How Kenya Can Achieve the SDGs and Universal Health Coverage
By Stephen Muchiri, HP+ Kenya/East Africa project director
In 2013 Kenya devolved much of the function and authority of its central government out to 47 newly created counties. This devolution of power, if effectively leveraged, creates an opening for the country to accelerate progress toward achieving both the Sustainable Development Goals (SDGs) and universal health coverage.
Since devolution, Kenya’s county governments have progressively increased their allocations to health, from about 13 percent of the total county government budget in fiscal year (FY) 2013/14, to 25 percent in the current year (FY 2016/17). By FY 2015/16, several counties — including Nyeri, Embu, and Kiambu — had allocated over 30 percent of their total county government budget to the health sector for the year.
Yet, these monetary gains won’t translate into progress unless they are paired with efficiency improvements and directed toward priority interventions. Costs associated with staff continue to use up around two-thirds of county health funds (around 70 percent) and medical supplies, on average, receive about 15 percent of the total health allocation, leaving little for priority interventions and programming.
This means that households are still paying significant amounts for healthcare, contributing about 37 percent of county healthcare costs in FY 2014/15. In several counties, the amount that households are spending on healthcare far exceeds the national average. This level of household spending leads to “catastrophic health expenditures” — health spending that is at or greater than 40 percent of a household’s non-food expenditures — and puts families at risk of slipping into poverty.
To fully gain from devolution and the devolution of health services, county governments should continue to increase their allocations to health. But investments alone cannot fix the population’s healthcare needs or achieve the SDGs and universal health coverage. Counties will also need to focus on efficiency improvements, redirect personnel expenditures to free funds for priority interventions, and partner with public- and private-sector partners to avoid duplication and competition and relieve catastrophic health spending. Only then can Kenya achieve universal health coverage for its people and contribute the achievement of the SDGs.
Stephen Muchiri is project director for Health Policy Plus/Kenya and East Africa and has been with Palladium since 2012. Prior to that, Mr. Muchiri worked for Abt Associations as a health policy advisor and served in the government of Kenya in various capacities, including as chief economist at the Ministry of Health overseeing the Policy and Planning Division. He holds a Master’s degree in health services planning and administration from the University of British Columbia, Canada.
References: Data on county government allocations to health come from the Kenya Ministry of Health’s forthcoming report, National and County Health Budget Analysis, FY 2016/17. Data on household contributions to healthcare and catastrophic health expenditures are reported here as they are in the Ministry of Health’s 2013 Kenya Household Health Expenditure and Utilisation Survey.