Thursday, 1 August, 2019
Kenya is making commendable progress in the push to attain universal health coverage (UHC) for all its citizens. UHC is about financial protection and equity in access to quality health services that address the most significant causes of disease and death, and ensures that the quality of these services is good enough to improve the health of the people receiving them.
A pointer to the progress Kenya is making in UHC is increased NHIF enrolment. In 2018, NHIF membership rose 23 per cent on an annual basis to 7.7 million people, with most of the new members coming from the informal sector. This is according to data released by the Kenya National Bureau of Statistics (KNBS), which further shows that pay-outs by the national insurer increased an impressive 41.4 per cent to sh37.2 billion last year.
What this means is that there is a Jua Kali operator or a mama mboga somewhere who would have previously been forced to sell household items to get treatment but is now able to access the same treatment without financial strain. To sustain this momentum, the government is setting aside Sh47.8 billion for UHC in the 2018/19 budget—more than half of the approximately KES 90 billion overall budgetary allocation for healthcare.
Although UHC accounts for more than 50 per cent of the entire national health care budget, there is still a huge funding gap. Access, quality and financing of health care – the three key pillars of UHC – collectively require tremendous investment and expertise, which the public sector cannot provide alone.
Historically, this funding and technical skills gap has been bridged by donors. However, this is quickly coming to an end. Today, due to demands for accountability as well as creeping nationalism in donor countries, donors are only willing to put money into programs that can sustain themselves after the initial set of donations. In other words, the shift from aid-led development to enterprise-led development is in full swing.
This has set the stage for the growth of social enterprises – organisations that combine their primary goal of driving positive social change with the efficiencies and profit-orientation of the private sector. However, unlike fully-fledged capitalist businesses, profits generated in a social enterprise are not distributed to directors or shareholders, but re-invested into scaling up solutions for greater impact.
In Kenya, social enterprises can play a uniquely instrumental role in accelerating the attainment of UHC.
First of all, increased public funding for UHC provides a powerful form of risk underwriting for private sector players keen on providing health care solutions. This is very critical as very often private investors in Africa are unwilling to spend in areas where government support in the form of funding, policy and regulation is doubtful or lacking.
Secondly, Kenya has made considerable steps in advancing the ICT sector. In fact, ICT is currently the fastest growing sector of the economy, having grown 11.4% last year, according to data from KNBS. ICT is important when talking about private investment in healthcare because new technologies allow healthcare providers to scale solutions at a fraction of the cost while not compromising quality.
Third, and perhaps most important, more Kenyans are embracing entrepreneurship. At its heart, entrepreneurship is not about avoiding problems, but confronting them and getting rewarded for solving them. Fewer bigger problems exist in Kenya, and indeed Africa, than lack of access to quality and affordable healthcare. In fact, Ministry of Health data indicates that the leading reason why Kenyans slide into poverty is actually medical bills, underlining the severity of the problem.
Entrepreneurship lends itself well to solving the challenges in health care. The good news is that social enterprises provide room for entrepreneurs to solve problems, get rewarded, but still drive social impact. Scottish economist, Adam Smith, famously said that “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.”
When people are motivated to make money, they find a solution. When people are motivated to make money and transform lives, they find a lasting solution. The latter is what social enterprise is all about and why it is essential in accelerating the attainment of UHC in Kenya.
By Peter Waiganjo, Venture Development Manager at Amref Health Africa in Kenya