The 58th World Health Assembly urged member states to ensure that “health-financing systems introduce prepayment mechanisms for the health sector, with a view to sharing risk, avoid catastrophic health-care expenditure and impoverishment of individuals as a result of seeking care” (WHO). The 2010 World Health Report identified the vital role of health financing in achieving universal health coverage (UHC). Health care financing has three interrelated functions namely: (i)revenue collection- process by which health systems receive money from households and organizations; (ii) pooling- accumulation and management of revenues to ensure that the risk of paying for health care is borne by all the members of the pool; and (iii) purchasing- pooled funds are paid to providers in order to deliver a set of health interventions on behalf of the population for which the funds are pooled.

The WHO identified four key elements necessary towards the realization of universal coverage:

  • A strong, efficient, well-run health system.
  • A system for financing health services.
  • Access to essential medicines and technologies; and
  • A sufficient capacity of well-trained, motivated health workers.

The Government of Kenya (GoK), with support of various stakeholders, has over the years, initiated policy reforms and strategies earmarked towards improving the health of its citizens. Its commitment is outlined in policy documents such as Kenya Health Policy Framework (KHPF 1994–2010), Health Sector Strategic Plans, Vision 2030, Constitution 2010, and the Health Act No.21 of 2017. The Government further provided a legal framework for ensuring a health care delivery system that is driven by the people while bridging the gap on geographical access by providing for a devolved system of governance. These efforts can be seen to contribute towards universal health coverage for the populace in the country.

The Government has also made strides in promoting access to comprehensive health care services to its people. Kenya adopted UHC as one of the big four priority agenda by His Excellency the President, with an aspiration that by 2022, all persons in Kenya will be able to use the essential services they need for their health and wellbeing through a single unified benefit package, without the risk of financial catastrophe. The UHC program was piloted in four (4) counties: Machakos, Nyeri, Isiolo and Kisumu, and has provided the Ministry of Health (MoH) and County Governments key lessons to roll it out to the rest of the country.

Despite efforts made by the Government, the country grapples with a high disease burden. Although communicable diseases, maternal, neonatal, and nutritional conditions have been leading causes of Disability Adjusted Life Years (DALYs) in Kenya in the past, non-communicable diseases (NCDs) and injuries are increasingly becoming an important contributor to the disease burden and represent the leading DALYs among adults. For example, while HIV contribution to the burden of disease has decreased by 61% in the period 2005-2016, the combined contribution of ischaemic heart disease and cerebrovascular disease has increased by 57% in the same period (MOH, 2018). Generally, NCDs account for 50% of hospital admissions, 55% of hospital deaths and 33% of total deaths in the country.

The proposed assignment is part of Non-Communicable Diseases Alliance of Kenya’s (NCDAK) effort to comprehensively address NCDs in the country by analysing the status of UHC and inclusion of NCDs in UHC in Kenya. The NCDAK is working towards developing a policy brief that will steer its participation in the development of the UHC framework in Kenya. The development of the policy brief will be achieved by undertaking thorough review of the UHC performance reports in the four pilot counties; MoH policy framework around UHC; global best practices on UHC and experiences of people living with NCDs (PLWNCDs) relating to access to health care, essential drugs and commodities. This assignment aimed to develop a UHC policy brief that will provide strong recommendations towards the development of the Kenya UHC framework.

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