Achieving Universal Health Coverage in Kenya through Innovative Financing

Universal Health Coverage (UHC) is a big concept with simple meaning. In Kenya, we will have achieved UHC when all of our citizens have access to the health services they need, when and where they need them, without facing financial hardship. This is the vision shared by everyone working in the health sector.

Achieving UHC has the potential to transform the lives of millions of Kenyans by creating a safer, fairer and healthier country for us all. It requires a well-functioning health system with sustainable financing that is equitably distributed and efficiently used.  

The list of global and national commitments to UHC is long: embedded in the Sustainable Development Goals under the goal for health, globally prioritized in 2017 in the Tokyo Declaration on UHC, enshrined under the right to health in the Kenyan constitution, and recently flagged as one of the Kenyan government’s ‘Big Four’ priorities. How then do these political promises translate to sustained and meaningful action? 

As a country, Kenya has already made progress on the path towards UHC, through the National Hospital Insurance Fund (NHIF). Since 2017, NHIF has been running a free maternity cover dubbed Linda Mama, which stemmed from Free Maternity Services program of the national government, rolled out in 2013. The goal of Linda Mama is to achieve universal access to maternal and newborn health services, thus contributing to the country's progress towards UHC. The country’s health care financing strategy is also forthcoming, and is expected to pave a clear roadmap to achieving UHC nationwide.

However, Kenya’s public spending on health is low, resulting in limited service coverage, inequitable health care access, and poor quality of care. An over reliance on external donors and on out-of-pocket (OOP) spending by poor patients are also major challenges. Evidence shows that when OOP payments are above 20% of a country’s total health expenditure, the impact of catastrophic health expenditure and impoverishment are high. In Kenya the proportion of OOP out of the total health expenditure is estimated at 27% and only 17% of Kenyans are covered by NHIF.  

Experts affirm that while ambitious, achieving UHC is both technically and financially feasible. For Kenya to make substantial progress, it is critical to increase the domestic resource allocation to health, and to ensure the equitable and efficient use of resources. Drawing on the experiences of other countries, diversifying health financing mechanisms, and improving health sector governance and efficiency are essential keys to success.

We also know that harnessing and leveraging innovations in health financing is a crucial cog in bridging these funding gaps and accelerating progress. Kenya is a renowned hotspot for innovation in all sectors, and health is no exception. The DFID-funded County Innovation Challenge Fund is tapping into this local ingenuity to facilitate the design and delivery of innovative interventions, products, processes, services, technologies and ideas to reduce maternal and newborn mortality.

This edition of Vumbua features two innovative health-financing models that have demonstrated value in the quest for UHC. It also covers Linda Mama milestones, shining light on how to leverage free maternity resources for rapid scale-up. I hope these ideas will add value to the country’s ongoing dialogue on health financing reform, and encourage more stakeholders to embrace innovative approaches that can position Kenya on the path to UHC.

Enjoy the reading.

Kimani Karuga, CICF Technical Fund Manager