How to bridge gaps in provision of UHC

Healthcare financing gaps: Many shortfalls exist in the provision of UHC in Kenya. Apart from the government coming up with innovative ways to increase the national health budget, it can also tap into other sources of funding for the health sector in order to bridge these gaps. The government can introduce special taxes such as Sin Tax (on alcohol and tobacco), Airtime Tax, and improve tax revenue collection. Sin Tax is levied on goods that are detrimental to human health. Debt swaps for health and guarantees can also be negotiated by governments (UNDP, 2019b). A debt swap is ‘a method of transforming debt into resources for development work. Debt swaps are a type of debt relief, often as part of official development assistance (ODA) funding: instead of paying back the debt to creditor countries, debtor countries use the debt money for their social development, such as education and health care’ (UNDP, 2019b:27). This means that money meant for debt repayment can be redirected to social development, including health financing for UHC. However, debt swaps depend on the donors’ willingness to cancel the debt. The government can also continue seeking donor funding for the health sector. It can also work towards the removal of user fees for the poor, indigent and marginalised groups in society through provision of subsidies (HISP) and introduction of social protection insurance .The government can also gradually increase its budget allocation to the health sector from the current 7 percent of the total Government Budget towards the Abuja Declaration target of 15 per cent. This is, however, dependent on the level of economic growth of a country.

Infrastructure gap: This is made worse by skewed distribution of health infrastructure with a bias to urban areas. There is also obsolete equipment that urgently needs replacement. The government should create an enabling infrastructure for quality service delivery by promoting public private partnerships (PPPs). Also, the model of lease financing can be explored further as it reduces the need for upfront capital, and monthly rentals are paid for from the use of the assets. Kenya Managed Equipment Service is a good example of the foregoing, where the owner of the assets gives the right of use to the government and then receives periodic payments (UNDP, 2019b). Another option is to rationalise hospital infrastructure and create a network of hospitals within counties and inter-counties to optimise efficiency, like in the case of Brazil and Central Asia (Kimathi, 2017).

Corruption in the health sector in Kenya has been highlighted in various literature as being an eyesore and one of the biggest impediments to implementing UHC. Among the funding sources plundered are donor agencies’ funds. This leads to inefficiency, shortage of human resources and inadequate supply of other HPTs at public health facilities. Combating corruption, and prudency in management of public and donor funds, should be strengthened.

Human capital deficit: The Kenya Health Policy 2014-2030 aims at ‘achieving adequate and equitable distribution of a productive health workforce’. This can be done through identifying training needs and training those identified. Also, postgraduate training and internship programmes should be promoted as part of capacity building in the health sector. Faith-based health facilities can also work out arrangements/agreements with county governments where some of their workers can be deployed to support those in public facilities, especially where there is an acute medical personnel shortage. Putting in place mechanisms that ensure attraction, retention and motivation of workers, especially in marginalised areas, should also be an area of focus.

Health Product and Technologies (HPT): Kenya, Malawi, Peru and Haiti are among early adopters of electronic medical records. Kenya should strengthen its Health Information System (HIS) to facilitate procurement of health products and related modern technologies and timely distribution of the same to health facilities. The system can also help in ‘micro-targeting those furthest’ (UNDP, 2019:69), hence improving access to quality UHC. The system should also have the capacity to trace drugs and equipment to ensure monitoring of quality and facilitate recall in the event of dangerous products entering the supply chain. In January 2020, KEMSA signed a contract with the Postal Corporation of Kenya for use of their wide transport network to distribute HPT. It is important to put in place an effective and reliable procurement and supply system. The Kenya Health Policy 2014-2030 categorises HPTs as: Strategic (vaccines and drugs for TB, HIV/Aids and epidemics); special and expensive (cancer drugs, immunosuppressive agents); and essentials/basic products.

Strengthen research and development: KEMRI should boost its research and development component on public health and health systems, traditional medicine and drug development; biotechnology; infectious parasitic diseases; non-communicable diseases; and sexual, reproductive, adolescent and child health. The agency, working with international partners should also re-energise research on how best to implement UHC, deal with emerging challenges, and how they can be addressed.

Strengthen the capacity of the PPB to ensure that only legally registered pharmacies operate and that the drugs they procure and sell are of unquestionable quality. They should increase monitoring and evaluation of pharmaceutical companies to guarantee high standards of the HPTs they produce. The PPB should monitor and ensure adherence to set standards and regulations in order to eliminate influx of counterfeit drugs.

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