Government set to reform Kenya’s health system

The Kenyan government has called on an independent panel of experts to help transform and reposition the National Health Insurance Fund (NHIF). Mr James Wambugu, a former insurance company manager, is leading the panel of experts. They have 90 days from 26 February to present a report, which will guide the country’s progression to universal health coverage (UHC).

The NHIF is in dire need of reform and the government’s commitment to UHC is commendable. But, building a strong public health system must be at the heart of any transformation process to realise quality health for all in Kenya.

The high administrative costs of running the Fund is the first challenge to overcome. It represents 22% of the funding available for NHIF against an average of 2,7% for social insurance funds globally.

Even more worrying is the fact that private health providers are benefitting the most. Kenyan Members of Parliament recently pointed out that “small private hospitals are the biggest beneficiaries of the NHIF millions”

Between July 2018 and 25 February 2019, about 1,266 private and faith-based health facilities claimed 2 billion Kenyan Shillings (US$19,848,300) from the Fund. But, 5,751 public hospitals claimed just KSh789,002,629 (US$7,830,170).

On average, a private provider drew US$15,678 from the fund while a public hospital drew just US$1,361:  barely 9% of the average amount obtained from the fund by a private health provider.

In addition, most private health facilities are far smaller than the public hospitals, so the difference in funding per patient is even greater. Not even the prestigious public tertiary health institutions are spared.

The National West Hospital, which is the eighth largest private hospital in the country, was allocated KSh 147,362,358 (US$ 1,462,440). But between them the two leading public health institutions in the country were allocated only KSh 155,933,682 (US$1,547,510). These are the Kenyatta National Hospital, which is Kenya’s oldest and largest hospital and the teaching hospital of the University of Nairobi, and the 113-year old Moi Teaching and Referral Hospital.

Thus, we agree with Mr Wambugu that “the government has to come in” to ensure provision of universal health coverage, because “it is their responsibility”. Improved public funding of health is a pressing need. For example, despite a gradual increment in budgetary commitment to healthcare delivery over the years, the Kenyan national and county governments have spent an average of just 7.1% on health. This is less than half of the 15% budgetary allocation commitment made by African Heads of States and Governments in the 2001 Abuja Declaration.

It is equally important to stop enriching for-profit interests such as insurance companies and private health establishments with public financing of health, especially while the immense majority of the population use only public health facilities.

A well-funded public health system is the cornerstone of health for all. And the public must have the opportunity to be active in governance of the public health system to ensure transparency and democratic accountability.

We welcome the words of Ms Sicily Kariuki, Cabinet Secretary for Health who said when inaugurating the panel that government will “ensure that the reform process attains highest possible level of public participation”. PSI affiliates in Kenya will engage with the process and in line with the objectives of the Campaign for Public Health for All in East Africa launched last May in Nairobi. They will call for “a Human Rights Based Approach (HRBA) to the pursuit of Universal Health Coverage,” putting people over profit in reforming the NHIF in particular and the Kenyan national health system in general.