The Government is seeking to achieve 100 per cent Universal Health Coverage (UHC) by scaling up National Housing Insurance Fund (NHIF) uptake. It has invested heavily to make access to health care a reality for millions of Kenyans at affordable or no cost. The Government distributed World Class medical equipment to all counties, introduced a free maternity health programme and expanded the NHIF.
On the 8th of February 2022, President Uhuru Kenyatta launched the national scale-up of the Universal Health Coverage (UHC) with a call to all to register with the National Health Insurance Fund (NHIF).
The President affirmed the Government’s commitment to spreading the benefits of UHC across the country through the development of a focused policy to accelerate its implementation.
“In this regard, my administration has developed the Universal Healthcare Coverage Policy, covering the period 2020 – 2030, to guide the acceleration of the progress in attaining Universal Health Coverage,” the President said at Port Reitz sub county hospital in Mombasa, where he said the Covid-19 pandemic has brought to bear the urgent need for the country to upscale implementation of the UHC.
“Under this pillar, we seek to eradicate the ‘poverty of dignity’ and transition our nation into an era where no Kenyan should be forced to choose between medical bills and other essential needs,” President Kenyatta said.
The Head of State said the programme was started in the country in 2013 with the launch of the highly acclaimed free maternity programme dubbed “Linda Mama”, which currently benefits over one million mothers annually.
He outlined various initiatives the Government has put in place to ensure the successful implementation of UHC including investment in health infrastructure and development of a digital health platform to support the effective monitoring of the health sector.
On health infrastructure, President Kenyatta said the investments the Government has made since 2013 have seen an increase of 43 percent in public health facilities from a stock of 4,429 facilities in 2013 to 6,342 currently.
On Covid-19, President Kenyatta urged all Kenyans to be vaccinated and continue observing the Ministry of Health protocols even as he noted the progress the country has made in the vaccination exercise.
As of today, a total of 12,390,116 doses have been administered and we are well on our way to the target we have set for ourselves of 27 million fully vaccinated Kenyans by the end of 2022,” President Kenyatta said
On coordination of public health functions across all sectors, the President said on January 1st this year he established the Kenya National Public Health Institute to lead the coordination process and promote evidence-based decision-making on health matters.
At the same time, the President directed the Ministries of Health and the National Treasury to ensure consolidation of all Government sponsored programmes is finalized and operationalised by the end of June this Year.
Kenya will begin making vaccines to be available from April 2022 following the establishment of Kenya Biovax Ltd.
The Covid-19 pandemic came with unexpected opportunities, including construction of 15 level two and three hospitals in various informal settlements in Nairobi with 15 others under construction under the Nairobi Metropolitan Services (NMS).
The country’s Intensive Care Unit (ICU) capacity has also increased by 502 percent, from 108 to 651, fully equipped, for managing patients in critical state.
The total hospital bed capacity in Kenya also increased by 47 percent from 56,069 in 2013 to 82,291 across the country besides revamping medical oxygen from threemillion litres per day in March 2020 to 32 million litres per day by this October. The pandemic saw laboratory testing capacity increase from one in March 2020 to the current 95. The diagnostic investments have strengthened the country’s healthcare system especially in response to the Covid-19 pandemic.
Kenya also played a key, behind-the-scenes role in the recent approval of the first-ever malaria vaccine in the world. The country was one of three in Africa, which provided pilot phases for the RTS vaccine since 2019 and which was tested in the counties of Vihiga, Homa Bay, Kisumu, Migori, Siaya, Busia, Bungoma and Kakamega.
The Ministry of Health, through the National Vaccines and Immunisation Programme, led the phased vaccine introduction in areas of high malaria transmission in Western parts of Kenya which bear a heavy malaria burden.
There are an estimated 3.5 million new clinical cases and 10,700 deaths annually in Kenya. The programme targeted about 120,000 children per year, who provided enough data for analysis of RTS,S. Eventually, it was approved by the World Health Organisation (WHO), whose Director General, Dr Tedros Adhonom, said the vaccine would not only save hundreds of thousands of children, but historically was “a breakthrough for science, child health and malaria control.”
The vaccine made by GlaxoSmithKline was found to significantly protect children under five years against death and severe malaria illness.
At least more than 800,000 children have received one dose of RTS,S, in Kenya, Ghana and Malawi, through a pilot programme coordinated by WHO. In addition, a total of 2.3 million doses have been administered, through routine immunisation programmes.
The piloting programme was designed to address public health use of RTS,S, specifically the feasibility of administering the recommended four doses of the vaccine to establish its role in reducing childhood deaths, and its safety in the context of routine use.
The vaccine that has been on trial since 1987 reduces severe malaria by 30 percent, even in areas with diagnostic treatment and wide use of insecticides.
