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

2. 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

3. 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

4. Kenya has committed to achieving UHC by 2022

5. 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

6. 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

7. 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: /journal.pmed

9. Results

10. Results

11. Results

12. 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

13. 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

15. THANK YOU
@HERU_KEMRI_WT