Inclusive Social Protection and Affordable Health Services: An Approach Towards Achieving Universal Health Coverage

By James Onsongo, Public Health Manager, Health, Nutrition and Social Services | Co-Authors Sylvia Khamati, Head of Health, Nutrition and Social Services; Noellah Musundi, Public Relations and Communications Manager

Social Protection in Kenya

Social protection in Kenya has experienced significant growth in the past few years, however, fragmentation and lack of coherent coordination mechanisms remain a threat. Consequently, duplication of efforts and parallel implementation structures do not optimize the limited capacity or support a coherent approach to capacity building across the sector.

Single Registry System for social protection programs has been adapted as part of the implementation of National Social Protection Policy. Currently, it links programs in the social assistance component of social protection with clear safety net linkages to other components such as social security and health insurances.

The vision of Universal Health Coverage (UHC) embodies principles of equity in access to, and utilization of health services, the quality of the services which people obtain, and financial protection for people needing health services. The principles are also fundamental to the objective of Health for All developed at the Alma Ata conference of 1978 with its focus on primary health care.

UHC Perspectives for Kenya

Health economics must insist on developmental strategies that adopt public health perspectives which address social determinants of health. In Kenya, National Hospital Insurance Fund (NHIF) takes the shape of a Hospital Insurance, that expects individuals to become sick prior to supporting them to “maintain” their health. This is loosely interpreted to mean covering the disease as opposed to covering the person! This must be corrected to embrace the ideals of UHC in accordance to the health for all global objectives.

A comprehensive health care model with a conscientious health financing strategy is paramount. Health models should not be developed in isolation of other ventures of development. Leveraging strategic development can boost the health status of a community without necessarily allocating new budget lines.

Concentration should be on access to services, better quality of care, with a greater focus on prevention, early management of diseases and reducing unnecessary specialist care. Investing in prevention and control of disease earlier on in life will reduce morbidity and mortality, and in return improve households’ income and productivity.

Experience from Humanitarian Lenses

Evidence deduced from Kenya Red Cross Society (KRCS)’s humanitarian and development work in Kenya depict verifiable conclusions which show that:

1. Everybody should be able to access health services including promotion, prevention, treatment, rehabilitation and palliative care.

2. Primary health care enables one medical practitioner and their team to integrate multiple services; and to follow people throughout their life course.

3. UHC is a key component to achieve the human right to health.

4. The worldwide movement towards UHC is an essential step towards reducing health inequalities and achieving health for all.

5. Universal access to health care should be complemented with equitable support of government for actions that address the socioeconomic determinants of health.

6. Universal access to health care will only be achieved if all three dimensions of UHC are tackled:

● Expansion of population coverage

● Reduction of out-of-pocket expenditures to ensure protection from catastrophic health spending

● Increased benefits to respond to current and emerging population needs and expectations

7. Need to establish and define a standardized essential package for UHC to bridge the loopholes in access, quality and affordability of health services

8. The current National Hospital Insurance Fund to be restructured to enhance covering the Person and not the disease for UHC envisages leaving no one behind

UHC will only be successful with synergistic results of all the six building blocks of a health system as described by the World Health Organization.UHC being a multi-sectoral issue, requiring multi-sectoral solutions can succeed with the collective interventions by humanitarian institutions such as KRCS, the Central and County Governments, NGOs and other actor in the Health sector, Research and Training institutions- local and global community, the World Health Organization and Civil Society Organizations.

Link to the full report: http://www.redcross.or.ke/landing/reports.php