Amidst UHC pomp, germane issues persist

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As President Uhuru Kenyatta’s final term stutters towards an increasingly closer 2022 expiry, one of his flagship legacy projects, the much touted Universal Health Coverage (UHC) program chugs along, urged on by a hopeful public keen for relief from astronomical health care costs, and an overzealous bureaucracy eager to please an increasingly flustered master at the tail end of an eventful decade in power.

UHC was launched to counter the runaway costs of healthcare that have been sending poor Kenyans with treatable ailments to an early grave, and consigning thousands of families to poverty every year. More precisely, the program aims to provide safe, timely, effective, efficient, equitable and patient-centred health services to all Kenyans irrespective of financial circumstances or economic wellbeing. 

Currently being piloted in Kisumu, Isiolo, Machakos and Nyeri, the President’s program is noble and timely. But, however honourable the President’s intentions, the architects of the UHC program must come out clearly on some key issues that have arisen from the experience in the pilot counties.

First, and perhaps the biggest elephant in the (cabinet) room, is just how sustainable the program is. Haven’t we been told that the government is broke? Isn’t the Salaries and Remuneration Commission looking to chop civil service packages because Big Brother is unable to pay public workers’ (the same people expected to implement UHC, mind) house and commuter allowances? 

Health care is not cheap; just how does government plan to raise a few hundred billion shillings per year to provide healthcare to some 50 million Kenyans? 

Again, haven’t we been here before? Wasn’t the idea of free health services dropped in the late 1980s with the introduction of co-payments in hospitals because free health care services were unsustainable? Kenya produces some of the best innovators, sportsmen and, of course, teachers in the world. We also produce the most cunning looters of public property, whom we later reward with some of the most lucrative offices on the planet. But for all our industry and wisdom, we obstinately refuse to learn from history.

Second, how are UHC and NHIF integrated? Why would people continue paying premiums to NHIF when they can access the same services for free? And where do faith-based hospitals, some of the most important players in health care, come in? Additionally, UHC promises to cover the ‘full range of essential health services including chronic care.’ Does this include costs for dialysis, transplants and cancer treatment?

Finally, it has been claimed that about 70% of UHC funds will go towards procuring health products and technology – i.e. drugs. However, commodities represent just one pillar in the expansive health care system. For these drugs to be deployed effectively, we need adequate clinicians to prescribe them. For them to be adequately managed, stored and dispensed, we require pharmacists at every level of health care as well as an effective Commodity Information Management System. Healthcare provision is not just about procuring medicine and dumping it in health facilities. Government must, of necessity, employ more health care workers and deploy requisite systems and infrastructure in addition to the huge volumes of commodities they are sending to the counties.

As UHC moves towards full implementation, these are key issues that need ironing out if the dream of universal quality, affordable healthcare is to be actualised. (

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