It registered 716,947 people under the Universal Health Coverage (UHC), the government initiative aimed at providing improved and cost-effective healthcare. Through a concerted and collaborative approach, the county has ensured that 349,901 households, with 86.2 percent of its population, are under the programme.
According to the Nyeri County Executive Committee Member for Health, Dr Rachel Kamau, the programme took off with remarkable success despite some teething problems. Nyeri County is one of the four counties identified to pilot Universal Health Coverage in Kenya, owing to a high prevalence of communicable and non-communicable diseases, high population density, high maternal mortality and high incidents of road traffic injuries.
Dr Kamau said in a media briefing that UHC, which was identified as one of the Big Four Agenda of national development and economic priorities towards achieving the Kenya Vision 2030, has seen the county record a tremendous expansion of oncology and Intensive Care Units (ICUs), among other services. She said 10 haematology machines were procured and installed in health centres across the county, while Nyeri County Referral Hospital and Naromoru Hospital were provided with generators and coolers for the mortuaries.
Other achievements include boosting surveillance and research on non-communicable diseases, establishment of weekly clinics for diabetes and hypertension in selected health centres in the eight sub-counties and recruitment of 2,500 community health volunteers spread across the county.
The health official, despite painting a rosy picture of the UHC initiative, enumerated challenges which should be addressed. She said increased workload at referral hospitals due to community preferences, compounded by referrals from the neighbouring counties of Laikipia and Kirinyaga, were putting pressure on both health workers and infrastructure.
Isiolo County Pilot Case
Isiolo is among the four counties that have been piloting the Universal Health Coverage programme (UHC). The project has been implemented successfully and is a huge step in improving healthcare since it provides access to cost-effective, specialised health services.
Isiolo was selected based on research pegged on the Kenya Health Strategic and Health Plan 2014-2018. The high number of non-communicable diseases, accidents, cases of maternal mortality, and prevalence of communicable diseases like HIV/Aids formed the basis for selection.
Those registered under the programme include both employed and unemployed residents who already have identification cards for the package. According to the Chief Officer for Health, Ibrahim Alio, recent statistics show that about 100 per cent of patient’s seeking healthcare services in public facilities are already registered under the UHC programme.
The UHC package caters for outpatient care such as consultation, mental illness and emergency healthcare. Any beneficiary of the UHC package card can be referred to Kenyatta National Hospital (KNH) for further treatment. Isiolo Governor Mohammed Kuti, who is also the Council of Governors’ health committee chairman, has been at the forefront of ensuring the county becomes a role model for the programme. He says Isiolo has made significant steps in finding solutions to challenges hindering health policy implementation.
Maternal and child health are among the main areas of coverage for UHC in the county. Many households spend more on maternal and child health complications as a result of lack of medical cover. The programme has brought positive change to the health sector in Isiolo, with its 56 health facilities experiencing an upsurge in the number of patients seeking free services.
The Isiolo Teaching and Referral Hospital (ITRH) is overstretched, with about 100 patients being attended to by one clinical officer daily. The administration has had to hire additional healthcare workers – nurses, doctors, clinicians and community health workers – to supplement the workforce.
In November 2018, Governor Kuti accompanied then Health Cabinet Secretary Sicily Kariuki at the launch of a biometric registration exercise for locals to acquire UHC cards in Isiolo, Merti and Garbatulla sub-counties.
The exercise, conducted by community health volunteers (CHVs) at household level, targeted more than 184,765 people in 36,953 households, as per the 2018 population estimates. At least 157,289 people were registered, translating to 85 percent of the population. There has been subsequent registration with the NHIF.
The county health official added that to ensure that residents fully benefit from the programme, the county government, through the health department, is conducting a mop-up exercise to ensure they attain 100 percent coverage. Mr Alio said two additional theatres in Merti and Garbatulla sub-county hospitals have become emergency service delivery points following a Rapid Results Initiative (RRI) in compliance with the UHC policy.
He added that good leadership and governance structures to oversee smooth implementation of the UHC programme makes them optimistic that the project will help address poor health indicators and reverse the tainted image of public facilities in the region.
To ensure adequate supply of essential commodities, Mr Alio revealed that the administration resolved to regularise medical supplies on quarterly orders with timely payments after they signed a memorandum of understanding (MoU) with the Kenya Medical Supplies Authority (KEMSA).
To address a shortage in radiology services, the administration recently opened a CT scan facility which is connected to Kenyatta National Hospital (KNH) through cloud computing. It sends back details through a digital reporting system.
