KIPPRA Presents Health Study Findings at Universal Health Care Conference, Makueni
The convergence of the top leadership and stakeholders in Kenya’s health sector during the 2018 Universal Health Care (UHC) Conference in Makueni County provided a golden chance for KIPPRA to disseminate the findings of a recent study on health delivery under devolution. Slotted among the opening remarks of various keynote speakers, the KIPPRA presentation acted as an important reference point for subsequent discussions in the conference. The Institute also got a chance to disseminate other research outputs in one of the few display stands at the conference.
The conference, which took place on 4th to 5th April 2018, brought together Makueni and Laikipia governors, deputy governors as well as leaders in the health sector in all county governments, the Ministry of Health, non-governmental organizations and private institutions dealing with health issues.
While explaining the impact of corruption and the need to address it to ensure the achievement of UHC, Ministry of Planning Principal Secretary Dr Julius Muia extensively quoted another KIPPRA study: “National Values and Principals of Governance”.
What stood out during the KIPPRA session included the call to move to provision of quality health care and patient-centred care in all private and public institutions and delivery of health care as a human right; the need to adequately measure productivity of health workers; scaling up continual training of all health workers, especially in the use of new technology; call for the national government and counties to dialogue on human resource management, including provision of minimum health services and running of critical care units (such as ICU) during strikes and the need to have an umbrella body (commission) for all health workers and or institutionalizing an intergovernmental mechanisms (involving both County and National Governments) for effective management of health workers.
Other key issues that stood out during the conference were:
- The importance of good leadership and stewardship in the achievement of UHC.
- The need to look into the welfare of health workers, such as ensuring they have health insurance and work in a safe environment, provision of incentives for workers in hardship areas and recognition for best-performing employees.
- Negotiation of minimum service agreements to avert crises during strikes.
- The introduction of task-sharing modalities to promote equitable and enhanced coverage as well as improve utilization of human and financial resources. This also allows for specialist workers to over contracted services in more than one county.
- Need for facility reassessment as some facilities were upgraded to level 4/5 but still have level 3 facilities and workforce.
- Need for universities and training institutions to adopt online trainings so that workers can train while continuing to work.
- Need to put up cottage industries for medical equipment. In the US, health employs 30 per cent of workers followed by manufacturing at 18 per cent.
- Undertake regular staff audits and cadre mix. Identify mechanisms on how to bridge the staffing gap. The WHO norm is 23:10,000 and Lamu County (30:10,000) was identified to have met this target.
- Counties need to invest more in disaster preparedness to be able to respond to disasters and manage risks;
- It is a fact that UHC is not free and the role of the National Health Insurance Fund in achievement 100 per cent insurance coverage from the current 36 per cent need to be fast tracked.
- NHIF has deployed community health workers to enroll citizens to NHIF in the process of offering basic health support.
- Counties need to learn from the role of strategic partnerships and case studies of successful Public-Private Sector Partnerships in the delivery of UHC;
- Technology integration to ensure efficiency in health care service delivery;
- Call for amendment of the Health Act 2017 E.g. on articles related to HR hiring- PSC and CPSC. Not possible to have a council unless you have a referendum. Counties should consider having intergovernmental agreement on how to manage HR. Article 187.
- Population based planning for UHC to take into account diverse issues such as population structure and dynamics, agro-climate issues, availability of electricity, GDP per capita and water, sanitation, nutrition, disease incidence, among other issues.
- The critical role of monitoring and evaluation in the achievement of UHC.
- Need to employ a multi-sectoral approach in developing UHC systems as well as allowing independent audits to ensure efficiency.
- Need to include HIV care package in health insurance to reduce long-term health costs.
- Country needs to address issues leading to the emergence of Non-Communicable Diseases early in life including child nutrition.
- Kenya’s old age population (above 60 years) is on the rise hence need to effectively plan for their health needs.
- Call for counties to engage with National Cohesion and Integration Commission and the Ethics and Anti-Corruption Commission to come up with strategies to curb corruption
- Draft county statistics bill once passed and enacted shall provide for preparation of County Economic Surveys.
- Health care financing to involve an overarching regulator, establish clear costs and sustainable systems and allow for pooling of resources, strategic purchasing, domestic resource mobilization, an increase in Treasury funding from the current 7 per cent to 10 per cent and bringing in new players e.g. social impact investors.
- Need to come up with a unique identifier for all patients to enable proper tracking of progress and efficient management
- Government should consider option of converting national debt to health financing facility.