Kenya's healthcare system: Is universal coverage a pipe dream?

Access to quality healthcare is a fundamental human right, enshrined in Article 43 of Kenya’s Constitution, which guarantees every citizen “the highest attainable standard of health, including the right to healthcare services.” However, for millions of Kenyans, this promise remains far from reality. The healthcare system faces challenges ranging from inadequate funding and infrastructure to a lack of personnel and systemic inefficiencies. While the government has committed to achieving universal health coverage (UHC) as part of the Big Four Agenda, the question persists: is this goal achievable, or is it merely a pipe dream?

Understanding Universal Health Coverage (UHC)

Universal health coverage means ensuring that all individuals have access to the health services they need—whether preventive, curative, or rehabilitative—without suffering financial hardship. UHC is not only about making healthcare affordable but also ensuring that healthcare services are available, accessible, and of high quality.

Kenya officially launched the pilot phase of its UHC program in December 2018 in four counties—Nyeri, Kisumu, Machakos, and Isiolo. These counties were chosen due to their unique health challenges, such as high prevalence of non-communicable diseases, maternal health issues, and insecurity. The pilot aimed to test strategies for scaling UHC nationwide by addressing service delivery gaps, healthcare financing, and community engagement.

Challenges Facing Kenya's Healthcare System

1. Inadequate Funding

Kenya’s healthcare spending is significantly below the recommended levels. The Abuja Declaration of 2001 mandates African Union countries to allocate 15% of their national budgets to health. However, Kenya consistently falls short, with health sector allocations hovering around 7-8% of the national budget. This underfunding has led to shortages of drugs, equipment, and medical personnel.

2. Human Resource Crisis

Kenya faces a chronic shortage of healthcare workers. According to the World Health Organization (WHO), the country has an average of 13 doctors per 100,000 people, far below the WHO recommendation of 100 doctors per 100,000 people. The shortage is compounded by frequent strikes by healthcare workers demanding better pay, working conditions, and benefits. Brain drain further exacerbates the issue, with many trained professionals leaving for better opportunities abroad.

3. Poor Infrastructure

Many public health facilities, especially in rural and underserved areas, are under-resourced and ill-equipped. Patients often have to travel long distances to access basic services, and even then, they may encounter stockouts of essential medicines, malfunctioning equipment, or a lack of specialists.

4. High Out-of-Pocket Costs

A significant portion of healthcare financing in Kenya comes from out-of-pocket payments, which account for 26% of total health expenditure, according to a 2021 report by the Ministry of Health. This burden leaves many households at risk of catastrophic health expenditure, forcing families to sell assets or fall into debt to pay for treatment.

5. Governance and Corruption

Corruption remains a major obstacle to healthcare reform. From mismanagement of funds to procurement scandals, such as the infamous COVID-19 PPE scandal at KEMSA (Kenya Medical Supplies Authority), the diversion of resources intended for public health has undermined trust and efficiency in the system.

Steps Toward Universal Health Coverage

Despite these challenges, Kenya has made significant strides in laying the foundation for UHC. Some of the key initiatives include:

1. National Health Insurance Fund (NHIF) Reforms

The NHIF has been positioned as the main vehicle for financing UHC. Recent reforms aim to expand coverage, improve efficiency, and make contributions mandatory for all Kenyans above 18 years. The government is working to integrate informal sector workers and vulnerable populations into the scheme, with subsidies for low-income households.

2. Devolution of Healthcare

The 2010 Constitution devolved healthcare to the 47 county governments, aiming to bring services closer to the people. Counties now have more autonomy to address local health challenges, such as building dispensaries, hiring personnel, and equipping facilities. While devolution has improved access in some regions, disparities remain, with wealthier counties performing better than poorer ones.

3. Public-Private Partnerships (PPPs)

The government has encouraged partnerships with the private sector to bridge gaps in healthcare delivery. Initiatives such as the Managed Equipment Services (MES) program have brought modern diagnostic equipment to county hospitals. However, PPPs have faced criticism over cost transparency and implementation challenges.

4. Community Health Strategies

Kenya has invested in community health volunteers (CHVs) to provide basic health services at the grassroots level. These volunteers are instrumental in promoting preventive care, maternal and child health, and management of chronic diseases. Strengthening this network is vital for achieving UHC.

Is Universal Coverage Achievable?

Kenya’s commitment to UHC is commendable, but the road ahead is fraught with obstacles. Achieving universal coverage will require bold reforms, sustained investment, and a multi-stakeholder approach. Here’s what needs to happen:

1. Increased Health Financing

The government must allocate more resources to the health sector and ensure efficient use of funds. Innovative financing mechanisms, such as sin taxes on tobacco and alcohol, could help generate additional revenue for healthcare.

2. Strengthening Governance

Curbing corruption and improving accountability in health financing and procurement are essential. Institutions like KEMSA need comprehensive reform to restore public trust and ensure that resources reach intended beneficiaries.

3. Addressing Inequities

UHC must address the stark disparities in access to healthcare across regions and income levels. Special attention should be given to marginalized communities in arid and semi-arid areas, informal settlements, and remote regions.

4. Investing in Human Resources

Kenya needs to train, recruit, and retain more healthcare workers. Improving pay, working conditions, and career development opportunities can help address the human resource gap. Local training institutions should be strengthened to produce skilled professionals who can serve in underserved areas.

5. Emphasizing Preventive Care

Preventive healthcare is cost-effective and can reduce the burden on health facilities. Campaigns to promote vaccination, healthy lifestyles, and early disease detection should be prioritized.

6. Leveraging Technology

Digital health solutions, such as telemedicine and electronic health records, can improve service delivery and efficiency. Mobile platforms like M-TIBA, which allows users to save and pay for medical expenses, demonstrate the potential of technology to revolutionize healthcare access.

Conclusion: Pipe Dream or Realistic Goal?

Universal health coverage is not an unattainable pipe dream for Kenya, but it will require unwavering commitment, strategic planning, and bold action. Countries like Rwanda and Ghana have demonstrated that UHC is possible in resource-constrained settings, offering valuable lessons for Kenya.

While the journey toward UHC is challenging, the benefits far outweigh the costs. A healthier population translates to increased productivity, reduced poverty, and greater social cohesion. For Kenya, achieving UHC is not just a constitutional obligation but a moral imperative that could transform the nation’s future. The dream of universal coverage is within reach—but only if rhetoric is matched with sustained action and political will.