By Alfred Nyakinda

Discussions at the IEA public forum in Nairobi

Greater spending on public health is crucial in Kenya’s progress towards Universal Health Coverage (UHC) according to experts at a public forum organized by the Institute of Economic Affairs (IEA) in Nairobi this week.

They stated that in order to reduce the financial burden on households in accessing health care, policy makers needed to focus on preventive measures and the development of community based and primary health care facilities.

“Most of our investment as we move will go towards those actual areas, which is community and primary public health services,” said Dr. David Kariuki of the Ministry of Health, “When you address 80 percent of the primary services then you do not need a lot of investment in curative and tertiary services.”

He added that institutional reforms are required and the National Hospital Insurance Fund (NHIF) and the Kenya Medical Supplies Agency (KEMSA) need to be key drivers in efficient resource use. This would be accompanied by changes in the service delivery systems to ensure more people use primary health care facilities, reducing the burden on higher level referral hospitals.

The country’s annual total health expenditure is approximately Ksh 345 billion. According to the Kenya Institute for Public Policy Research and Analysis (KIPPRA) the government pays for 40% while households account for 31 percent, with the rest being covered by donor funding and the private sector.

Dr. Eldah Onsomu of KIPPRA noted Kenya’s health spending is about 6.7 percent of government expenditure. However, she pointed out that this proportion does not take care of spending on public health which is crucial to quality healthcare delivery.

“We have to talk about UHC in the context of other support systems like transport and other amenities-water, sanitation, electricity and all the others,” she said.

Kenya’s health spending falls short of the target of the 2001 Abuja declaration, which is 15 percent of government expenditure. There is also a gap between the nominal health expenditure and the real expenditure due to inflation.

“Healthcare tends to be one of the key areas. If you do not take care of malnutrition – stunting for instance in young children – then at the end of the day you don’t have any human capital,” added Dr. Onsomu.

The experts further raised the issue of the reduction in donor funding after the country was upgraded to a lower-middle income status, warning that most of the preventive interventions were being covered by donor funding.

They recommended that the government should look for strong policy initiatives to address the gap in funding, adding that it should also consider financing for community health workers who, in many cases, are volunteers.

A positive trend highlighted was the increase in NHIF enrollment over time for people in the informal sector, who are the majority of the working population in the country.

Daniel Mulinge of the NHIF said the organization is promoting the strategic purchasing of health services, which involves developing a quality assurance and provider accreditation system for continuous quality improvement.