Recent revelation by the Health Cabinet Secretary of a staggering Sh20 billion loss at the National Health Insurance Fund due to fraudulent activities highlights the inefficiencies plaguing Kenya's healthcare financing.
This highlights the fact that Kenya’s healthcare financing challenges have nothing to do with inadequate funding but rather wastage and inefficient use of available resources.
Following the 1994 genocide, Rwanda faced the daunting task of reconstructing a healthcare system that was both devastated by conflict and historically inaccessible due to cost.
This period of adversity led to innovative healthcare financing reforms that have significantly improved access and efficiency. In contrast, Kenya’s healthcare financing system grapples with inefficiencies and resource mismanagement.
Drawing from my recent visit to Rwanda, specifically to Butaro District and its Level 2 Teaching and Referral Hospital, this article explores Rwanda's strategies and offers lessons for Kenya.
Witnessing the country's community-driven healthcare system first-hand, I couldn't help but draw parallels to the challenges faced in my home country, Kenya. While both nations share a common goal – a healthy population – the melodies of their healthcare systems resonate quite differently.
In 2004, Rwanda rolled out the Community-Based Health Insurance Scheme, known as Mutuelles de Santé. This initiative, which evolved from a pilot project in three districts, is rooted in principles of mutual aid and communal solidarity.
Achieving an impressive coverage of up to 91 percent at its peak, the CBHI exemplifies Rwanda's commitment to making healthcare accessible to all. Funded through a mix of member premiums, government subsidies and donor contributions, the scheme shows the power of collective risk pooling.
The scheme has been placed under the insurance regulatory authority and not the Ministry of Health to enhance accountability.
During my visit to Butaro, I witnessed first-hand the CBHI’s impact. The scheme operates on a tiered premium system based on categorisation, ensuring that the most vulnerable receive necessary support. The CBHI ensures that healthcare access starts at the community level, with community health workers diagnosing and treating minor illnesses.
More complex cases are systematically referred to higher levels of care, ensuring that each patient receives appropriate, cost-effective treatment. This model not only streamlines patient care but also controls costs by preventing unnecessary use of specialised services.
However, Rwanda's journey has not been without its hurdles. Despite its success, the scheme faces sustainability challenges, necessitating government intervention to manage deficits.
Kenya's struggle with healthcare financing is not primarily about the lack of funds but about how existing resources are managed. The frequent scandals involving health insurance funds and the preference for private healthcare point to systemic issues.
Kenya could benefit from Rwanda's model by fostering greater community involvement in health insurance schemes and implementing a structured referral system to enhance efficiency and service quality. My observations in Butaro suggest that integrating local community structures, such as the Nyumba Kumi initiative, with health insurance processes could improve coverage and reduce corruption.
Moreover, Rwanda’s method of linking insurance usage to the referral system offers a blueprint for making healthcare spending in Kenya more cost-effective. For Kenya, adopting a similar approach means restructuring the NHIF to work hand-in-hand with a referral system that guides patients through various levels of care.
This would involve strengthening primary care and enhancing the capacity of primary healthcare facilities and community health workers to handle a broad range of health issues, reducing the burden on tertiary hospitals.
It would also entail implementing a referral system that ensures patients are seen at the correct level of care for their condition, optimising resource use and improving patient outcomes. Lastly, we need to leverage community structures to monitor and support the health insurance system, ensuring that funds are used appropriately and efficiently.
My recent visit to Rwanda revealed a comprehensive approach to healthcare financing that contrasts sharply with the challenges faced in Kenya. Rwanda's success story, characterised by widespread coverage, community solidarity and efficient resource use, provides valuable lessons for Kenya.
This isn't just about replicating Rwanda's model; it's about adapting it to Kenya's unique context. By learning from the Rwandan experience, we can create a healthcare symphony that resonates with the needs of the Kenyan people, one where every citizen has access to the right care, at the right time, and in the right place.
And perhaps, this harmonious melody will one day echo across the borders, inspiring the region to collectively play a healthier tune.
Orthopaedic surgeon heading the Orthopaedic Oncology Unit at the Kenyatta National Hospital and is formerly the Head of the Department of Orthopaedics at the same institution. He is also the CEO of Stratus Medical Imaging Solutions Ltd, a private healthcare provider in Nairobi, and a 2024 Global Surgery Advocacy Fellow
