Universal Health Coverage isn’t mere policy—it’s the slap of reality when a mother’s insurance is rejected, an old man in pain but no cash…the daily hustle to ensure healthcare isn’t just for the lucky—or the loaded.
As a pharmacist in a busy private hospital in Kenya, I witness firsthand, on a daily basis, the stark realities of our messy healthcare system. It is worse in rural clinics where heartbreaking truths are a choice between buying maize meal or medicine.
I remember old Mama Zipporah, her hands trembling as she counted coins, just enough for a handful of sukuma wiki or her crucial blood pressure pills. Her tear-filled eyes spoke volumes about the impossible calculus poverty imposes.
Then there was the young man, still bending his early 20s, who came to my counter with a prescription of antibiotics from a county referral hospital. He looked pale and frail. Must have been a severe infection. I told him the cost, and his face just fell. He fished out all the notes and coins in his pocket, barely a third of the bill, and pleaded for a few doses for one or two days. “I will look for money to come back for the rest,” he promised, his voice trembling, fingers fidgeting.
These aren’t abstract problems, but real faces of quiet desperation. Addressing this ethical and developmental imperative demands integrated solutions that reach into the heart of these communities.
To me, Universal Health Coverage (UHC) isn’t just a policy—but the real pain of a mother whose medical insurance is rejected, the heartbreak of the penniless elderly patient being turned away, and the daily fight to make sure everyone has fair access to the care they need.
The Kenya Harmonized Health Facility Assessment (KHFA 2018) report exposed Kenya’s urgent need for health governance reform to achieve UHC, while the 2020-2030 UHC Policy outlines a potential solution, but will these plans actually deliver?
Firstly, robust and effectively targeted social protection programs like Inua Jamii initiative, are crucial, but they must explicitly consider healthcare needs. Imagine these funds being sent via mobile money with a portion for local clinic vouchers – a direct lifeline connecting sustenance and health, preventing families from emptying their cooking pots for crucial medication.
Critically, our dedicated community health workers, already trusted pillars, must be empowered as “health and nutrition navigators,” linking families to clinics, agricultural support, and nutritional guidance – a holistic approach to well-being.
Improving access to affordable medicine in remote areas through innovative solutions like mobile dispensaries and leveraging technology for efficient stock management is vital.
Finally, the long-term answer lies in empowering communities economically. Imagine agricultural cooperatives receiving government support to improve yields and access markets, breaking the cycle of poverty that forces these agonizing trade-offs?
Making UHC work in Kenya requires evidence-based approaches and understanding what blocks healthcare access. This means creating clear implementation plans with timelines and responsibilities at national and county levels besides tracking progress using measurable indicators.
The uneven availability of essential medicines across regions shows why this matters.
For instance, some counties have reliable supplies of important drugs like for diabetes and high blood pressure, while nearby counties often run out, forcing patients to buy expensive alternatives. We need a national digital system to track stocks in real-time at all healthcare facilities, with transparent purchasing and regular checks. This would help turn policies into actual medicines for patients.
Adequate, sustained funding and transparent financial management are also essential. Policies, however well-intentioned, require budgetary allocations that reflect their ambition.
A significant portion of healthcare expenditure in Kenya remains out-of-pocket, directly undermining the goals of UHC. Like a family struggling to pay for physiotherapy after a stroke, even when hospital care was partly covered.
We thus need bigger health budgets-devoid of corruption, especially for primary and outpatient care. Ghana’s National Health Insurance Scheme, funded by a dedicated health tax, offers useful lessons in sustainable health financing.
Kenya must urgently train more healthcare workers, especially specialists for rural areas, and improve incentives and working conditions to address critical shortages that leave patients travelling far to overburdened facilities.
A recent experience at my counter had this worried elderly patient needing a heart medication refill, but couldn’t remember the exact dosage. Thanks to our digital health records, I instantly pulled up their medical history and got the right pills—no guesswork, no delays. This is why Kenya needs one unified national health database: to give every medic instant access to patient histories, preventing errors and saving lives.
Empowering communities and ensuring their active participation is also essential for the relevance and sustainability of UHC. See, many Kenyans are disappointed when they visit a Level 5 or Level 6 hospital, expecting comprehensive care under UHC, only to be told the Social Health Authority (SHA) primarily covers inpatient services and not their outpatient needs, such as managing chronic conditions or routine check-ups.
This exclusion creates immense frustration and undermines trust in the UHC promise, often forcing individuals to forego necessary preventative care. This contradicts the principle of universal access. Addressing this requires clearly articulating the scope of services covered at different levels, while the exclusion of outpatient services at higher-level facilities warrants careful review to ensure equitable access at all levels.
Kenya’s UHC system mixes public, private and SHA-funded care—a promising but messy reality. While this hybrid model could combine the best of all systems, current gaps block equitable healthcare access.
The core problem? Primary healthcare (PHC)—the backbone of UHC—gets starved of funds and staff, especially in rural areas. Budgets favour big hospitals over local clinics, leaving PHC centres short on medicines, doctors, and working equipment.
Result: Patients flood referral hospitals with treatable conditions, overwhelming the system, all because their nearest clinic lacked basics.
Expanding mandatory health insurance with targeted subsidies for low-income and informal workers will help achieve fair healthcare access for all Kenyans. Rwanda’s community-based health insurance offers a useful model to learn from. Insurance benefits should be revised to cover more essential services based on actual health needs.
We must limit co-payments and fees in public hospitals, especially for vulnerable populations who cannot afford them. Stronger regulation of healthcare quality and pricing across both public and private sectors is essential for protecting patients, and regulatory bodies thus need more authority to enforce standards.
Achieving UHC requires collaboration across all sectors, committed leadership, and a determination to ensure every Kenyan can access healthcare without facing financial ruin. This calls for better governance through parliamentary oversight, financial transparency, and strong anti-corruption measures to ensure resources reach those who need them most.
As a pharmacist, I’ve seen how clear protocols and transparency ensure patients get crucial medicines, but when bureaucracy, corruption, selfishness, or poor coordination dominate, the system fails. Patients suffer from medicine stockouts, forcing expensive private purchases.
Many travel between facilities seeking unavailable diagnostic equipment, lab reagents, or qualified professionals.
UHC is achievable in Kenya, but requires more than policies. We need a fundamental mindset shift from illness treatment to health promotion via citizens taking ownership of their health through lifestyle changes. This should be buttressed by the government prioritising access to quality healthcare for all, regardless of income or geographical location.
Dr Madeline Iseren is a Pharmacist.
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