After fanfare launch, hard work on UHC programme now starts
By Print Reporter, October 25, 2023After the fanfare that accompanied the launch of Universal Health Coverage (UHC) last week, the hard work of implementing it now begins amid questions over its sustainability and how to overcome its inherent challenges.
The four laws that paved the way for the programme take effect on November 2 according to a Kenya Gazzete notice published yesterday.
During the launch, President William Ruto gave his commitment to delivering quality healthcare to all Kenyans through the implementation of newly enacted laws that anchor UHC.
He noted that though the Constitution guarantees Kenyans the right to the highest standards of health, previous governments were unable to deliver the same due to a lack of laws and policies to translate the promise in the Constitution into a programme.
“Access to healthcare will no longer be based on the ability to pay; It will be based on the health needs of every Kenyan,” said the President, who also emphasised that the government will prioritise preventive healthcare, anchored on community health promoters. Preventive care is meant to make it possible to deal with health challenges early and at the household level to ease crowding in hospitals.
“There have been two failed attempts to implement universal healthcare. But this time round, we are determined to achieve it successfully,” he had said earlier while unveiling the 100,000 Community Health Promoters who have been dispatched to all the 47 counties.
“Every Kenyan will pay as per their earning, and those without pay, the government will pay for them. Everyone will have the SHA card, either paid by self, or by the government”.
According to the Social Health Insurance Act, 2023, all Kenyans will access free medical care at Level 1, 2 and 3 hospitals, whereas the medical cover will enable them to access treatment at Level 4, 5 and 6 hospitals, all of which are public institutions.
The president also announced that no Kenyan should be turned away from any public health facility for lack of money or having reached the limit for their medical cover. Experts said that if this directive is implemented it would be a milestone not only in East Africa but also in Africa.
While the programme, if successfully implemented, would transform the country’s health sector as well as the social status of Kenyans to an unprecedented level, experts have voiced concerns that the haste with which the government is rolling it out could lead to its failure.
According to Dr Davji Atellah, Secretary General of the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU), while the government consulted stakeholders, it had not factored in the issues of human resource, financial sustainability, and availability of infrastructure and equipment.
There are fears that the government, reeling from financial pressure, could face challenges sustaining the huge outlay implications that would come with the ambitious programme.
Questions have also emerged over the practicability of engaging the services of Community Health Promoters, who will be charged with the responsibility of making early diagnosis as primary health care givers if there will be a shortage of nurses and clinicians to offer the requisite treatment.
“The major challenge facing the health sector in Kenya is financing and shortage of manpower,” said Dr Dennis Miskellah, the Deputy Secretary General KMPDU.
According to him, many Kenyans avoid public hospitals due to congestion, poor services, negative attitude by the personnel and lack of drugs and other essentials.
“These are the areas that the government needs to concentrate efforts on to succeed because they are the reasons why people flock to private hospitals despite them being too expensive,” Dr Miskellah told People Daily.
Both UHC and the stipend for the Community Health Promoters are expected to benefit from donor inflows in addition to the deductions of salaried workers. Part of the funding is expected from Masterscard, the World Health Organisation (WHO), United Nations agencies, the Bill and Melinda Gates Foundation and the Global Fund.
According to Health Cabinet Secretary Susan Nakhumicha, the promoters will be required to interact with the people at the community level and obtain the relevant health information that will help in referral of specific cases. The data collected countrywide is expected to guide policy-making at the national level.
Based on projects that each of the promoters would be paid a Sh5,000 monthly stipend, that would require the government to allocate Sh500 million for the vote per month, raising questions about the sustainability of keeping them at work when the government is cutting down on expenditure in a tough economy.
Already, the government plans to allocate Sh3 billion annually towards the UHC programme, a figure that experts say could turn out to be a drop in the ocean if the implementation is to be successful.
Health economists believe the government was too ambitious with the recruitment of 100,000 promoters and should have started with a more moderate number that is sustainable and matched this with skilled health personnel, such as nurses, clinicians, lab technicians and doctors.
Dr Atellah proposed that the government employ 20,000 nurses and clinicians as the Kenya Kwanza administration promised to do within its first year in office.
“Unless the issue of human resource is adequately addressed, the new initiative is likely to face the same fate that President Uhuru once faced,” he warned. “Patients are forced to endure long waits before being attended to by an overworked, underpaid and ill-motivated health workforce”.
Dr Atellah also cited lack of proper medical supplies in public hospitals as another hindrance of effective service delivery.
“These shortages have profound implications for our healthcare system, resulting in compromised quality of care, lengthened hospital stays and undue suffering by patients,” he said. “Vital surgeries are postponed, diagnoses are delayed and healthcare workers are forced into unthinkable situations where they must choose between who receives limited supplies and who goes without.”
And for the promoters to work effectively, they would require supervision, which requires enough human resource and funds.“Without this supervision, we are likely to have numerous cases of misdiagnosis and impersonation,” Dr Atellah said. “We can’t rule out the possibility of seeing cases of Dunning-Kruger effect, which is a cognitive bias in which people with limited competence in a particular domain overestimate their abilities and behave as if they know.”
In his view, the government must put in place measures to ensure that the promoters are not involved in prescriptions of drugs and laboratory tests.