The year 2013 offered what can only be described as a new dispensation in Kenya. For the first time since independence, the country got semi-autonomous governments, 47 in all, known as counties, and run by elected governors.
Health was devolved and transferred to the counties from the National Government. By 2014, it seemed like the idea of improving people’s health in the counties was by quickly getting them to health centres whenever they fell sick. This saw a rush to buy or hire ambulances.
Machakos County Governor, Dr Alfred Mutua, is on record saying that in his county, most children are named Nzia (road) because they were born by the roadside. He explained that their expectant mothers, confronted by long distances, rough terrain and lack of transport, could not reach health centres in time. Some were ferried to health centres on wheelbarrows and even donkey carts.
This scenario was the same throughout the country, and thus the governors wanted to change the state of affairs. In February 2014, during the launch of a comprehensive care programme, Kenyatta Stadium in Machakos was resplendent with 70 new ambulances, 10 rapid response motorbikes and 89 security cars.
Fast forward to 2018, and Machakos was among the four counties selected to pilot Kenya’s Universal Health Coverage (UHC). The others are Kisumu, Isiolo and Nyeri.
According to Machakos County Executive Committee Member for Health, Ancient Kituku, the county had registered over 1.2 million residents by January 2020, which is equivalent to 86 percent of the total population.
The CEC, in an interview, said that the UHC programme is ensuring that all residents get accessible, affordable, and quality healthcare.
“But even before the pilot,” said Kituku, “we had invested heavily in our healthcare. We had ambulances which helped ferry patients from all corners of Machakos. The ambulances were also used to rush serious referral cases to Nairobi, mainly to the Kenyatta National Hospital”.
The county minister added that the UHC programme is ensuring that all residents get accessible, affordable and quality healthcare. The UHC package includes services accessible in public health facilities, such as door-to-door screening for non-communicable diseases, immunisation, antenatal care, outpatient services and inpatient services.
But what do the residents of Machakos say about UHC? We sought to find out.
“I was very sick in January 2020,” says Joyce Mutei of Machakos. “I was told to register for the M-TIBA card so that I could be treated for free.” The county used M-TIBA, a mobile app which allows people without medical insurance to save for medical care. The app has evolved to integrate payments, as well as health services like registration.
It is to this platform that Machakos County turned to for help to achieve UHC for the residents.
Mutei had pain in her legs and feared that she the cost of treatment would be overwhelming. “I expected the treatment to cost me an arm and a leg, ” she said. When the doctor recommended an X-ray and she saw the amout payable for the examination, she believed that her worst fears had been confirmed. “As if to confirm my fears, I was handed a Ksh1,000 invoice,” she says. “But I was not required to pay for it because I had the M-TIBA card,” she explained. But there was more good news for Mutei. She also did not have to pay for the prescribed drugs.
When we met her a month later, she had returned for a check-up at the Machakos Level Five Hospital, where she was expecting to see an orthopaedic.
“A few months ago, I could never have expected to seek a specialist’s services. I know they are expensive,” she said beaming. She explained that in her village, most people self-medicate using herbs, while others pray for a cure. Others, she added, ignore their ailments and hope to get better. “No one would like to suffer, or watch their families suffer, from ill health. But people fear that the cost of treatment at hospitals is very expensive. They do not have money even for food, so going to a hospital is out of the question.”
Machakos, according to the 2019 Census by the Kenya National Bureau of Statistics, has a population of 1,421,932, most of whom are scattered and live away from the town. But like most Kenyans, in case of illness, the residents sought treatment at the highest level hospitals, believing they are better equipped and staffed.
For this reason, the CEC in January 2020, and with a view to extend free, quality services to all residents, the county upgraded Mutituni, Masinga, Ndithini and Athi River health centres to Level Four status. In addition, the county upgraded 40 dispensaries to advanced health centres (Level Three).
Most of the residents are happy, as Joseph Kilonzo told us.
“Unastahili tu kuregister with M-TIBA, kufuatiya hivyo, matibabu na dawa ni bure; kwako na kwa familia yako pia (you just need to register with M-TIBA, after which treatment and medication is available for free to you and your family).
When it comes to healthcare seeking behaviour, both anecdotal and scientific evidence shows that women are more likely to go to health centres, especially for check-ups. On the other hand, men only go to hospitals when they fall ill, very ill at that. Peter Komu from Kangundo however dispels this notion. Armed with his card, he decided to get tested for ‘everything’. “I got tested for free and was given drugs without paying a cent. This thing is real”, he said,
However, Komu says that he had to travel to the Level Five hospital in Machakos, as some of the tests he wanted were not available in his home area of Kangundo. “I hope they could bring all the machines closer to the people,” he says.
Indeed, though most residents of Machakos hail the initiative, it does not lack a few challenges, as Christine Mueni highlighted.
Born in Makueni, Mueni got married in the next-door county of Machakos. When she heard about UHC, she rushed to the Level Five hospital to be registered. But there was a hitch. “Unfortunately, I was told I couldn’t be registered as my national identity card showed that I was not a resident of Machakos, but Makueni,” she said.
Mueni decries this, urging the government to look into the issue as many people have migrated from their birth areas. She notes that people move due to marriage, work and a myriad other reasons.
“The government should look into this. Does it mean if I was born in Mombasa and I live in Nairobi, then I have to travel to Mombasa every time I am ill to benefit from this government programme?” she posed.
These, and Komu’s concerns, are some of the lessons the government has learned from the pilot counties, which will inform the rollout to the rest of the country.