Universal Health Care (UHC) remains a key priority of the national and county governments in Kenya. The country aims to ensure that “all Kenyans have equitable access to safe, quality, and affordable health services” by 2030. In 2018, the country began piloting its UHC program—a part of the Big Four Priority Agenda of His Excellency—in four sub-national governments (Machakos, Isiolo, Nyeri, and Kisumu counties).
Nyeri, one of the four pilot counties, with a population of 759,164 has a high burden of non-communicable diseases with an estimated two out of three deaths resulting from non-communicable diseases that contribute to 55 percent of all hospital admissions. The county, however, has among the lowest maternal and infant mortality rate in the country with 67 maternal deaths per 100,000 live births and 28.3 infant deaths per 1000 live births, both indicators of which are within the targets of Sustainable Development Goal 3.
Nyeri county implemented the UHC pilot program in three key phases. In the first phase, critical enablers for successful implementation of the program were strengthened including building or renovating existing infrastructure, strengthening primary and community health systems, ensuring all health facilities had access to clean water and electricity, sufficient staff and equipment, and establishing appropriate legal and financial frameworks. One of the key outputs of this phase was the establishment of 251 community health units, the selection of 2,510 community health workers (CHWs), and the training of the CHWs on basic community health services and prevention and control of non-communicable diseases.
Director of Health Services, Nyeri County, Dr. Nelson Muriu
In the second phase, residents of Nyeri were registered with the National Health Insurance Fund to facilitate access to ”free” health services. Through the exercise, 86% of the county’s population was successfully registered, which meant that all Nyeri UHC-registered residents could access free health services from any public health facility in the County. In the third phase, funds were disbursed from the national government to the county governments and hospitals to enable them to deliver their objectives of increasing access to affordable healthcare services for all its residents. The four pilot counties received KSh. 3.1 billion, of which 72% was spent on the delivery of basic and specialized care services, 15% on health system strengthening, 12% on community health services, and, 1% on public health services.
The implementation of the UHC pilot program successfully increased access to healthcare. However, the implementation experienced challenges such as understaffing, long patient waiting times, and increased workload resulting in reduced quality of patient care, underutilization of primary health facilities, and partial financial protection.
CHW in Nyeri – Courtesy of The Star newspaper
The pilot program also showed that there is a need to reorient the health systems towards Primary Health Care with a skilled health workforce that leverages CHWs and is responsive and accountable to communities. The role of CHWs in achieving critical global health objectives, including Universal Health Coverage is noted by the Director of Health Services, Nyeri County, Dr. Nelson Muriu: “CHWs can help achieve universal health coverage as they represent a useful puzzle in the health system. They are an essential workforce in the provision of preventive and promotive health care services at community and household level.”
Financing Alliance for Health (FAH) has deliberately partnered with Nyeri county to achieve Primary Health Care goals and objectives. With FAH’s support, the county has conducted a situational analysis of Nyeri County community health services to develop a costed implementation plan and an investment case and mobilize resources for community health. Investment in CHWs has been shown to have a positive return on investment—a return of US$ 10 for every dollar invested in sub-Saharan Africa—from increased productivity, preventing and containing health crises, and increased economic benefits from employment resulting in long-term sustainability.
As we rally for Universal Health Coverage, Financing Alliance for Health stands with partners globally to advocate for global leaders to invest in strengthening Community Health Systems, as this is imperative for citizens all over the world to attain the highest standard of health.
About FAH: We are a partnership that works primarily with African governments to develop and implement sustainable financing strategies for primary and community health systems that operate at scale. We partner long-term with the Ministries of Health and Finance to develop diverse and fit-for-purpose financing sources demonstrating the health, social and economic impact of adequately funded community health systems.