User fees threaten universal health plan
- Reducing out-of-pocket payments for health services is particularly important as they have been shown to not only present a substantial barrier to accessing health care, but also subject households to financial hardship.
- The inclusion of UHC as one of the “Big 4 Agenda” for the second term of the current administration signaled the country’s political commitment to better health.
To move towards universal health coverage (UHC), countries need to expand priority health services, include more people, and reduce out-of-pocket payments.
The reduction in out-of-pocket payments for health services is particularly important given that they have been shown to not only represent a substantial barrier to accessing health care, but also subject households to financial hardship and plunge. many people in poverty.
The inclusion of UHC as one of the “Big 4 Agenda” for the second term of the current administration signaled the country’s political commitment to better health.
However, President Uhuru Kenyatta’s administration has been implementing UHC reforms since the start of his first term in 2013.
These include the removal of user fees in public primary health care facilities (health centers and dispensaries) and the introduction of free maternity services (Linda Mama).
This also includes the expansion of services covered by the National Hospital Insurance Fund (NHIF), and of course the pilot and planned extension of the CSU.
Among these reforms, the removal of user fees to make point-of-care services free in public health centers and dispensaries has perhaps been the most impactful of these reforms.
Indeed, these health facilities have a wider geographic reach, primary health care services reach the greatest number and catch diseases before they get worse, thus promoting both equity and social security. health system efficiency.
Data from the Kenya Household Expenditure and Use Survey series show that catastrophic health cost incidents are lower for people who use these health facilities.
This key reform of UHC is, however, potentially threatened for two main reasons. First, counties will no longer receive the waived conditional grant for user fees.
Conditional grants are additional resources allocated to county governments from revenues collected at the national level or in the form of loans and grants from development partners to support national priorities and strengthen county functions.
The conditional grant waived on user fees provided earmarked funds for counties earmarked for health centers and dispensaries to replace user fee revenues.
Second, a major donor, the Danish International Development Agency (Danida) is planning to phase out funding for health centers and dispensaries in Kenya, exposing these health facilities to severe resource constraints.
Danida has provided on-budget funding to support the operating and maintenance costs of health centers and dispensaries since before decentralization.
Danida plans to reduce its support to primary health care facilities by 25% each year starting in fiscal year 2021/22 and fully withdrawing over the next three years.
Their exit is in line with donor transition trends as countries move to middle income status. The conditional grant foregone national government user fees and donor funds are the main sources of income for health centers and clinics.
In the absence of these funds, and unless alternative financing mechanisms are devised to replace these funds, counties will have no choice but to reintroduce user fees at health centers and dispensaries. .
Such a move will reverse gains made in expanding access to primary health care services and protecting Kenyans from financial disaster.
This will have a negative impact on the health of the population as individuals forgo health services due to the financial barrier and will also lead to impoverishment of households.
Simply put, if counties reintroduce user fees at health centers and dispensaries, all gains made in favor of UHC will be reversed. It will really be several steps back, after an important step forward.
To prevent this potentially catastrophic outcome, it is imperative that the National Treasury, Department of Health, and county governments develop and implement an effective framework for funding primary health care.
Such a framework should guarantee funds earmarked for health centers and dispensaries to cover the operating costs of these establishments.
To address this problem, the conditional grant framework should include the waiver of user fees as one of the county conditional grants.
Second, county governments should urgently develop donor transition which outlines how they will gradually replace donor revenue sources as donors stop supporting them.
Such a plan should identify other sources of funding, but also explain how the county’s existing funds could be redefined as a priority and used more effectively to avoid the erosion of gains made in the health sector as the health sector evolves. donor transition.
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