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Road to Universal Health Coverage Ensuring That All People Have Access to Sufficient, Affordable Health Services

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Road to Universal Health Coverage Ensuring That All People Have Access to Sufficient, Affordable Health Services THE KENYA YEARBOOK EDITORIAL BOARD HEALTHUNIVERSAL SERIES HEALTH COVERAGE ROAD TO UNIVERSAL HEALTH COVERAGE ENSURING THAT ALL PEOPLE HAVE ACCESS TO SUFFICIENT, AFFORDABLE HEALTH SERVICES 2020 REPORT PAGE 1 UNIVERSAL HEALTH COVERAGE UNIVERSAL HEALTH COVERAGE ROAD TO UNIVERSAL HEALTH COVERAGE UNIVERSAL HeaLTH COVERAGE IMPLEMENTATION IN KENYA PAGE 3 UNIVERSAL HEALTH COVERAGE THE TEAM Cabinet Secretary, ICT Innovation and Youth Affairs Joe Mucheru, E.G.H. Principal Secretary, State Department of Broadcasting and Telecommunications Ms. Esther Koimett Board Chairman Eng Sammy K. Tangus Board Members Nemaisa Kiereini Caroline Mukeli Wilson Kipkazi Hezekiah Okeyo Richard Gakunya Kennedy Buhere Mwaura Igogo Mulei Muia Publisher: Kenya Yearbook Editorial Board Chief Executive Officer: Edward Mwasi Marketing Officer: Jane Mareka Editorial Manager: Peter Okong’o Photo Editor: Hilary Kaimenyi Production Manager: Elijah Muli Photography: Presidential Consultant Editors: Julius Maina Delivery Unit (PDU) Peter Wangai Graphic Artist: Ong’any Kevin Sub Editor: Michelle Dibo Researcher: Julie Nyawira Contributors: Ken Opala Kiundu Waweru Luke Anami Kenya Yearbook Editorial Board P.O. Box 34045 GPO 00100, NHIF Building, 4th Floor Nairobi Tel: +254 20 2715390 / +254 757 029456 Email: [email protected] First published 2020. All rights reserved. © 2020 The Kenya Yearbook Editorial Board in part- nership with the ministry of health. No Part of this book may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the author. ISBN: 978-9966-1947-2-5 PAGE 4 UNIVERSAL HEALTH COVERAGE CONTENTS Foreword……………………………………………………....................................................................................................IV Preface………………………………………………………......................................................................................................V Introduction……………………………………………….....................................................................................................VII Chapter 1: Evolution of UHC in Kenya…………....................................................................................................1 Chapter 2: Legislative Pillars of UHC…………...............................................................................................31 Chapter 3: NHIF and Financing of UHC…………..........................................................................................71 Chapter 4: Infrastructure for Delivery of UHC…......................................................................................99 Chapter 5: Primary Healthcare………………………...........................................................................................151 Chapter 6: Implementation Progress of UHC ….....................................................................................177 Chapter 7: Public-Private Partnerships…………............................................................................................217 Chapter 8: Leveraging Innovation and Technology…….............................................................................251 Chapter 9: Living UHC – Case Studies ………………………........................................................................281 Chapter 10: Reforming KEMSA………………………………….............................................................................301 References: ………………………………………………………………...........................................................................321 PAGE 5 UNIVERSAL HEALTH COVERAGE FOREWORD Mutahi Kagwe, Cabinet Secretary, Health f we continue to behave normally, this dis- the poor and marginalised with healthcare ease will treat us abnormally. Behaving programmes tailored to their needs, and in- “Inormal under these circumstances is akin vesting in community and primary healthcare to having a death wish” Those were my words in partnership with civil society and private on 22nd March 2020, while giving my regular sector players. national update on the COVID-19 pandemic. Reforms envisaged under UHC should improve We are living in extraordinary times. The novel efficiency in spending on public and private Coronavirus Disease 2019 (COVID-19) has healthcare, and lead to better resource mobi- changed the way we approach simple everyday lisation for health. tasks like taking public transport, greeting one another, eating and drinking. By preventing malnutrition and reducing out-of- pocket spending, UHC is contributing to social It has changed how we consume our news and cohesion and stability, all of which are necessary pay for goods and services. More importantly, to sustain economic growth. it has highlighted