An International Centre of Excellence in Public Policy and Research

Affordable Universal Health Care Services

Adera Benard Bachelor of Economics The Technical University of Kenya 0704929200 The Big Four Agenda comprises transformational legacy projects that our President with the help of his government wishes to accomplish by the end of his second term by 2022.They are basically extracts from the long-term plan (Vision 2030) goals. In summary, these are the basic economic growth indicators explained in four major components. Universal Healthcare (UHC), one of the agenda items in brief, provides for:
  • 100 per cent of the projected population of 51.6million covered with health insurance scheme by 2022.
  • 100 per cent of the poor population covered by the Government by 2022.
  • 10 modern referral hospitals.
  • 50% reduction in out of pocket medical expenses.
  • Four modern cancer center.
  • One modern kidney center.
  • 50 per cent increase in health officer to patient ratio from 9: 10,000 to 14 :10,000
  • 36 million women covered under Linda Mama Programme.
  • 8 million elderly people of over 70 years covered.
UHC does not necessarily involve covering the sick population alone, but digs deep into the services provided (packages offered), healthy living and costs of such services. The current economic downtime and high unemployment rates have led to an even larger portion of the population falling into the category of the uninsured and underinsured with the large portion of the working poor being unable to meet their basic healthcare needs. The disparities in income are only surpassed by inequalities in access to healthcare. The healthcare industry generally includes providers, insurers and government regulators. Therefore, to meet the requirements of UHC, the following key issues should be addressed:
  • The pilot UHC programme will involve the strengthening of the public health system with a strategic focus on primary health approach.
  • Whenever we talk about UHC, what in most cases comes to mind is the National Health Insurance Fund (NHIF). However, this institution was developed in 1966 and has its provision in Act 9 of 1998, while on the other hand, UHC is barely 10 months old. Therefore, one of the best ways of achieving UHC provisions is to align NHIF policies to UHC requirements. This includes a mandatory informal sector coverage and introduction of multi-tiered packages.
  • Effective and sincere collaboration with county governments, both in equal share allocation and provision of conditional grants tied to health facilities and services, is also vital in the move towards faster achievement of wide health coverage.
  • Key to all, resources, specifically financial resources, which are the major drivers to any economic growth activity in any country. Therefore, to facilitate effective and efficient rollout of the programme, additional financing from the National Treasury is required that is, (increase in health allocation from the current 7% of GDP in 2017 to 10% of GDP by 2022).
  • New governance structures e.g. introducing UHC department under ministry of health to solely deal with issues provided for under the UHC requirements.
  • Civic education to all citizens to make them understand their role towards the achievement of this milestone agenda. Similarly, effective and professional training of the health officers is necessary since they play a major role in the implementation of the programme.
Towards the achievements of the UHC deliverables, the very sincere roles of youths, especially the school-going youths, can play a role. They include:
  1. Getting sufficient education to ensure that they are well informed on issues universal health coverage by reviewing the literatures about countries that have successfully implemented the programme e.g. Australia, Canada, France, Germany, Singapore, Switzerland and the United Kingdom.
  2. Giving civic education to people majorly in the rural areas about the benefits, provisions and procedures of UHC in specific NHIF.
  3. Selling policies to the Government in various platforms to inform the general government policies.
A successful rollout of the UHC programme will bring the following benefits.
  • Lower healthcare cost for the economy.
  • Standardization of services at a low cost.
  • Prevention of future social cost and health issues through early stages childhood health measures and health care practices.
However, the sheer cost of providing quality care will make UHC a large expense to the Government budget, leading to increased taxes to citizens hence challenging the whole programme. As the country gears towards the realization of the UHC agenda, my big question remains, will there be efficiency once the programme is fully in place? This is because the Government limits payment amount to keep the cost low hence healthcare providers will have less incentive to provide quality care. Cases of countries with Universal Healthcare
Country Type % of GDP Per Capita Infant Mortality Rate WHO Ranking
Australia 2-tier   9.6% $4,798 3.1 32
Canada Single 10.6% $4,752 4.3 30
France 2-tier 11.0% $4,600 3.2  1
Germany Mandate 11.3% $5,550 3.2 25
Singapore 2-tier   4.9% $2,000 2.2  6
Switzerland Mandate 12.4% $7,919 3.6 20
United Kingdom Single   9.7% $4,193 3.7 18
United States Private 18.0% $9,892 5.6 37

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