“Data from the pilots has shown that the vaccine has a favourable safety profile, significantly reduces severe, life-threatening malaria, and can be delivered effectively in real-life childhood vaccination settings, even during a pandemic,” noted WHO.
Financing for the pilot programme was mobilised through an unprecedented collaboration among three key global health funding bodies; namely Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.
The vaccine is the first to protect children against plasmodium falciparum, the deadliest malaria parasite globally and the most prevalent in Africa. RTS,S has demonstrated 56 percent efficacy and was most effective in children aged five to 17 months.
Flagship UHC Programmes
a) Managed Equipment Service
The Government undertook to radically improve the health sector by providing Kenyans access to uninterrupted quality healthcare services nationwide, by equipping 2 hospitals in each county, and the 4 referral hospitals with specialized medical equipment under the Managed Equipment Service (MES) Programme.
In 2013, only 4 public hospitals in Kenya were fully equipped with the 5 recommended classes of equipment; ICU/HDU Equipment, Renal (Dialysis) Equipment, Sterilization and Surgical sets, Imaging and Radiology Equipment and Theatre Equipment. These were insufficient and also costly to serve the entire Kenyan population.
Through the Managed Equipment Services (MES) the country equipped 115 hospitals with various theatre equipment, radiological and imaging equipment, 14 facilities with ICU equipment and 54 got renal equipment including dialysis machines, commissioned.
This has helped reduce historical disparities in the quality of care therefore moving the country towards equitability in the provision of health services. This has also improved access to world class health facilities at affordable costs.
The expansion of NHIF now allows for access to these world class services made possible by new equipment in the counties.
b) Free Maternity Programme
A Government directive on the 1st of June, 2013 declared that maternal health services would be offered at no charge in all public health facilities. The provision of high-quality maternal delivery services in public health facilities for free, coupled with access to world class facilities under the MES programme, was aimed at reducing maternal mortality, infant mortality and neonatal mortality and to increase the rate of child vaccination.
This initiative has seen an increase in deliveries taking place in public hospitals with a great reduction in mortality rates and an increase in vaccination.
Through NHIF expansion, the card service has also been extended to free maternal health services to allow mothers to access free pre and post-natal services at different health centres.
c) NHIF Expansion
The Government expanded NHIF cover which has enabled Kenyans from all walks of life to access medical cover at affordable costs. This includes vulnerable persons, orphans and the elderly. In 2013, NHIF only offered inpatient cover and non-comprehensive cover for civil servants & disciplined services. The expansion of NHIF has seen more members recruited and health financing increase. increase.
Social Protection (health insurance subsidy for vulnerable; poor, old, and disabled) was also introduced afresh. The cover is now comprehensive with expanded benefits comprising both inpatient & outpatient cover, surgical cover for both minor and major surgeries), cover for cardiac conditions and a chronic illness care package. This has enhanced access to specialised services, improved quality of life, reduced poverty levels occasioned by high medical bills, and reduced mortality caused by chronic diseases.
Kakamega county government partnered with the African Medical and Research Foundation (AMREF) and -Push (Innovative Partnership for Universal and Sustainable Healthcare) to enlist vulnerable households under the National Health Insurance Fund (NHIF) scheme.
Under the arrangement, the beneficiaries are paid for the full monthly premiums for the year (KShs 6,000) and then the ratio becomes 50:50 in the subsequent years..
d) Beyond Zero
Through the Beyond Zero Initiative, spearheaded by the First Lady, Her Excellency Margaret Kenyatta, Kenyans were reminded of what is possible when people with shared convictions come together to act, steadfastly.
Kenyans were inspired to keep in mind the big picture and the Beyond Zero Initiative’s overall mission: ending the unnecessary deaths of women and children and eliminating new cases of HIV infections.
This initiative depended on the partnership with national, county governments and health stakeholders, whose drive and commitment, enabled the delivery mobile clinic to all the 47 counties—making good on the promise to deliver a mobile clinic to every single county in Kenya.
The work throughout the country has been based on the understanding that access to decent affordable healthcare is the constitutional right of every citizen in Kenya, and on the conviction that we all were willing to play a part our part in expanding access to that right. The race is not over yet. There are still significant healthcare gaps which affect Kenyans—particularly underprivileged women and children—and which need to be urgently addressed.
For more insight or information on Kenya’s UHC programme, you can go online and read a copy of The Road to Universal Health Coverage published by the Kenya Yearbook Editorial Board, in partnership with the Ministry of Health. Just click on https://kenyayearbook.co.ke/publications.php or https://aphrc.org/wp-content/uploads/2020/10/Towards-Universal-Health-PRESS.pdf