We started this series on Kenya’s road to Universal Health Coverage (UHC) by debunking the misconception that this would mean free healthcare for all.
Today we end this series, transitioning the column to a digital platform. And I would like us to remember that UHC is the goal and the roll out of the Social Health Insurance Fund (SHIF), doesn’t equate to UHC.
There are countries that have achieved Universal Health Coverage without social health insurance.
Most countries grapple with what is the most appropriate health financing mechanism to meet the principles of UHC, that is, all people have access to quality health services, from prevention to rehabilitation, when and where they need them without financial hardship.
The complexity of designing such a system, making it acceptable to stakeholders and implementing the various components cannot be overstated.
It is not the first time that the country has proposed a strategy to guide the country towards UHC.
The late former President Mwai Kibaki, in the period of 2003 -2005 received the highly controversial (National Health Insurance Scheme) NHIS bill but declined to sign it due to a mix of both technical and political reasons.
Kenyans concerns on Universal Health Coverage
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Many would argue that the current reforms are sound. It has been said that Kenya is the land of good policies.
A credit to the capacity that exists in this great nation. It is not in the policy but in the implementation that the rain begins to beat us.
The delay in rolling out of SHIF isn’t the problem. It’s a symptom of the concerns being raised by Kenyans.
Let’s set aside the discussions on SHIF contributions for a moment and assume that in the space of twelve months we would have concluded the NHIF transition period.
The concern, put simply, is on the supply components. People require health services and thus the demand is there.
But how prepared is the health workforce and do we have well equipped, well stocked facilities?
It might appear a simple question, but if we were to set aside the technical details, the average person is concerned about quality of services. If these basic components aren’t in place, the risk of terming UHC a mistake is high. Yet, the UHC goal isn’t the issue but our implementation.
Take the example of women who received free maternity services under the Linda Mama programme in the now repealed (National Hospital Insurance Fund (NHIF).
If you were to ask this cohort to pay at a facility, because of the SHIF contracting changes, she would not only say the system isn’t working, that UHC is bad. But SHIF isn’t UHC.
An implementation problem
We could go into details around governance and the now slashed budget allocations to health and UHC implications. Let’s pack the political elements for now. Let’s propose solutions.
It’s clear that there’s a general lack of understanding on why and how. The resultant perception problem of the implementation strategy and associated costs, particularly in tough economic times, has generated opposition.
But it’s not an opposition to UHC, not when you listen to the concerns: It’s the services; It’s the implications to certain sectors, the population and the country.
Additionally, it’s the “underlying mistrust associated with perceived lack of government’s commitment towards transparency and good governance” as stated in a journal article on the ‘historical account of the national health insurance formulation’ by senior economist Jane Chuma et al.
In the same publication there was mention of “inadequate communication strategies to articulate the policy, leading to a vacuum of information flow to various players”.
My dear readers, I put to you that if one year had been spent on translation and communication, while transition was happening in the background, we wouldn’t be witnessing some of these challenges.
And I don’t just mean press conferences and opinion columns. Think about the focus of the finance bill movement.
Kenya has some good policy briefs and publications as just demonstrated, but these need to be digested into formats for the average person to drive public participation and action.
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