Crusade critical in achieving universal health cover

by Meshack Ndirangu

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The recent enactment of the Health Bill (2015)—now the Health Act—is welcome news for Kenya. It has taken up some of the priority issues dominating discourse in the healthcare sector and given them the full backing of the law.

One such issue, which is of particular importance to Kenya at the moment, is universal health coverage (UHC). Universal Health Coverage aims at ensuring access to  quality and affordable healthcare for all Kenyans. 
 
The Act, which was assented to by President Uhuru Kenyatta on 21st June 2017, establishes a unified health system, to coordinate the inter-relationship between the national government and county government health systems. This seamless coordination between the two levels of government, as the Act proposes, is a critical first step in making UHC a reality as it encourages a collective vision of the country’s health needs. 
 
Furthermore, the Act in clause 54 expressly singles out UHC as a top priority, stating that the “Ministry of Health shall ensure progressive financial access to universal health coverage” through a slew of measures.
 
One of the measures outlined in the Act include developing a mechanism for an integrated national health insurance system, including making provisions for social health protection. This is a move that Amref Health Africa commends in view of the challenge of affordability of health care in Kenya. 
 
The country’s health insurance coverage stands at 20 per cent, according to data from the Ministry of Health. This is unacceptably low as many Kenyans lack financial protection in the event of huge medical costs. Consequently, the World Bank estimates that one million Kenyans fall into poverty annually due to healthcare related expenditure.
 
Though health insurance has been available in Kenya since 1966 through NHIF, uptake is still dismally low. Granted, membership has grown in recent years; but there is immense scope for more growth. 
 
The informal sector, which constitutes around 80 per cent of the work force has not taken the full advantage of NHIF. Most informal sector workers and the general public have no health insurance, exposing entire families to impoverishment if one member suffers from a major illness.  This slow uptake among the informal sector and general public is the result of a combination of factors including low awareness on the existence and importance of health insurance.  
 
Media and billboard campaigns may not be the most ideal way of deepening awareness about health insurance, considering many of the uninsured are in hard-to-reach rural communities and the informal sector. 
 
 
We need to rethink our strategy and see how we can creatively work with community health workers and other health personnel at the grassroots to evangelize the broader public on the importance of health insurance, and support with regular reminders as cues to heads of households to pay their due premiums. 
 
As Amref, we work with a network of more than 50,000 community health workers spread across Kenya and have observed that the community places a tremendous amount of trust in them to convey accurate information about healthcare.
 
Why don’t we train and support these community health workers to become NHIF agents so that they can not only create awareness but also drive up awareness? After all, community health workers frequently and directly interact with communities on a case by case basis on health matters.
 
Working with community health workers will also allow them to earn commissions, which is critical as most of them are currently not being remunerated, despite the critical role that they play in public health. Community health workers provide the first line of defense and ensure there is wellness and disease prevention through basic tips such as handwashing and treating water. This significantly lowers disease prevalence and relieves the health system of disease load. 
 
 
Ultimately, working with community health workers to deepen awareness about health insurance is just one measure among many in the quest to increase medical insurance penetration. The ideal situation would be that all personnel who are a point of contact between patients and the health system be NHIF evangelists. It is what I call Provider Initiated NHIF Enrollement (PINHIFE) – whenever health service providers at all levels take lead on advancing an issue of interest, change happens pretty fast, as was the case when HIV preventation, care, and treatment programs adopted provider-initiated testing and counselling. 
 
At the same time, we also need to remain realistic. Not everyone can afford health insurance, even at heavily subsidized rates. Yet, even those who cannot afford need to be covered as health is a human right. This means that we need to explore social protection with greater urgency.  It is injustice for a Kenyan to lack access to quality health care or suffer catastrophic health expenditure while seeking health care. 
 
The Health Act is indeed timely as it helps codify the UHC issue. This will ensure that there is sustained political support for efforts to make quality and affordable healthcare accessible to all Kenyans. In countries where UHC has been made a reality like Japan and, closer home, Rwanda, political support has been more than instrumental. 
 
This Oped was first published here by the People Daily on Wednesday, October 4, 2017.
 
Dr. Ndirangu is the Country Director at Amref Health Africa in Kenya @Amref_Kenya Email: Meshack.ndirangu@amref.org Twitter: @meshackn 

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