Measuring Kenya’s Progress towards achieving Universal Health Coverage Edwine Barasa, Peter Nguhiu, Di McIntyre 10th Mar 2019

UHC is a Global Health Priority… UHC - ensure that everyone can use the health services they need without the risk of financial ruin or impoverishment Expand priority services, include more people, and reduce out-of-pocket (OOP) payments

Introduction: Kenya’s health financing system Revenue sources and contribution mechanisms Pooling arrangements Revenue generation mechanisms should be fair and offer financial risk protection Pooling arrangements should allow for effective income and risk cross-subsidization Purchasing arrangements should actively pursue the best possible ways to optimize quality, efficiency, equity and responsiveness of health service provision Purchasing arrangements

Kenya has committed to achieving UHC by 2022

The need to measure and track progress over time… Two Dimensions 1) Service coverage Those that actually receive the healthcare services that they need and of good quality/ Those that need healthcare services 2) Financial risk protection Incidence of catastrophic healthcare spending Impoverishing effects of Out Of Pocket (OOP) spending Equity

Study Objectives To develop a summary measure for UHC for Kenya and track progress over three time points (2003, 2008, and 2014) Integrate the ideas put forward by the WHO and World Bank framework for monitoring UHC (Boerma, Evans, et al., 2014), and the proposals by Wagstaff and colleagues (2015) on how to operationalize this framework

Methods Three rounds of the Kenya Demographic and Health Survey data (KDHS) (2004, 2008, 2014) to analyse service coverage indicators Three rounds of the Kenya household expenditure and utilization survey (KHHEUS) (2003, 2007, 2013) to analyse financial risk protection Indicator selection Relevance|Quality |Availability of data Boerma 2014: 10.1371/journal.pmed.1001728

Results

Results

Results

Discussion Increase in service coverage, but remains generally low Significant inequalities in service coverage The incidence of catastrophic healthcare expenditure reduced over time, BUT it continued to disproportionately burden the poor Impoverishment increased over the same period UHC index low… Increasing access to services, without improvements in coverage of pre-payment health financing has the unintended effect of increasing population exposure to financial risk This underscores the need for countries to prioritize both dimensions of UHC: service coverage and financial risk protection

Recommendations Increase public financing of the health sector| currently 2.28% of GDP vs at least 5% recommended by McIntyre et al (2017) Scale up prepayment financing while reducing reliance on OOP| re-orient health financing strategy away from a focus on contributory health insurance, and instead use a tax funding mechanism Move away from passive purchasing, and adopt strategic purchasing of healthcare services: A systematic process for the development and updating of a harmonized benefit package that Kenyans are entitled to (July 2018) The country should prioritize and invest in the delivery of services though primary healthcare facilities and community health systems

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