One year on Universal Health Coverage making Kenyans poorer, less healthy

By Gatonye Gathura

Reforms to support Universal Health Coverage (UHC) since 2013 have made Kenyans less healthy and poorer, says a World Bank report.

Despite the reforms, the report says the percentage of sick people not seeking medical care increased from 13 percent in 2013 to 28 percent in 2018.

The report published, days to the first UHC anniversary today, also says the number of Kenyans on self-medication increased from 30.7 percent in 2013 to 45.2 percent in 2018.

UHC was launched on 13th December 2018 by President Uhuru Kenyatta in Kisumu as a pilot in the Lakeside county, Nyeri, Machakos and Isiolo to run for six months followed by a national rollout.

Yesterday President Uhuru Kenyatta said UHC will be rollout next month, but gave no details on how it will be financed. He also did not explain how differences over the project between his and county governments will be resolved.

The new study: ‘The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018,” also says about 1.1million individuals have been pushed into poverty by crippling health expenses during the same period.

The report was published two weeks ago, (3rd December 2019) by a team from the World Bank offices in Nairobi and Washington, European Centre for Social Welfare Policy and Research, and the University of Basel, Switzerland.

The study was funded by the World Bank which is also a major financier of ongoing UHC activities in Kenya through its multibillion shilling: ‘Transforming Health Systems for Universal Health Care (THS-UC),’ project.

Among the study authors is Dr Jane Chuma of the World Bank-Nairobi, who was also a key member of the government task force on reforming the National Hospital Insurance Fund (NHIF) for a leading role in UHC.

In October the task force recommended, Kenya adopt a free tax-funded UHC instead of the government favoured contributory scheme under NHIF.

The task force recommendation had seemingly rattled the government. “Clearly, the 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,” Cabinet Secretary for Health Sicily Kariuki said while receiving the task force report.

The new report, however, reinforces the position of the NHIF reforms panel advocating for tax-funded UHC instead of a voluntary based insurance scheme.

Countries succeeding with UHC, the authors say are those offering tax paid or mandatory contributions schemes than those relying on voluntary premiums and contribution.

“Overall, our results indicate that interventions implemented so far to secure financial risk protection are not sufficient,” says the study appearing in the journal BMJ Global Health.

These interventions, the study says include the introduction of a Civil Servants Scheme and the expansion of the basic benefit package for NHIF members.

Others are the increase of the NHIF inpatient reimbursement rate and the introduction of a health insurance subsidy for the poor.

The removal of user fees at health centers and dispensaries in 2013, the report says had negative effects especially on poor patients who were referred to fee-charging higher facilities.

“Reforms undertaken between 2013 and 2018 (eg, coverage of outpatient treatments by NHIF initiated in 2015) did not have a meaningful impact in terms of financial protection,” concluded the study

One Tuesday the lobby group Open Society Initiative for Eastern Africa (Osiea) reported the free maternity programme – Linda Mama – also part of UHC reforms has failed to protect women from devastating out of pocket health expenses.

In his independence anniversary speech on Thursday, President Uhuru asked the Ministry of Health and county governments to quickly agree on a pending UHC Memorandum of Understanding (MoU).

Last month the Council of Governors refused to sign the MoU, demanding details on how UHC will work, be financed and its sustainability.

The other sticky issue is control of medical supplies with the ministry and donor beneficiaries propping up the Kenya Medical Supplies Authority (Kemsa) as the sole source while governors demand a free hand.

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