purchase medical products only from the Kenya Medical Supplies Authority be revoked, government takes up salaries for interning doctors and UHC implementation be made transparent.
Either that or no MoU for a national rollout said CoG Chair Kakamega Governor Wycliffe Oparanya.
In October the project suffered a major setback when a taskforce on National Hospital Insurance Fund (NHIF) reforms recommended Kenya adopt a tax-funded health scheme instead of a contributory scheme as had been envisaged.
All along the Cabinet Secretary for Health, Sicily Kariuki had made it clear; the national rollout would be financed through a contributory scheme led by a reformed NHIF.
A road map document for UHC prepared by her ministry last year estimated the whole project to cost about Sh543 billion by 2022.
The bulk of the money, Sh268 billion it estimated would be collected from about 12 million workers in the informal sector through a Sh500 monthly contribution.
The NHIF in its Strategic Plan 2018-2022 proposes to raise Sh101 billion from the informal sector during the period.
Bu the task force has said the co-payment from the informal sector is not sustainable is a burden to NHIF and contributors and should be discarded.
“There is no need of starting a house you cannot finish,” said task force Chairman James Wambugu.
Consequently, the task force recommended a free scheme with the national government covering about 35 million Kenyans through the consolidated fund. For the unemployed, there is no reprieve as they will continue contributing to NHIF.
“Clearly, sustainability of UHC cannot be a free scheme. Experts are working behind the scenes to see that UHC is delivered in a manner that is affordable to ordinary Kenyans. Please mark my words, affordable is not free,” Kariuki said while receiving the report.
Initially, the piloting was supposed to be launched through NHIF mainly to test the viability of the contributory model in the informal sector.
But just before this was done two things happened: A damning study by the World Bank and Kenya Medical Research Institute had laid bare the incapacity of NHIF to undertake the assignment while fraud investigations had been launched at the fund.
The World Bank/Kemri study found NHIF inept, corrupt, a captive of private sector interests and incapable of managing an enlarged UHC.
It also concluded that a voluntary contribution UHC scheme would not work in Kenya and recommended a tax-funded model.
Its arguments were so compelling that CS Kariuki incorporated two of the authors Dr Jane Chuma of WorldBank and Dr Edwine Barasa of Kemri into the NHIF reforms taskforce which has reinforced the same recommendations.
Kariuki had then to balance the advice from the technocrats, bureaucrats at Afya House, the private sector interests and political pressure to quickly get the show on the road.
In a meeting with the private sector – Kenya Healthcare Federation (KHF) – in November 2018 the CS said the way to deliver UHC was through NHIF on a premium base.
“This was the initial thinking. However, with time it has become clear that the UHC dream would not be implemented by 2022 as initially envisaged,” she told the federation.
“The new approach to this was to balance political and practical implementation,” thus the CS explained away the current free Afya Care piloting model.
“UHC must be delinked from politics so as to allow for a more realistic public health transformation agenda beyond the President’s term in office,” says the People’s Health Movement-Kenya (PHM-Kenya).
PHM-Kenya is part of a global network of civil society organization operating in about 70 countries.
In an advertisement placed in a local daily on 20th October 2019, the group asked the government to reconsider its 2022 deadline for getting every Kenyan on UHC.
“The government must unbundle Kenyans desire for a responsive, accessible and quality public health care from the President’s personal legacy.”
The lobby which last month had engaged the research firm Infotrak to gauge the public knowledge and perception of UHC accused the health ministry of cooking numbers to portray the pilot as a success.
“Only 42 percent of Kenyans have registered in the four piloting counties – Isiolo, Kisumu, Machakos, and Nyeri- as opposed to the government’s stated 62 percent,” claimed PHM-Kenya
Like the Wambugu task force, the civil society wants the government to adopt a tax-based financing model as the only sure way of delivering universal health care to all Kenyans.