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Are Kenyans Willing to Pay Higher Taxes For FINANCING HEALTH CARE IN KENYA: ARE KENYANS WILLING TO PAY HIGHER TAXES FOR BETTER HEALTH CARE? Billystrom Jivetti*1, Adélamar N. Alcántara1, Jacqueline A. Miller1, and Robert Rhatigan1 1Geospatial and Population Studies Institute for Policy, Evaluation & Applied Research 1 University of New Mexico MSC06 3510 Albuquerque, NM 87131-0001 *Corresponding Author: Email: [email protected] ǀ Phone: 505-277-2212 ABSTRACT correlation, and multiple linear regression. Kenyans have a choice of identifying The study findings lead to the conclusion that priorities for investments which range from there is a correlation between demographic, education, infrastructure, like roads and access, perceptions of governance, and bridges, security, like the police and military, perceived official corruption. The study finds agricultural development, energy supply, and the need to improve transparency and healthcare, among others. Under the accountability of revenue authorities and prevailing economic challenges, the Kenyan public institutions in Kenya. health sector has been struggling for funding. Recently, the government of Kenyan decided to import doctors from Cuba. Considering Keywords: Kenya, health care funding; taxes; the rising cost of health care and an policy; Kenya universal health care increasing demand for healthcare due to population growth, raising taxes or charging INTRODUCTION higher user fees are some of the options the Background to Health Kenya Policy government may resort to in order to sustain Kenya's original health policy was a public health care expenditure. This study post-colonial nation-building, socio- determined the demographic, geographic, economic development blueprint (1965) that and governmental factors that are associated focused on elimination of diseases, poverty, with the willingness of Kenyans to pay more and illiteracy. It was a three-tier system taxes for funding health care. Perceptions of involving district, provincial, and national government’s performance and levels run by the central government; trustworthiness are reflected in the missionary facilities at the sub-district levels, public’sopposition to paying higher taxes. and local governments in urban areas This study is important because it highlights (Mohajan, 2014; USAID, .; Wamai, 2009). the growing debate surrounding the Utilization of health facilities is a function of financing of universal health coverage in health status, health-seeking behavior, and low-income and middle-income countries. cost or quality of services. The cost of health Data obtained from the 2014–2015 services is still a major impediment to most Afrobarometer surveys and cover opinions Kenyans. About 70-80% of the population on governance, public-sector performance, resides in rural areas and an estimated 46.6% and how public health care is prioritized. live in poverty and on less than $1 a day. Data analysis involved descriptive statistics, Therefore, availability of health facilities does not always guarantee utilization (Wamai, 2009). Devolution of the Health Sector in Kenya Geography influences the size, For a longtime, the Kenya Health population, overall health, and social Policy Framework Paper of 1994 has been economic indicators. Kenya has a network of guiding the health sector development with about 5000 facilities which occur as national, the aim of providing quality healthcare that’s provincial, district, health centers and acceptable, affordable, and accessible dispensaries (Mohajan, 2014). The (Wamai, 2009). In 2010, a new constitution distribution of these health facilities in Kenya was enacted which subsequently devolved is still uneven. For instance, Central Kenya health functions to the county governments. and areas surrounding Nairobi are well Currently, the policy focus is on primary endowed while Nyanza and Western and Rift health care and universal healthcare access Valley regions which are considered as for all citizens per the constitution. The “worse-off” (Wamai, 2009). policy is guided by macroeconomic structural frameworks such as Kenya’s Vision 2030, Health Sector in Kenya Millennium Development Goals of 2015, and The main actors in Kenya’s health the Sustainable Development Goals of 2030 sector include the public sector represented (Bitta et al., 2017; Mohajan, 2014; Wamai, by the Ministry of Health; the private sector 2009). (for-profit and private not-for-profit); This decentralization of healthcare alternative medicine practitioners; functions to the county governments elicited individuals and households; and a series of challenges pertaining to planning, development partners such as ng United budgeting, misaligned policies, inadequate States Agency for International Development participation of the community, technical (USAID), United Kingdom’s Department for inefficiency, resource management, International Development (DFID), the procurement, as well as financial and European Union (EU) and the China information management (Mohajan, 2014; government as the main ones. The health Tsofa, Molyneu, Gilson, & Goodman (2017). facilities are owned by the government of There are now four levels of service delivery Kenya (41%), by non-governmental as explained by Table 1. organizations (15%), and 43% owned by private businesses (Mohajan, 2014). Table 1 Levels of Service in The Kenya Health System After the Devolution of Health Functions in 2010 Definition Level Description/Type of Facility National Level Self-autonomy, Highly specialized care Level 4 National Referral &Private Hospitals County Level All former public and private hospitals Level 3 County Hospitals Primary Level Level 2 Primary Care facilities 2 All dispensaries, health centers, and maternity homes in both public and private sectors County Level All health community-based activities and services Level 1 Community Health Centers and Dispensaries organized within the community Currently, the main objective is to reverse downward trends, and improve Financing Health Sector quality of services and efficiency in service Financing healthcare still faces delivery. However, the interventions in some numerous obstacles for adequate healthcare key areas are affected by the absence of a delivery in developing countries (Esamai et comprehensive approach (Mohajan, 2014). al., 2017). According to The National Health Therefore, there’s need for a system approach Accounts for 2015-2016, the health sector for improving the healthcare system in expenditure was $ 3.476 billion or 5.2% of Kenya. Such an approach could address Kenya’s gross domestic product (GDP). existing deficiencies of poor funding, Sources include from government of Kenya operational and management of healthcare (30%), households or out-of-pocket expenses facilities, the quality of service, the capacity (51%), the National Hospital Insurance Fund for planning, budgeting, and governance. (16%), and donors (3%) (from Japan, U.S., Most important, it will hasten the desired U.K., China, and the European Union health reforms, resource management, and (Mohajan, 2014; Mwai, 2016; USAID, ; policy implementation (Esamai et al., 2017). Wamai, 2009). Challenges to The Health System in Kenya THE STUDY Kenya's health challenges began in Problem Statement the 1970s-1980s leading to a degeneration of Kenyans have a choice of identifying services despite advances made in medicine priorities for investments which range from during the period and largely driven by education, infrastructure, like roads and widespread poverty and a rapidly growing bridges, security, like the police and military, population. In the 1990s, the socio-economic healthcare, agricultural development, energy and political environment further worsened supply. However, the Kenyan health sector the status of health sector (Wamai, 2009). has been struggling with funding. These challenges reflect the high burden of Considering the rising cost of health care and both communicable and non-communicable an increasing demand for healthcare due to diseases. Thus, the leading causes of population growth, raising taxes or charging morbidity and mortality in Kenya are higher user fees are some of the options the tuberculosis, HIV-AIDS, malaria, and high government uses to sustain public health care incidences of maternal, fetal, and neonatal expenditure. This study will determine the mortality. Inadequate health infrastructure socio-demographic, geographic, and limited human resources, and other health governmental factors that are associated with care inputs ultimately increase the the willingness of Kenyans to pay more taxes distribution of inequalities that lead to a for funding health care. reduction in the utilization of health services (Esamai et al., 2017; Mohajan, 2014). Rationale 3 Perceptions of government’s Q52J, Q52K); Q53: The level of perceived performance and trustworthiness are corruption in the tax department, the reflected in the public’s opposition to paying President and the officials in the office, and higher taxes. This study is important because parliament (Q53A, Q53B, Q53C, Q53D, it highlights the growing debate surrounding Q53E, Q53F, Q53J); Q55C: Difficulty in the financing of universal health coverage in obtaining medical care; Q55D: Paying bribes low-income and middle-income countries. to obtain medical service at public hospitals; Tax-financed spending to pay for Q68: Job performance of the President, improvements in health care provision member of parliament (MP), and local exposes the rising burden imposed on the government councilor (Q68A, Q68B, Q68C). taxpayers
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