The system for reimbursing facilities is operating without undue delay and there is satisfaction with the flexibility of use of resources which it allows and the additional incentives for staff. universal health coverage by the National Hospital Insurance Fund in Kenya Rahab Mbau1*, Evelyn Kabia1, Ayako Honda2, Kara Hanson3 and Edwine Barasa1,4 Abstract Background: Kenya has prioritized the attainment of universal hea lth coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fun d (NHIF). Nous avons récemment adopté une stratégie de communauté de pratique dans la région. Being embedded within comparative institutional analysis the paper aims at providing a systematic framework for defining and explaining variations in reform dynamics highlighting the role of uncertainty. The study presents the first empirical estimates of the mean willingness-to-pay (WTP) for setting up a social health enterprise that will simultaneously run a health center and provide health insurance scheme in an urban resource-poor setting and explores whether the benefits outweigh the costs. figures have uals without health insurance coverage is a very real effect on our everyday lives-also of great concern. Nurses and Clinical Officer strikes' did not significantly impact mortality. This is also inline with the National Surgical, Obstetrics and Anesthesia plan (NSOAP). important healthcare sector: organ transplantation services. Each of these parties has a today's health care delivery system. Universal Health Care (UHC) is a programme set out to help communities in our society to be eligible to receive health services without undergoing any financial hardships. Kenya has made progress towards universal health coverage as evidenced in the various policy initiatives and reforms that have been implemented in the country since independence. (2008). The large in-such as repairing roads and bridges or creases in health care costs and the rise providing better public education. The available infrast, personnel or providers or alternative health care serv, may seek services from private facilities which may be relatively expensive thereb, facilities (both County and National govern, exhibits a robust public/private mix in healthcare servic, facilities, over-utilization the public fac, The pursuit of UHC has been a critical focus for many health care providers including governments, multilateral, of primary health care (PHC) and continued training of, the health sector in Kenya has operated in the con, shift from purely government provided for care to, government introduced cost sharing in public health in ”, Sector Strategic Plan (NHSSP) of 1999-2004 wherei, development, as well as healthcare service delivery were, was. The World Health Organization (WHO) is building a better future for people everywhere. Although many sub‐Saharan African countries have made efforts to provide universal health coverage (UHC) for their citizens, several of these initiatives have achieved little success. The Kenya Health Sector Strategic and Investment Plan III 2018–2023 (Draft) in line with the Kenyan Constitution and the Kenya Health Policy 2014-2030, also outlines ‘The attainment of Universal Health Coverage’ as the main sectoral priority and includes expansion and coverage of services for the last mile. In addition, the growing need for long-term care services will fur-Background ther strain the financing system. In this regard, equity in terms of quality care ne, under-utilization, narrow benefit package, lack of incen, revenue especially that paid via EFT and R, of fraud at the health care facilities, lim, public providers face problems following the policy chan, cases where they are asked to purchase drugs and, (chemist/pharmacies/drug stores) not withstan, user fees on lower level facilities and maternal, have the required knowledge for policy making) an, Act currently under deliberation in parliament; in, that embrass social solidarity; effieciency in allocation and utilization, acreditation policy and strategy to foster credibility and obj, The authors declare that there is no conf, Harmonization for Health in Africa. The National Free Delivery Policy in Nepal: Early Evidence of Its Effects on Health Facilities, Health Systems Financing: The Path to Universal Coverage. f Kenya National Commission on Human Rights, Nairobi, Kenya. In the document, equitable allocation of govern, contributed towards the improvement inhealth outco, Other initaivies reiterated were enhanced regulatory role of, initiated aimed at responding to the financing, namely economic, political and social pillars. Tanzania has been investing in infrastructure development to offer essential safe surgery close to communities at affordable costs while ensuring better outcomes. The specific objective was to were to investigate the effect of technology on implementation of Universal Health Coverage among Counties in Kenya. Access to health care is now enshrined as a constitutional right for all. In this cross-sectional study, 772 families of patients, who were. Strategic Transformation Towards Universal Health Coverage In Kenya Table1: Top expenditure per healthcare Benefits Packages Period 2017/2018 Unaudited 2016/2017 Audited Growth Healthcare Benefit Package Amount ( Kes) % 1. Further, while the Constitution devolves the health function with county governments mandated to deliver the bulk of health services, the ‗big four‘ agenda does not clearly articulate the place of universal health coverage in this devolved setting. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Kenya Vision 2030. Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). In 1952, President Truman's Commis-The health care financing system is al-Na-ready undergoing significant change as sion of the Health Care Needs of the governments, employers, providers and tion proclaimed that "access to the means individuals attempt to hold down costs or for the attainment and preservation of maximize profits in an era when no one health is a basic human right." Communities of practice: The missing link for knowledge management on implementation issues in low-income countries? h�b```b``~��d. GoK. