The Kenya health sector has re-aligned its policies and strategic direction in line with the Constitution of Kenya, 2010. The Constitution guarantees the highest attainable standard of health as a right while devolving governance to ensure improved service delivery, greater accountability, improved citizen participation and equity in the distribution of resources.
Additionally, Kenya’s Vision 2030 aims at transforming Kenya into a globally competitive and prosperous country with a high quality of life.
The Kenya Health Service Delivery is one of the eight policy orientations specified in the Kenya Health Policy (KHP, 2014-2030), which outlines the direction the sector is taking to ensure significant improvements are made in the overall status of health in line with the Constitution of Kenya 2010, the country’s long-term development agenda, Vision 2030, and global commitments such as Sustainable Development Goals (SDGs).
Kenya is a signatory to the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs), and has committed to put in place the appropriate measures and investments needed to realise the targets set under Goal 3: to ‘ensure healthy lives and promote well-being for all at all ages’.
The attainment of SDG3 is underpinned by the achievement of target 3.8 to ‘achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all’.
Universal Health Coverage (UHC) is based on the principle that all individuals and communities should have access to quality essential health services without suffering financial hardship.
Access to, and use of, health services enables people to be more productive and active contributors to their families, communities and society at large. UHC brings health and development efforts together, contributing to poverty reduction as well as building solidarity and trust financial risk protection prevents people from being pushed into poverty (or being further impoverished) when they have to pay for health services out of pocket.
Universal Health Coverage, therefore, calls for a holistic health systems approach to improving performance. Health System Strengthening (HSS) involves investments in inputs in an integrated and systemic way, and reforming the architecture that determines how different parts of the health system operate and interact to meet priority health needs through people-centered integrated services. HSS is, therefore, the key means to achieve UHC.
Prioritisation of HSS actions for UHC will need to vary depending on county contexts and needs, but must be underpinned by a commitment to a human rights-based approach. This is premised on the principle that access to health services is universal, putting a particular emphasis on the poorest, vulnerable and marginalised groups and on the principle of non-discrimination.
This suggests that the promotion of UHC must be supported by a commitment to address inequalities and exclusion. In this way, a human rights-based approach provides not only a framework for accountability, but also for development of inclusive health policies and programmes, and for mobilising civil society to achieve the right to health.
In 2017, the Government of Kenya committed to implementing Universal Health Coverage as one of its Big Four Agenda. This will ensure that all individuals and communities in Kenya have access to quality essential health services without suffering financial hardship.
Laying a firm foundation for UHC under the Big Four Agenda is a progressive programme that runs between 2018-2022. UHC is defined as the desired outcome of health system performance whereby all people who need health services (health promotion, prevention, treatment, rehabilitation and palliative care) receive them without undue financial hardship. UHC has interrelated, equally important dimensions, which need to be attained for its progress to be real and sustained.
A key goal of UHC is to provide healthcare and financial protection to all people in the country, with three related objectives:
- Equity in access – everyone who needs health services should get them;
- Quality of health services – good enough to improve the health of those receiving the services;
- Financial-risk protection – ensuring that the cost of healthcare does not push people into poverty.
Attainment of UHC has remained elusive due to many challenges, which include the following:
Unequal access to different healthcare services due to poor distribution and use of resources.
Many interventions are not reaching the people that need them most due to geographical and social-cultural barriers.
High costs associated with accessing and using available services. These tend to drive households into poverty and limit their ability to use health services.
The Government is committed to UHC as part of a socio-economic transformation. It will do this by providing equitable, affordable and quality healthcare. UHC will ensure that Kenyans receive quality preventive, curative and rehabilitative health services without the usual financial strain. Kenya has drawn the roadmap towards accelerating implementation of the UHC agenda, determining the level of service availability, readiness, and quality of care across the sector.
The following programmes are in place to enhance the achievement of UHC: free maternity where one million women are covered annually; abolition of user fees in primary health facilities; introduction of health insurance subsidy programmes for the elderly, very poor and persons with severe disability; introduction of EDU Afya for all students; and launch of UHC pilot programmes in four counties.
Universal Health Coverage (UHC)
Universal Health Coverage is firmly based on the World Health Organisation (WHO) constitution of 1948 declaring health a fundamental human right, and on the Health for All agenda set by the Alma-Ata Declaration of 1978. UHC cuts across all the health-related Sustainable Development Goals (SDGs) and brings hope for better health and protection for the world’s most vulnerable. WHO has defined UHC as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial strain.
Kenya’s population is expanding and is projected to hit 60 million people by 2030, up from the current 47.5 million (as per the 2019 Kenya National Bureau of Statistics, Housing and Population Census).
This growing population raises the critical challenge of providing the foundations for long-term inclusive growth. This is as witnessed by the fact that today, less than 20 percent of Kenyan households have any form of health insurance (KHHEUS, 2018).
The fact that the rest of the population is largely dependent on donor aid, government relief and out-of-pocket spending to access healthcare is of grave concern to the government. Hence the decision to make provision of quality and affordable healthcare a non-negotiable priority is vital.
Kenya’s health system struggles to manage the triple burdens of communicable diseases (with frequent epidemics), road traffic injuries, and non-communicable diseases (NCDs), which are on the rise.
An interesting statistic from the National Aids Control Council shows that while HIV contribution to the burden of disease has fallen by 61 percent in the period 2005-2016, the combined contribution of ischemic heart disease (where an organ is not getting enough blood and oxygen) and cerebrovascular disease has increased by 57 percent in the same period.
Key players…
To deliver UHC, key stakeholders must be engaged with players from the Ministry of Health, National Hospital Insurance Fund (NHIF), faith-based health service organisations, the private sector, non-governmental organisations and international development partners with clear roles and responsibilities.
UHC has been adopted as Target 3.8 of the Sustainable Development Goals (SDGs), with a clear aim of ensuring that individuals and communities receive the health services they need without suffering financial hardship.