Page 42 - KMD 2022-23 EDITION

KENYA KWANZA HEALTH MANIFESTO PROPOSES
FAR-REACHING HEALTH REFORMS

good healthcare system is something penetration double from 10 per cent of the
all countries struggle to achieve. The population in 2003 to 20 per cent in 2018. That
Co
A vid19 pandemic has demonstrated said, the penetration is uneven with Nairobi at over
how important this is, and also shown that even 40 per cent, while Wajir is still below 1 per cent.
wealthy countries can be badly exposed by Health This increase in contributions was achieved partly
emergencies. One of the lessons from the Covid19 by increased enrolment and partly by change of
crisis is that, although resources matter, the contribution structure from a flat rate of Sh300 a
qualitative aspects of the system matter more for month to a graduated contribution ranging from
Health outcomes. Sh150 to Sh1, 700 a person.

1. 36 Per Cent of Kenyans at Risk of being But the NHIF still falls far short of the social Health
Impoverished by Health Financial Burden insurance scheme that it ought to be, both in its
Our country is moving in the right direction, but we design as well as operational performance.
need to be more creative, deliberate and ambitious
in how we use the substantial resources spent on These shortcomings include:
healthcare to address old and emerging challenges. • NHIF is primarily designed to be funded by
We need to build on the momentum of recovery statutory payroll deductions from employees
from the Covid -19 pandemic to build back better, in the formal wage economy. As observed
for we know not when the next health emergency earlier in this manifesto, this number is only 15
will hit. Of particular concern is the growing burden per cent of Kenya’s workforce. While NHIF has
of non-communicable diseases such as cancers, sought to expand coverage to the vast majority
heart disease and diabetes-related complications who are self-employed through voluntary
that, if not addressed urgently, will become a threat enrolment, this has come with challenges
not only to health but also to the socio-economic notably intermittent payments of people
wellbeing of the country. Presently, 36 per cent typically enrolling when they are unwell. This
of Kenyans are at risk of being impoverished by is a systemic problem of insurance known
the financial burden of catastrophic illness. There as adverse selection. The statutory payroll
is also the question of financing programmes system is also inequitable because deduction
that are currently heavily donor-dependent is on individuals while benefits accrue to
and yet not properly planned for transition to households. Thus households with one payroll
domestic financing even as donors make plans to worker and those with two or more receive the
transition out. The HIV, TB, malaria, family planning, same benefits even though they contribute
immunisation and nutrition programmes are key different amounts.
donor-funded and the gains already realised must • Shift towards curative at the expense of
be guarded jealously. preventive care, with the share of inpatient
expenditure increasing from 23 per cent to 29
The most recent assessment shows that our Total per cent over the last decade (2010 - 2020),
Health Expenditure (THE) stands at Sh550 billion while the preventive care spending declining
a year, financed by government (63 per cent), by from 24 to 12 per cent. The shift from cheap
households “out of pocket” (27 per cent) and the to expensive is a systemic problem with
balance of 10 per cent also financed by households insurance financed healthcare systems.
through insurance schemes. The out-of-pocket • Fragmented overlapping schemes within the
share translates to Sh150 billion per year, which is NHIF, for example, Linda Mama, civil servants
a big burden to households. This is the reason that scheme, school children and elderly support,
one in three families is at risk of falling into poverty undermine the principle and benefits of the
because of the financial burden of catastrophic widest possible risk pooling that a social Health
illness. The number is growing daily as the non- insurance scheme is supposed to provide.
communicable disease burden grows. • The operational capacity has not grown
in tandem with the enrolment, leading to
2. NHIF Suffering from Adverse Selection inefficiency, high administrative costs and
Insurance System Problem poor responsiveness to its customers and
Over the last decade, considerable progress made service providers.
in enrolling Kenyans in NHIF, has seen insurance

40 Kenya Medical Directory