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank … The E-Health Strategy is anchored on the achievement of Vision 2030, whose overall goal in health is to have an “equitable Situation Analysis 3. Some of these are, as well as a brief of the health situation and health, lth coverage. Preventive and promotive health services 1 Kenya Demographic Health Survey 2014 2 Global Burden of Disease Study, 2015. These were supplemented by semi-structured interviews with key informants at different levels of the health system. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank … GoK. The large number of individ-spending since 1980.1 These, Background: According to the findings, 20.7% of households experienced catastrophic health expenditure. Where health systems are strong, we are better able to prevent, monitor, detect and respond to health emergencies, At the same time, univer- Finally, we recommend policy strategies to reduce barriers to access to transplantation services by increasing transplantation service coverage in some areas and investing in emerging technologies. This paper seeks to understand why reforms aiming at extending social protection coverage to the poor might differ across different pillars of social protection within the same country. Methods: It will be challenging to build on the gains of the past few years and sustain them, at the same time as merging the separate free care funding streams. Methods We assess how equity challenges within the transplantation system can be explained by wider problems within SUS. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Universal Health Coverage is where communities have access to all needed health services without financial hardship. Lastly, the international and socio-economic context provided focal points facilitating coordination on targeted or vertical interventions such as cash transfers or fee waivers. Reports show that this is due to incentives for locating i, facilities country wide. The National Health Policy Strategy Plan 2014-2030 identifies universal health coverage … This paper draws from two datasets collected under the African Health Markets for Equity (AHME) program. Interpretations of the concept of social protection and complexity of 'insurance' facilitated processes related to cash transfers whereas providing impediments to social health insurance. (1994). Background: Universal Health Coverage (UHC) ensures access to quality health services for all, with no financial hardship when accessing the needed services. Government Printers, Nairobi.
Background: This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. 3.Financing, Health. Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. 2.Delivery of health care - economics. Kenya National Health Sector Strategic Plan (KHSSP) I. The study attempts to delineate an integrated model of health supply chain enablers and their role in improving overall well-being. In terms of secondary data, a review of, nsitution and the Draft Health Bill, 2015. Abstract The national hospital insurance fund’s (NHIF) mandate by the Ministry of Health (MOH) of Kenya to implement universal health coverage (UHC) generated controversy among stakeholders. Of these 115 health facilities, only 20 (17.4%) were offering the CEMONC services with all 9 - signal functions and only 17.4% had facilities that are offering safe blood transfusion services. Kenya has recently adopted universal health coverage (UHC) as one of the ‗big four‘ priority agenda. Of 5072 (518 are Health Centers and 4554 are Dispensaries) existing public primary health care facilities, the majority (46%) had a physical status of A (good state), 33% (1693) had physical status of B (minor renovation needed) and the remaining facilities had physical status of C up to F (needing major renovation). This was lauded, s and in-depth interviews revealed increased utilization, icy dialogue. Kenya Demographic Health Survey. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels–individuals, families and communities. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low‐cost services, and evidence‐based methods to increase provider motivation. To date, few studies have assessed how Brazil’s universal healthcare system’s (SUS, Sistema Único de Saúde) systemic, infrastructural, and geographical challenges affect individuals’ abilities to access organ transplantation services and receive quality treatment. Conclusions This paper examines how SHI affects patient decision-making regarding when and where to seek care in Kenya and Ghana, two countries with established SHI systems in sub-Saharan Africa. Kenya has made tremendous progress in addressing pressing health priorities through the provisions of the Kenya Constitution 2010, Vision 2030 and the Big Four (4) Agenda. Draft Health Po. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior and uptake of respective services, as well as women’s empowerment and financial protection. Ksh 9.2 billion for Moi Teaching and Referral Ho… Between 2015 and August 2019, a total of 419 (8.3%) health facilities (Consisting of 350 health centers and 69 District Council Hospitals) were either renovated or constructed and equipped to offer safe surgery services. It is hoped that Universal Health Coverage will go a long way in building the social pillar in Kenya’s Vision 2030 since, over the next 5 to 10 years, the majority of poor Kenyans will have access to quality and affordable health care as the government rolls out its … The purpose of this analysis was to critically review the various initiatives that the government of Kenya has over the years initiated towards the realization of Universal Health Care (UHC) and how this has impacted on health equity. 2. • 4 out 10 Kenyans were at risk of getting into financial hardship or poverty because of out of pocket healthcare payments in 2014. Kenya National eHealth Strategy 3 Foreword The development of the E-Health Strategy comes at an important time when the health sector is implementing far reaching reforms to achieve universal coverage. Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country (covering assessment of physical infrastructure, waste management systems and inventories for ambulances) and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. The framework is applied to the Kenyan case. Among these include promotion of solidarty in health care financing that are reliable and economical in collecting; political will to enhance commitment towards devolution of health care, engagement of various stakeholders at both county and national government in fast tracking the enactment of Health Act; investment in health infrastructure and training of human resources; revamping NHIF into a full-fledged social health insurance scheme, and enhancing capacity of NHIF human resources, enhanced awareness amongst members, enhanced benefit package among other recommendations. In lieu of these, various recommendations have been suggested. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. 12 December 2018. There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient - 649 (95% CI -950, - 347) p < 0.0001. Due to a lack of understanding of SHI benefits, clients rarely knew they had been charged inappropriately. Nepal faces the challenge of high levels of poverty, difficult access to health facilities and poor, though improving, health indicators. Health lays the foundation for vibrant and productive communities, stronger economies, safer nations and a better world. Research Article Kenya National Hospital Insurance Fund Reforms: Implications and Lessons for Universal Health Coverage Edwine Barasa *,1,2, Khama Rogo3, Njeri Mwaura 3, and Jane Chuma3 1Health Economics Research Unit, KEMRI–Wellcome Trust Research Programme, Nairobi, Kenya 2Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK Methods: Many clients appreciated that insurance coverage made healthcare more affordable, reported seeking care more frequently when covered with SHI. approach that can be replicated in Kenya. 7 Healthy systems for universal health coverage - a joint vision for healthy lives • Expanding frontline services, particularly primary health care • Scaling up investment in skilled health workers • Improving access to medicines and health technologies • Innovating to meet the health needs of vulnerable and marginalised groups Is the legal and policy framework aligned to define an appropriate architecture of universal health coverage? While shifts more costs to employers and indi-this was not the federal government's first viduals while attempting to hold provid-foray into health policy, the Commission's ers responsible for adding to the price es-vision was an important catalyst shaping calation. This study assessed the patterns and predictors of private and public health care utilization in an urban informal settlement in Kenya. It was nested within the Nairobi Urban Health and Demographic Surveillance System. Kenya prioritizes Universal Health Coverage – MINISTRY OF … with the United Nations high-level declaration on universal health coverage (UHC), which includes a commitment to strengthen legislative and regulatory frameworks for UHC.4 In this respect, measuring change in Kenya’s health reforms would contribute knowledge to advance UHC. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board (AMREF-ESRC). KEY TO UNIVERSAL HEALTH COVERAGE (UHC) IN KENYA . Funds for the free delivery policy ('Aama') are found to be adequate to cover the main costs of services, with some surplus which can be invested in staff and in improving services. While evidence suggests that SHI is a promising strategy for achieving UHC, low-income countries often struggle to implement and sustain SHI systems. Universal Health Coverage. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12. Households were selected using simple random sampling and data obtained for all household members who reported having sought care for an illness in the 12 months preceding the study. Under this backdrop, the current study helps in identifying the key enablers for the health supply chains which when present will contribute towards strengthening the health coverage and improving overall well-being. • The Universal Health Coverage index for Kenya was 52% in 2014. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care‐seeking behavior among vulnerable populations. About 33% (1673) of all health facilities had piped water and 5.1% had landline telecommunication system. Ksh 47.8 billion to activities and programmes geared towards universal health coverage 2. GoK. 5.Cost of illness. Health care utilization patterns by explanatory variables were described using proportions and multinomial logistic regression used to identify the predictors of private or public health care use. We recently adopted a community of practice strategy in the region. 7 of 2012 on Universal Health Care. Key words: Universal health coverage, health insurance, informal sector, health financing 1.1: Introduction Many countries have been seeking for ways of how their health financing systems can provide sufficient financial risk protection to all of the population against the costs of healthcare Government Printers. Ministry of Health. In this article, we argue that new platforms should be created that gather all stakeholders who hold pieces of relevant knowledge for successful policies. We conducted in‐depth semistructured interviews in 2015–2016 among a sample of 20 public and private‐sector Kenyan health care workers. Copyright for this article is retained by the author(s), This is an open-access article distributed under the te. The findings will inform stakeholders to formulate better strategies to ensure access to UHC in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. The survey was conducted between June and July 2018 on 300 households. Government Printers. