PHM Kenya at the 3rd UHC Conference that was held in Kisumu on 15th – 17th May 2019

The fundamental right to enjoy “the highest attainable standard of health” is enshrined in the Kenyan constitution. The pilot of Universal Health Coverage (UHC) through the “Big 4” agenda aims to ensure that “all people obtain the health services they need without suffering financial hardship when paying for them”. The Kenya UHC model derives from WHO recommendations, particularly regarding Primary Health Care (PHC), and an analysis of UHC and PHC will inform refinement of the UHC programme, to achieve health for all Kenyans.

Following endorsement by the World Health Organization (WHO), the World Bank, and, most recently, the UN’s Sustainable Development Goals, the drive towards universal health coverage (UHC) is now one of the most prominent global health policies. As countries progress towards UHC, they are forced to make difficult choices about how to prioritize health issues and expenditure, which services to expand first, whom to include first, and how to shift from out of pocket payment towards prepayment. Building on an extensive philosophical literature on the ethics of priority setting in healthcare, a recent WHO report provides guidance on how states may resolve these issues.

In this regard, PHM-Kenya together with HENNET had a privilege to present their views focusing on Primary Health Care as responsive approach to achieving universal health coverage with a clear focus on community participation/involvement and empowerment. Some of the issues include: transparency and accountability, eliminate out-of pocket expenditure, allocation of national funds according to the needs of the people was highlighted.

People’s Health Movement-Kenya views Universal health coverage as a direct impact on a population’s health and welfare. Access and use of health services enables people to be more productive and active contributors to their families and communities. It also ensures that children can go to school and learn. At the same time, financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets.

Priority Actions

•       Advocate for improved access and coverage, especially at primary and community levels and strengthen community participation to address environmental and social determinants

•       Prioritizing the funding of PHC and ensuring transparency in resource allocation and utilization to minimize or alleviate deficits and misuse of funds.

•       Develop comprehensive approaches that  address social determinants of (ill) health through healthy public policies and intersectoral action

•       Build a broad-based social movement for health: the example of the People’s Health Movement

•       Engage both local, national and international implementing civil society organizations to have a PHC component in all programs and to advocate for increased investment in primary health care.

Recommendations

Government should prioritize primary health care, including prevention and health promotion as a first step, and well structured, efficient primary health services that meets most of the health needs of most of the population, most of the time,

Build accountability to citizens through transparent progress tracking and monitoring;

Make UHC a ‘whole of government’ decision linked to nation-building and achieving citizen development;

Engage beyond health to strengthen the critical drivers of UHC systems such as tax collection and budget management.

Ways Forward

Peoples Health Movement Kenya plans to engage with the County governments in Kenya on;

-       How well County governments are prepared for UHC rollout in terms of infrastructure, role of private actors especially the World Bank, human resources, financing and accountability;

-       Placing primary health care-oriented health systems strengthening in the context of universal health coverage, through Phased approach, especially in the context of low-income settings with weak health systems –starting with PHC priorities and addressing avoidable inequities and inefficiencies; and, scaling-up and extending services to more comprehensive coverage as requisite institutions and capacities are strengthened.

-       Improving equity in financial coverage by reducing inequities through social protection; shifting to mandatory pre-payment and consolidated pooling using tax-based funding and/or social insurance contributions.

-       Improving equity and efficiency in service delivery by Improving access, affordability and effective use of medicines; improving human resource performance in both public and private sectors; improving service delivery structures; improving regulation.