President Ruto’s ambitious Universal Health Coverage will cost Sh550 billion a year, the Ministry of Health says.
Health spending in Kenya is about Sh247 billion, and must be doubled for this to be realised.
This means UHC financing will be Ruto's new headache.
Affordable healthcare was a key plank in the President's campaign pledges.
Although the government is expected to increase contributions to the National Health Insurance Fund to raise more money, the ministry noted nearly half of all Kenyans live below the poverty line and struggle to pay the current premiums.
“As such, 5.3 million households require government subsidies for health insurance,” the ministry said in a technical paper presented at the ongoing National Dialogue on Sustainable Health Financing in Kenya in Nairobi.
The three-day event is discussing how the UHC will be financed.
It brings together the government, civil society, development partners, and private sector for a consolidated political statement.
The ministry's paper adds that although allocation to health has been rising, it is still insufficient compared to global benchmarks.
“A recent analysis of health expenditure and costing of health services in the country estimated the cost of delivery of essential health services at about Sh520 billion and is projected to rise with the increase in population and change in epidemiological pattern of disease burden,” the paper says.
It recommends that Kenya must find a way to raise and enforce mandatory NHIF contributions.
The government has already proposed Kenyans pay 2.7 per cent of their gross monthly income to NHIF, but the proposed regulations have not been taken to Parliament.
In a speech read by Prime Cabinet Secretary Musalia Mudavadi, President William Ruto said most of the UHC funds will go to primary health services.
"It has been demonstrated for every dollar invested in primary health care the return is 16 dollars," Ruto said.
He said national and county governments will jointly recruit and pay about 100,000 community health promoters to drive the programme.
"For once all the 100,000 Community Health Promoters will receive a matching stipend from national and county governments," he said.
Each community health worker will receive Sh5,000 a month, shared equally by the two levels of government
"Investing in primary health care will free resources that can be redirected to strengthening our health systems," Ruto said.
The ministry’s technical paper says to realise UHC, Kenya must direct to health a minimum of 15 per cent of the general government expenditure, a minimum of 35 per cent of counties budget and a minimum of five per cent of the GDP to health.
Currently, most counties spend about 30 per cent of their budgets on health while the national government’s health spending is 11 per cent of the national budget and only 2 per cent of the GDP.
The paper also lays bare the challenge Ruto’s government faces to ensure all Kenyans have access to health services without falling into poverty.
“The country’s health insurance coverage stood at 26 per cent of the population in 2021. This is below the World Health Organization recommended coverage of more than 90 per cent,” the paper says.
Health PS Harry Kimtai said Kenya agrees with the African benchmark of 15 per cent of the budget going to health.
“AU agreed we must increase domestic investment in health to 15 per cent of budget. The dialogue will come up with a country paper on health financing and this paper will be presented to the EAC,” he said at the meeting.
Kenya’s health system is funded through government, out of pocket contributions, private firms and donors.
The government contributes about 52 per cent of all health expenditures while Kenyans pay 24 per cent out of pocket, the report shows.
Tharaka Nithi Governor Muthomi Njuki said UHC will only be achieved if Kenya focuses on preventive health.
“If we focus on preventive we will reduce the number of Kenyans flocking to hospitals because they are very sick. We have agreed to focus on preventive and pump resources to villages to train community health workers,” he said.
“From our calculation, it's 10 times cheaper to invest in preventive rather than wait for them to come to hospital. Because of the lack of a system that governs how we take care of patients, we don’t have a comprehensive referral system guided by principles of diagnosis. Our Level 5 or 6 are congested with patients who have done self-referral.”
He said counties have a draft law to allow them ring-fence all money realised from county public health facilities.
Council of Governors chair Anne Waiguru said that most donors are reducing support to Kenya after the rebasement of Kenya’s economy in 2015 made the country a middle-income economy.
“We need to increase budget annually to cover drop from donors. We want to increase from 11 per cent to the current 15 per cent as proposed in the Abuja Declaration,” Waiguru said.
“We will also work with the national government to improve health insurance coverage for all and UHC. We want NHIF reimbursement to the public facilities to be predictable and reliable.”
Health CS Susan Nakhumicha said the UHC plan should be financed through domestic finances.
“The government is also focused on local manufacturing of strategic commodities to address high cost of healthcare,” she said.
“The benefit of pooling procurement can be realised if the East African countries can also pool the procurement of their commodities."
UHC was first launched by President Uhuru Kenyatta in December 2018, in Kisumu and piloted in four counties: Kisumu, Machakos, Isiolo ad Nyeri.
However, President Ruto claims the rollout by Uhuru failed.
“There have been two failed attempts to implement universal healthcare. But this time round, we are determined to achieve it successfully,” he said two weeks ago when he met Global Fund executive director Peter Sands at State House Nairobi.
In the coming financial year’s budget, Treasury CS Njuguna Ndung’u allocated Sh18.4 billion towards the funding of Universal Health Coverage.
Despite UHC reaping big from the total Sh141.2 billion allocated to the health sector by the Treasury, this is a decrease from the Sh62.3 billion allocated to the programme in the 2022-23 budget.
The allocation had gone up from Sh47.7 billion in the 2021-22 budget.
“The Kenya Kwanza administration is committed and determined to realise the constitutional right to health in the shortest time period by delivering a UHC system,” Ndung’u said.
“This entails promoting access to quality and affordable healthcare through the UHC programme,” he added.