Ailing hospitals risk President Ruto’s new health insurance plan

President William Ruto’s administration is walking a tightrope in the delivery of quality and affordable healthcare that was used as a justification for the looming monthly deductions that will be getting at least Sh133 billion annually amid poorly equipped public and private hospitals.

Kenyans may as early as March start parting with 2.75 percent of their gross monthly income to fund the Social Health Insurance Fund (SHIF) which promises a generous package to respond to primary healthcare, emergency, chronic and critical illnesses.

SHIF, which is replacing the National Health Insurance Fund (NHIF), that has served Kenyans for more than 57 years, is even promising to fly Kenyans overseas in cases where treatment sought is not available locally.

All that will be expected of Kenyans to enjoy these health services is to get registered as SHIF members and contribute the required amount every month. The government estimates that this is going to cut out-of-pocket spending on health from about 24.3 percent to less than 10 percent.

However, findings of the study commissioned by the Ministry of Health (MoH) and the Kenya Medical Practitioners and Dentists Council to assess the situation of hospitals in the country, cast doubts on whether Kenyans will be able to enjoy these services unless the government builds new facilities, equips existing ones and hires more personnel.

“Once Kenyans have insurance coverage and are empanelled to a primary care network, there’s a need to ensure that the care they access in health facilities is of the highest quality possible at each level,” recommends the study.

The facility census study carried out last August and findings published in December offer worrying findings on the availability of services being promised by the government in hospitals, with many lacking enough healthcare providers and the necessary infrastructure.

Of the 16 basic outpatient services checked by MoH, including minor surgical services, immunisation and basic laboratory tests, only two per cent of the 12,384 health facilities surveyed were offering all 16 services.

“The readiness to offer basic outpatient services, defined as having all the necessary personnel, equipment and infrastructure requirements to offer a specific health service, was at seven percent,” says MoH.

The 12,384 health facilities represented 86.2 percent of all the 14,366 public, faith-based organisations and private health facilities from across all counties in Kenya whose details were available on the master health facility list.

The findings suggest that Kenyans will struggle to access basic outpatient services for their enhanced monthly insurance premiums unless the government invests in equipping hospitals to be able to deliver the full package that was used to justify the looming increase in health insurance premiums.

Setting in of enhanced monthly contributions without addressing these gaps will see many Kenyans continue to struggle to access healthcare despite entitlement to a buffet of preventive and curative outpatient services such as consultation, diagnosis and treatment in both general and specialised clinics and drug prescription, administration and dispensing.

Less than half of the hospitals in the country were offering maternity services with only a third of the facilities providing emergency obstetric care, according to the study. The study also shows only 40 percent of hospitals offered blood transfusion services while only 54 percent of the facilities had a source of oxygen.

The MoH study also established that more than half (51 percent) of hospitals in Kenya have no access to functional ambulances, meaning that Kenyans will struggle to access the ambulance and evacuation services promised under the emergency services.

“Availability of emergency services in the country is at a precarious state as indicated by the census. For instance, only 5.8 percent of all facilities had an accident and emergency unit while 49 percent of facilities had access to an ambulance,” said MoH.

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A third of those with access to an ambulance could only access a basic life support ambulance. The study recommends that arrangements should be made for all facilities to access an ambulance, even on a contract basis to facilitate an efficient referral process.

Access to newborn health services in the country was low at 12 percent, with MoH, stating that this impacts negatively maternal and newborn health outcomes and is a barrier to improving the quality of care during and after delivery.

The government will have to invest in equipment, supplies and human resources to deliver both basic and comprehensive maternity services and newborn care, including buying vacuum extractors, and resuscitates and investing in oxygen sources.

Dr Ruto’s administration will also struggle to make true the promise of delivering critical care services, including the intensive care unit (ICU) and high dependency unit (HDU). MoH study found that only 1.8 percent of the surveyed health facilities offered HDU services while just 1.3 percent can help patients requiring ICU services.

“Investments in critical care services should be scaled up, especially in public facilities in consideration of the proposed chronic diseases fund, so that once established, patients can access quality critical care services within acceptable cost,” says MoH.

The ministry found that just slightly more than half (57 percent) of facilities were providing pharmacy services, with only a small proportion (six percent) having the full basket of tracer medicines. Some 15 percent had tracer non-pharmaceutical supplies.

Tracer essential medicines are drugs, which fully fulfil a population’s health requirements and ought to be always available to allow for a properly functioning health system all the time.

Having many hospitals without drugs means many patients with insurance cover are likely to continue with out-of-pocket spending to buy drugs, lowering the expected outcomes unless the Kenya Medical Services Authority is properly funded to supply drugs.

‘Investments need to be scaled up at Kemsa to ensure 100 percent availability of all tracer drugs and non-pharmaceutical supplies in all health facilities. This would prevent the inconvenience experienced when patients have to buy drugs and non-pharmaceuticals especially while admitted,” says MoH.

Renal services were available in only two percent of facilities, with only less than half (42 percent) of facilities providing renal services having all the necessary equipment, services and infrastructure. This means patients with renal failure will struggle to access services.

Investments in such services and equipment will also have to be matched with aggressive recruitment of health personnel including doctors and nurses. MoH, has been flagging off such personnel to go and work overseas but admits Kenya is also in need.

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‘Health workforce was inadequate and below the WHO recommended norms per population. This could have a negative effect on access to quality health care and more so for understaffed cadres such as dental and pharmaceutical staff,” says MoH.

‘Human resources should be revamped in the primary facilities as this presents a threat to the delivery of UHC. Each facility should have (in addition to a nurse), at least a clinical officer/medical officer and a laboratory.”

From the census, the density of facilities in several counties was wanting with one facility for every 10,000 compared with the national average of 2.4. This means that Kenyans have to travel far to access the health facilities or they have to wait for long to get the services due to overcrowding.

The study also found that only 40 percent of the surveyed facilities were accredited with NHIF, with only 10 counties having more than half of their facilities accepting NHIF. This means SHIF will have to accredit more health facilities, many having resisted NHIF over recurring delays by the government to settle claims.

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