The number of Kenyans who cannot get treatment when sick has almost doubled since the current Jubilee administration came to power.
A national study by the Kenya Bureau of Statistics shows 20 percent or about 9.5 million Kenyans cannot access primary health care when sick compared to about 5.6 million in 2013.
This proportion, the study says is significantly higher compared with the 12 percent reported in the 2013 Kenya Household Expenditure Survey.
Universal Health Coverage
The dip, the report says is surprising because it happens despite the ongoing widespread implementation of Universal Health Coverage (UHC) in Kenya.
The rise in the number of sick who can’t access care, the survey says, “is unexpectedly high given that the Kenyan government has recently prioritized UHC as one of its agendas for socio-economic transformation.”
The Jubilee administration has been implementing UHC including free maternity and primary health care since 2013.
Also, it has subsidized health care for the disabled and elderly, indigent populations, some students, and recently unsuccessfully piloted UHC in four counties.
“Despite the wide implementation of UHC, it is unclear whether the programme has improved access to health care” says the report.
The survey published on 28th May 2021 in BMJ Open, says most in trouble are households headed by single persons compared with those who are married or in a union
The study also involving the African Population and Health Research Center, Nairobi, had engaged 9,447 households comprising 15, 539 members.
About one in every five study participants had experienced an untreated case of sickness, highest being the uninsured and those in households headed by unmarried persons.
“Our findings show that there is still a considerable unexpressed demand for primary care services despite widespread implementation of Universal Health Coverage in Kenya,” says the study.
National Hospital Insurance Fund (NHIF)
To shore up an increasingly failing UHC programme, President Uhuru Kenyatta in October launched biometric registration mainly targeting the poor.
However, evidence indicates more poor Kenyans recruited to the National Hospital Insurance Fund (NHIF) are dropping out than those retained.
The NHIF Chairman Lewis Nguyai says of the 10.4 million registered members only 5.1 are paying their premiums. Voluntary contributors from the informal sector data show are the main defaulters.
Nguyai has blamed the poor show on the current poor economic environment due to Covid 19 pandemic.
But this may not be entirely true; a 2018 study by a team from the World Bank and Kenya Medical Research Institute (Kemri) revealed that the informal sector NHIF members had high attrition rates.
“In 2017 the proportion of enrolled informal sector individuals who subsequently did not renew their membership was 73 percent signaling a high attrition rate,” said the study published in the journal Health Systems & Reform in November 2018.
A key reason for this high dropout rate by the poor, the study said was partially due to discrimination by service providers. Many service providers favoured NHIF members with higher capitation such as teachers and civil servants.
The latter groups, the study said were likely to be allowed to jump the queue and get medicines while the poor were directed to buy drugs elsewhere and from their pockets.
The poor also had problems in raising the Sh500 monthly contribution due to low and irregular earnings in the informal sector.
Consequently, the team, led by Dr Edwine Barasa of Kemri, suggested the government adopt a fully tax-funded UHC as the most viable option.
But the government has decided to make it mandatory for all households to pay a Sh 500 monthly contribution to NHIF.
However, it has not been explained how this will be enforced or how the poor will be cushioned against discrimination or erratic earnings.
By Gatonye Gathura