Despite these milestones, the programme faces several challenges, including high depletion of drugs due to a surge in patients and increased workload. The county government has formulated new leadership and governance structures comprising a technical working group, and steering and oversight committees for implementation of UHC. Provision of quality healthcare remains the top agenda of the county government despite the meagre resources it receives from the Exchequer.
Kisumu is one of the four counties that were identified for piloting the UHC programme. On 25th March 2020, the county organised a meeting to sensitise leaders and partners on the UHC programme, facilitate exchange of views and ensure access to quality health services without financial hardships. The County Executive Committee (CEC) leader for Health and Sanitation, Dr Rosemary Obara, said all stakeholders, including Members of the County Assembly, County Government, National Government together with the private sector, should work together to realise affordable healthcare. She highlighted UHC’s three key elements: equity in access to healthcare in terms of geographic coverage, range of available services; and financial protection against any hardship to users of health services which may arise from out-of-pocket payments.
Dr Obara also highlighted key achievements on healthcare, among them operationalising of maternity theatres in all sub-counties to reduce referrals and mortalities.
By May 2019, the UHC mobilisation had registered 306,697 households, with details of 887,038 people being captured, which reflects 75 percent above the estimated number of 250,000 households. However, it was reported that since the mop-up began, the county has had an influx of people seeking health services, occasioning an 82 percent increase in outpatient workload.
The county was allocated Kshs 217,383,080 by the National Government in the first half of the financial year and had already spent Kshs158,242,582, equivalent to 72.79 percent of the allocation, in just the first quarter of the financial year.
The sensitisation conference heard that the county was planning to address human resource deficits caused by high enrolment of residents to the programme, ensure adequate supply of commodities to laboratories and pharmaceuticals, expand the capacity of existing facilities, and ensure prudent flow of funds, efficiency and accountability.
Other key stakeholders who attended the conference included representatives of the National Government, Ministry of Health, Kisumu County Assembly, Members of the Health Committee, NHIF, and community health workers.
Machakos County was among the four pilot counties for UHC. The County Governor officially launched the programme in December 2018, promising to remain uncompromising on issues that provide comfort and quality treatment to patients and their guests. The county anticipated to register 100 percent of the population and provide free UHC. Machakos County was selected for the UHC pilot phase because it has the highest number of accidents in Kenya, high number of non-communicable diseases, prevalence of communicable ailments like HIV/Aids, and many cases of maternal mortality.
The county had achieved about 86 percent UHC registration, equivalent to 1.2 million people, by December 2019. The number of visits by patients hit 2.8 million. The county has also endeavoured to enhance access to medical care through upgrading of its health facilities. It has established a 35-bed, well-equipped cancer treatment centre which provides free treatment to patients registered under UHC.
The county has been able to avert industrial action by health workers through Comprehensive Bargaining Agreements (CBAs) with relevant trade unions and ensuring timely payment of salaries for health workers. As one of the health officials said, ‘a motivated employee is an employee who delivers’. The Principal Secretary (CS) for Health, Ms Susan Mochache, during a visit in March 2019 with a delegation from Thailand led by the Minister for Public Health, announced that Kenya and Thailand have a memorandum of understating (MoU) and a plan of action on UHC. The MoU focuses on capacity building, research and health technology assessments.
The county has also procured 70 ambulances and five advanced ambulances and has employed 84 paramedics and 75 drivers. To take UHC to the grassroots, the county plans to procure more ambulances and employ more middle cadre workers and additional health professionals.
Like the other three counties, there has been a surge in the number of patients seeking healthcare under UHC, coupled with an increase in patients from neighbouring counties. This points to the need for more investment in human resources to make the implementation of UHC a reality. Also needed is procurement of more health products and technologies (HPTs) and construction of additional health facilities in response to the high number of people seeking medical services under UHC.
- To progressively increase human resource to enhance access to health services, the two levels of government must demonstrate commitment to recruit additional skilled staff to offer services and help cope with the increased number of people seeking healthcare under UHC.
- Increase budgetary provisions for UHC. Under the negotiated Intergovernmental Partnership Agreement (IPA), counties are required to allocate a minimum of 30 percent of their respective budgets to health and progressively increase it.
- The National Government should commit to supplement county allocations for supply of essential medicines and supplies, including laboratory commodities, through the Kenya Medical Supplies Authority (KEMSA).
- The two levels of government should jointly invest in community health services to ensure full implementation of the Community Health Strategy and ensure augmentation of Primary Health Care (PHC) to bring health services closer to the community.
- Counties should focus on households and robust screening of illness with the aim of early identification, management and referrals to the appropriate health facilities.