By Felipe Jaramillo and Siddharth Chatterjee
Consider this. One million Kenyans fall into poverty every year due to catastrophic out of pocket health expenditures.
For the almost four in every five Kenyans who lack access to medical insurance, the fear that they are just an accident or serious illness away from destitution.
Ill health is easily the most destructive wrecking-ball to any country’s plans for sustainable development, which validates President Uhuru Kenyatta’s commitment to deliver Universal Health Coverage (UHC) by 2022, as part of his Big Four development agenda.
The number of Kenyans who continue to suffer from communicable diseases such as HIV/AIDS, malaria and TB, as well as the increasing burden of non-communicable diseases like diabetes, cancer and hypertension, present formidable challenges to the country.
Among the poorest in Kenya, only 3% have health insurance, which is provided by the National Hospital Insurance Fund (NHIF). Among the wealthiest, many who also have private cover, this rises to 42%, indicating again that the poorest are at risk of being left behind even further, and do not have an appropriate safety-net to fall back on.
Investing in UHC is: 1) a moral obligation – it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost; and 2) a very smart investment – prevention of malnutrition and ill health will have enormous benefits in terms of longer and more productive lives, higher earnings, and averted care costs.
But delivering quality affordable healthcare for all comes at a cost. And this cost should certainly not be carried by those who cannot afford it.
The delivery of UHC requires robust financing structures. When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness. Pooling funds from compulsory funding sources (such as mandatory insurance contributions) can minimise the financial risks of illness across a population.
Health Cabinet Secretary Sicily Kariuki recently unveiled a team of experts to spearhead radical reforms at the NHIF. This new initiative will build on past efforts at reforming NHIF, which were only partially implemented. The team will analyse the financial sustainability of NHIF, oversee legal and regulatory reforms among other propose organisational reforms to reposition NHIF as a national social health insurance provider and ensure its accountability and transparency.
The realization of UHC in Kenya will only be achieved if the Government of Kenya will increase its budget allocation towards health and lead solid health system strengthening initiatives – as for example the NHIF reform – to increase efficiency, effectiveness and accountability within the health sector.
The health system strengthening initiatives currently on their way in Kenya are critical, yet exciting, and require “all hands-on deck” and much collaboration.
The Government of Kenya can count on the support of the World Bank, and United Nations family as its development partners.
Within the United Nations Development Assistance Framework (UNDAF) 2018-2022 for example, the human capital development pillar (which includes health) is receiving the largest share of human and financial resources – and rightly so, as we recognise the importance of supporting the Country to realise the vision of UHC by 2022.
The World Banks’ Transforming Health Systems for Universal Care Project for Kenya is improving utilization and quality of primary health care services with a focus on reproductive, maternal, new-born, child, and adolescent health services. Supporting health financing reforms is a key component of this project. Under the recently approved Kenya Social and Economic inclusion Project (with US$ 250 million IDA credit and US$ 70 million of DFID grant), the Bank is supporting the Government to systematically enrol and register National Safety Net Program beneficiaries in the NHIF through an established referral mechanism.
The Government of Kenya is aligning forces as well with the private sector. Through the United Nations’s SDG Partnership Platform, the Government has already been identifying and scaling up transformative primary health care partnerships through galvanising support from the private and philanthropic sectors.
The successful delivery of the NHIF reform will demonstrate Kenya’s ability to efficiently pool revenues to cover for a healthcare package with essential services for all Kenyans, at all ages. This again will enhance confidence to join and invest in NHIF and create opportunities within the health sector to develop new partnership models for the delivery of care which all will help the Country to make rapid strides towards the realization of UHC.
Kenya can lead the way in realising Universal Health Coverage – and we stand with Kenya to “Deliver as One” and leave no one behind.
Siddharth Chatterjee is the UN Resident Coordinator to Kenya.
Felipe Jaramillo is the World Bank country director for Eritrea, Kenya, Rwanda and Uganda, based in Nairobi