the importance of ensuring that every Kenyan can access basic healthcare. For these reasons, this book could not have come out at a better time, when many Kenyans Our goal of achieving Universal Health Cov- are looking to better understand the Govern- erage (UHC) by 2030 is even more important ment’s plans to improve public health services now than it was before the pandemic. It is in- and lower the cost of healthcare. creasingly obvious that COVID-19 will be with us for some time, but UHC is not just about this I am happy that our partnership with the Kenya terrible disease. It is about reducing the cost Yearbook Editorial Board (KYEB) has borne fruit of out-of-pocket spending on health services and it is my sincere hope that this publications by the poorest Kenyan. It is about targeting will enrich the public’s knowledge of UHC. If we continue to behave normally, this disease will treat us abnormally. Behaving normal under these circumstances is akin to having a death wish - Mutahi Kagwe, Cabinet Secretary, Health PAGE 6 UNIVERSAL HEALTH COVERAGE PREFACE Eng. Sammy Tangus, KYEB Board Chairman ne of the most important developments and economic advancements, as envisioned in Africa over the last decade has been in the Big 4 Agenda pillars of UHC, Enhancing Othe growing political support for Univer- Manufacturing, Food and Nutrition Security sal Health Coverage (UHC). The task is massive and Affordable Housing. because communicable, maternal, neonatal, and nutritional diseases continue to be the biggest UHC is a noble goal, premised on the moral causes of premature deaths on the continent. obligation to ensure that people do not die UHC is now integrated in the national health because they are too impoverished to afford strategies of most African governments. basic healthcare. A population shielded from malnutrition and ill health is likely to be more Kenya recognises that social health insurance productive. for the poor, which guarantees them access to essential health services, is necessary to safe- Africa’s population, Kenya included, will double guard gains made in eliminating deaths from by 2050. Before the advent of the novel Coro- diseases that can be treated. navirus Disease 2019 (COVID-19), the United Nations Economic Commission for Africa had Overall, tuberculosis, diarrhoeal diseases, lower projected a healthcare-financing shortfall of respiratory tract infections, malaria and HIV/ US$66 billion annually for the continent. AIDS are among the biggest killers in Kenya, yet deaths from all five can be prevented. Our Although spending on health has increased sig- motivation for this book is to spark and sustain nificantly over the last 20 years in middle-in- important conversations about the journey of come countries like Kenya, most of the spending UHC in Kenya thus far. There is no magic bullet is by households supplemented by development and no one-size-fits-all prescription, because aid, thus worsening poverty. With the budgets of gains in healthcare must be balanced with social most African countries already stretched, a new UHC is a noble goal, premised on the moral obligation to ensure that people do not die because they are too impoverished to afford basic healthcare. A population shielded from malnutrition and ill health is likely to be more productive. - Eng. Sammy Tangus, KYEB Board Chairman PAGE 7 UNIVERSAL HEALTH COVERAGE approach to public healthcare is therefore the also grappling with the negative social and eco- only option. This book captures tangible efforts nomic impact of the pandemic. by the Government, in partnership with the private sector, to translate the lofty ambitions Kenya is not alone. The pandemic created un- of the global UHC agenda into a sustainable charted territory globally and its effects will homegrown alternative for Kenya. still be felt long after the crisis is over. We track the origins of UHC in Kenya and inter- The numbers of confirmed cases have been on ventions by the Government and its partners in an upward trajectory since the first case was starting the long journey towards achieving a reported on 13th March 2020. Measures by measure of equity in access to primary health- the Government to counter the COVID-19 chal- care for all Kenyans. lenge are well summarised in the introduction. The Government’s approach includes UHC in an This book would not have been possible without ecosystem that includes investment in access our partnership with the Ministry of Health, roads to public healthcare facilities; legislative whose help proved invaluable with critical in- reforms; restructuring of key agencies like the sights into the public healthcare system, and Kenya Medical Supplies Authority (KEMSA) and how the challenges therein are being dealt with. the National Hospital Insurance Fund (NHIF); adoption of digital technologies that save time Indeed,
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