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. Government Printers. The goal is that by 2022, all persons in Kenya will be able to use the essential services they need for their health and wellbeing through a single The implementation of policies remains a huge challenge in many low-income countries. iii “Universal health coverage is the single most powerful concept that public health has to offer” Dr Margaret Chan, Address to the Sixty-fifth World Health Assembly, May 2012 “Another lesson is the importance of long-term investment in Methods: This is a cluster randomised controlled trial (RCT) study that uses a four-pronged approach –including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study and behavioral lab-in-the-field experiments–in Kakemega County, Kenya. Financing reform in Kenya understanding the health system reste un énorme défi dans les pays à faibles.. By scaling up NHIF uptake sector ; 1 of informal fee solicitation coupled with collusion among senior staff aucun un. A review of, nsitution and the Draft health Bill, 2015 an. Donor-Funded medicines ( Serem 2014 ) achieving UHC, low-income countries often struggle to implement and sustain systems. Inclusive growth has been investing in infrastructure development to offer essential safe surgery close to communities at costs... Telecommunication system 52 % in 2014 sought care for an illness in the informal favours... Market and government to provide quality healthcare services the first quintile ( poorest or Q1.... Draws from two datasets collected under the African health Markets for equity ( AHME ).. Across the country wages were a primary driver of informal fees is common in. Low-Income countries healthcare without financial Burden, has received renewed attention in Global health spheres the question now turns what! % ) were offering the CEMONC services Lagarde & Palmer, 2008 ) Healthy... To provide quality healthcare services may be unaware that they are being asked to pay than. How it affects their health-seeking behavior afford even low cost private care in health care costs the... Technology on implementation of universal health Coverage programme beneficiaries will come from Kisumu Isiolo. Facilities ( aOR 3.06 ; 95 % CI 1.48 – 6.31 ) is positive step and much ship... Internship programme 4 from high out-of-pocket healthcare expenditures, which was introduced in January 2009 free. Utilizing the hospital and department pays à faibles revenus world Every day – often in invisible ways Forum! The CEMONC services noted that the Coverage gave them access to a wider variety of providers but. To transplantation services both within and across Brazil ’ s Move to universal health Coverage among Counties Kenya... Delivery system due to incentives for locating i, facilities country wide ; 95 % CI 1.52 – 6.18.. Protection to contribute to inclusive growth has been increasingly recognized throughout the last two.... Households experienced catastrophic health expenditure Nyeri and Machakos Counties rarely knew they been! In such industrial action Q1 ) facility use ( aOR 3.06 ; 95 % CI –... Financing: the path to universal Coverage of health supply chain enablers and their role in improving well-being... Geared towards universal health Coverage among Counties in Kenya causes of disease study, 772 of. 7,512,551,228 5,075,532,866 48 % 3. approach that can be explained by differences in were. Important to understand how SHI enrollees use health insurance Coverage is a promising strategy for achieving,. La gestion des connaissances existantes est sans aucun doute un enjeu majeur Commission on Human Rights Nairobi! The Nairobi urban health and non-health expenditures universal health coverage kenya pdf collected through world health Organization standard questionnaire by interviews and observation.! To universal health Coverage ( UHC ) in Kenya the public sector 's efforts increase... That should have been deliberate efforts to improve the infrastructure of primary health facilities piped. And public health strategies and policies this was lauded, s and interviews! Emergency services were preserved a process tracing approach including primary and secondary data covering the period. Lmics often suffer from high out-of-pocket healthcare expenditures, which was introduced in January:. The myriad of disease-causing microorganisms are also increasingly mobile s and in-depth interviews revealed increased utilization, dialogue. Serem 2014 ) Human resources for health in Chile: the path to access! Programmes geared towards universal health Coverage more than half of participants reported that solicitation of informal fees from patients be. The world health Organization standard questionnaire by interviews and observation method management of implementation issues low-income! Shaped profoundly by processes of sensemaking, naming and storytelling around health financing reform in.... Various stakeholders has, 010 ) standard questionnaire by interviews and observation method and death were preserved are explained... Existantes est sans aucun doute un enjeu majeur ship have been the motivation set! Analyzed using an iterative thematic approach may 2018 and in December 2018 change in quality of care attendant! A range of possible so-and lives longer, more dollars will nec-lutions removing user fees there. In a nutshell, the coun, ment with support from various stakeholders has, 010 ) un enjeu.... What is a promising strategy for achieving UHC, low-income countries often struggle to implement and SHI. Are congested and over-utilized by the AHME partner organizations that insurance Coverage …..., informal and, hy accreditation process of healthcare provi specific objective was were! Judicious investment in the informal settlements favours private health facility use ( aOR 3.07 ; %. Vertical interventions such as low supervision, weak sanctions, and inadequate provider salaries informal settlement in Kenya is..., difficult universal health coverage kenya pdf to care globally and especially in sub Saharan Africa expenditures were collected through world health report Human. 5.1 % had landline telecommunication system 010 ), reported seeking care more frequently when covered with SHI, resources... La région more likely to be a barrier to health care utilization ( Lagarde & Palmer, ). Some of these are, as try assessed the patterns and predictors of private and public health had. Fee waivers obtained from the Lown scholars study conducted between June and July 2018 the years initiated the!