Universal Health Cover or Care – Which Should We Do First?

Universal Health Cover or Care – Which Should We Do First? This is a naive concern that many Kenyans share and with a good reason too. Healthcare is a public good that should be available for all Kenyans. Given the public’s concern about health care in Kenya, best health care everywhere is an aspiration of Kenyans as enshrined in the constitution.

Internationally “Universal Health Care Coverage” is a big concern. It is not just an SDG goal, vision 2030 goal but it is one of the Agenda Four of the Jubilee government of Kenya’. It is along this that the Jubilee government of Kenya has set out to fulfill universal health care coverage by the year 2022.

Big 4 Agendas flagship include affordable housing, universal healthcare, food security, and manufacturing. Borrowed from SDGs Vision 2030:

United Nations’ Sustainable Development Goals – SDGs (Assembly UG. Transforming the World: The 2030 Agenda for Sustainable Development. , 2015) which calls for member states to:

  • Goal No. 1: End poverty in all its form;
  • Goal No. 3: Ensure healthy lives and promote well-being for all ages including universal health coverage (UHC) by 2030;
  •  Goal No. 4: … promote life-long learning for all
  •  Goal No.10: Reduce inequality within the country
  • Goal No. 16… promote inclusive societies for sustainable development.


Kenya’s Vision 2030 aims at creating “a globally competitive and prosperous country with a high quality of life by 2030”. It states that Kenyans shall have affordable and quality healthcare for healthy and productive citizens. Health care is a sound investment in human capital for any country.

Realizing these ambitious goals will require both political will and the know-how among care providers on-the-ground among other requirements.

Universal health coverage is defined in the World Health Report, 2010 – ‘all people with access to needed health services’, ‘quality’, ‘does not expose the user to financial hardship’.

UHC covers six technical areas: Primary health care access, quality health care, provider payment, population coverage, information technology, health financing. It’s going to be a futile task addressing the cover (health financing, population coverage, access and provider payment) and sideline quality care. Quite a lot goes into the quality care concept and it is the rider that the private hospitals thrive on. 

let’s get the Great agenda out of  ‘on paper’. Benchmarking is not good enough, that is still lab work (in vitro). Let us drive it on the hard surface, where the rubber meets the road. Kenya’s health system.

We must ask hard questions.

The big question most people were asking is – How do we make universal health care for all Kenya a reality? In the words of one nurse, ‘the ultimate aspiration ought to be universal health care for all patients (as well as for care providers themselves) and not just universal health cover’.

Maybe we just start with the cover, the care will follow suit. Can we have the universal cover which is devoid of universal care? Your guess is as good as mine. The answer is a resounding Yes! To be fair I feel cover should come first.

Makueni Governor Kivutha Kibwana, who has been able to implement a form of universal coverage in his county explained that all it took was doing the math.

“It’s actually very simple. We did the math: How many people come to pay in hospitals and how much do they pay? Suppose we take the 162,000 households and divide the amount? We found that if every household paid Sh500, we would be able to get the money that everybody pays when they come to our facilities. Through that we have 70 per cent coverage,”

This blog has tried to address some of these questions.

1. Were health care costs provider induced and not client demanded? Please follow the link

2. rising care costs in Kenya and how to cure the insanity. Please follow the link

3. Were health care costs in Kenya driven by an insatiable demand to make more profit or there was more? Please follow the link

4. Showcasing concern for health care costs in Kenya. Please follow the link

5. Bring your hospital bill up to date by interrogating it.  Please follow the link


Next, we will be looking at the concept of universal care (not just the cover). Meanwhile, what can we learn from Cuba next? Why Cuba?

Kenyans want to see if the Cubans can make them  at least realize their right to health. This right was contested vis a vis labour rights of health care workers  in much of 2017.

Quote link  KNHCR  dated 2016‘… the sector is slowly degenerating further into a ‘no-access’ to healthcare at all let alone the quality of services offered. It is disturbing to see patients in dire need of treatment lying desolate on waiting benches in county hospitals. It is equally moving to see frail patients, some carried on wheelbarrows because they could not afford ambulance charges being turned away’.

Kenya has yet to come up with a comprehensive health workforce strategy with detailed norms and standards yet we know that human resources for health (HRH) is among the biggest headaches for the nation now. Shouldn’t we have addressed this matter before embarking on UHC?  Even the best intentions might not fix our health systems unless they deal with this. UHC  presents an important opportunity to sort out the HRH mess.



Drawing courtesy of clip developer

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