By Sophie Nyongesa
Universal Health Coverage means that all individuals and communities receive the health services they need without suffering financial hardship. This includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. The world celebrates the international Universal Health Coverage Day (UHC Day) annually on 12th December to raise awareness of the need for strong, equitable and resilient health systems that support universal health coverage for all. The theme of UHC Day 2020 is “Health for all: protect everyone” and it emphasizes on the need to invest in health systems that protect all in order to end the COVID-19 pandemic and build a healthier and resilient health system that can withstand unforeseen health crisis in future.
Kenya adopted Universal Health Coverage as one of the big four priority agenda by His Excellency the President, with an aspiration that by 2022, all people in Kenya will be able to access affordable health care through a single unified benefit package, without the risk of financial catastrophe. In order to achieve UHC, Kenya alongside other UHC countries must advance along the three lines of action involving the expansion of priority services to include more people and reducing out-of-pocket expenditure on healthcare.
There has been deliberate actions to increase the access to and demand for health care services in Kenya. In order to ensure that quality services are offered, Kenya adopted a national quality assurance framework; the Kenya Quality Model for Health (KQMH), which provides a pathway through which optimal levels of patient safety can be achieved. Moreover, it introduces joint health inspections checklists, which emphasize on risk based ranking of facilities and enforcement of an appropriate follow up action. The UHC policy brief outlines that the KQMH will lead to a locally driven quality assurance framework on which a regulation and accreditation system can be developed to incentivize facilities to move towards accreditation and total quality management. Moreover, this will create a level playing field for competition towards the highest attainable standards of quality of care as stipulated in the Constitution.
The Universal Health Coverage program was rolled out in four pilot counties in Kenya (Machakos, Nyeri, Kisumu & Isiolo) in 2018/2019. All the four counties were selected because collectively they have a high prevalence of communicable and non-communicable diseases, high population density, high maternal mortality, and high incidence of road traffic injuries, thus representing a diversity of challenges in Kenya. During a joint parliamentary meeting on the roll out of the 3.9 billion UHC pilot program in November 2018, the then Cabinet Secretary of Health, Sicily Kariuki stated that through UHC, the Kenyan government aimed to strengthen health systems with emphasis on community health services and primary health care. Moreover, it aimed at ensuring availability of essential commodities and basic equipment in health facilities as well as removal of user fees in level 4 and 5 public health facilities.
The COVID -19 pandemic struck only a few months after world leaders endorsed the landmark Political Declaration on UHC, committing to accelerate efforts towards the achievement of universal health coverage so that everyone, everywhere can access the health services they require, when and where they need them, without suffering financial hardship. This year, COVID- 19 has shown the importance of resilient health systems and universal access to quality healthcare.
The pandemic has tested our resolve to deliver health for all and threatened to undo decades of progress. It has disrupted delivery of essential health services in many countries, stretched resources to the limits, and revealed the impact of decades of underinvestment in primary care and essential public health functions.
According to the Expertise Global Consulting (a Public Finance Management Consulting firm), some of the key elements important to the health systems affected by COVID -19 in Kenya include;
- The government budget formulation and spending has been influenced by the outbreak of the virus. This has led to the introduction of three supplementary budgets, all of which had UHC budget cuts and the money redirected to address the pandemic.
- Equity in access to quality health systems between and within counties has been weakened by the outbreak of the virus.
- Weakened linkage between the health sector and other sectors such as education, energy and infrastructure, thus affecting the multi-sectorial approach to ensure all Kenyans have access to UHC.
Despite the various challenges experienced during the ongoing pandemic towards achieving UHC, Kenya has made effort towards achieving UHC. For instance, on 31st October 2020, his Excellency, the President of the republic of Kenya launched the biometric registration into the UHC program for millions of poor and vulnerable individuals who cannot afford to pay for medical care. This is a first step towards enrollment to and achievement of UHC.
In order to capitalize the achievement of UHC amidst the COVID -19 pandemic in Kenya, Expertise Global Consulting outlines that the government should;
- Align the spending of funds with locally defined priorities during the COVID-19 period by utilizing to expand and equipping the existing infrastructures, employing more health workers, and implementing projects that complement the priorities outlined in the UHC plans.
- Strike a balance in responding to the effect of COVID-19 and providing universal health care to its citizens. For instance, the government initiative of expanding health infrastructure across the counties and recruiting more health personnel to meet the demand for health care addresses both the effect of the virus as well as attaining the UHC goal.
- Build a resilient health system that has the ability to absorb disturbance, to adapt and respond with the provision of needed services. This can be achieved by having a dynamic objective of investments and reforms.
It is critical not to wait until the COVID -19 crisis has past to accelerate political and financial commitments to achieve Universal Health Coverage. Instead, the county and national governments together with the Ministry of Health must prioritize investing in strong, resilient and equitable health systems that protect everyone, respond to emergencies and leave no one behind in ensuring health for all by 2022!