rticle 43 of the Kenyan Constitution states that every Kenyan has a right to quality and affordable health care, including reproductive health; it further states that no Kenyan can be denied access to emergency health services when in need. The implication of this article is that barriers to health care services of whatever kind will not hinder access, hence the government is duty bound to remove such barriers so that health rights are met in reality.
It has always been the goal of the government to fight poverty, ignorance and disease in Kenyan society. Eliminating these three enemies of social progress was set at independence, and various government initiatives have been taken with different results. While the fight against poverty still remains the most daunting task, achievements in the education and health fields have been more encouraging. But with the onset of the HIV/AIDS pandemic, the emergence of non-communicable diseases, the continued influx of populations in urban areas, growing poverty in rural areas and tremendous environmental degradation, health problems have become worse. Rather than decrease, mortality rates have gone up among all age groups as more and more people seek health care both as in-patients and out-patients. Implementing health rights as envisaged in the constitution is hence a major task at this point in time.
Health service delivery has always been shared by the public and private sectors almost in equal proportions. Since the private sector tends to cost more and demand more out-of-pocket expenditure, government services which are highly subsidized in turn get over stressed with many more people trying to get services. It has therefore always been necessary that government seeks to invest more and more in health care delivery under severe budgetary constraints.
It is in this regard that adequate financing of health care has become an urgent and important topic in government, leading to a systematic review of health care financing approaches adopted since independence, and updating them in line with present challenges and available best practices globally.
Debates have therefore intensified since 2004 regarding how best to achieve Universal Healthcare Coverage (UHC) to ensure access to quality and affordable health care for all Kenyans, whether such services are available in the private or public sectors. This policy document gives a comprehensive background to the history of public health insurance in Kenya, its evolution and challenges over the years, the necessity to transform the National Hospital Insurance Fund (NHIF) into the National Health Insurance Fund at the present conjuncture and the managerial and financial imperatives for this change.
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 support for indigents under this scheme. The catastrophic expenditures that families currently experience in treating “difficult diseases” such as cancer, diabetes and cardio-vascular problems will also be minimized for all social strata in our communities.
Hon. (Prof.) P.A. Nyong'o
Minister of Medical Services