Homabay County’s path to universal health coverage
By Lilian Kaivilu
In its Big Four Agenda, Kenyan government hopes to achieve affordable healthcare for all Kenyans by 2022 alongside improved food security, affordable housing and manufacturing. Lilian Kaivilu spoke to Professor Richard Muga, the Homabay County Executive member for Health on the measures that the county is taking toward universal health coverage in the county.
What is universal health coverage in simple terms?
Universal health coverage is the concept of allowing every citizen to access the basic package of healthcare. There are several packages of care. But the basic package is what we can call the human rights based care. This is where all citizens are entitled to immunization, disease prevention, safe delivery, screening to prevent diseases like cancer, receive information and be treated for malaria. UHC should deliver that basic care. Universal health coverage is a basic package that everyone in every household should access without any financial barriers.
In your opinion, what would be key drivers of universal health coverage in Kenya?
First, barriers to healthcare access are supposed to be removed. One of such barriers is financial burden and out of pocket expenses for the citizens. In order to attain UHC, all citizens, whether poor or living with a disability should have access basic healthcare. We also want to protect the children against ant form of violence. All these fall in the package of UHC.
Universal Health Coverage is one of the key areas of focus in the government’s Big Four Agenda. How are you addressing this at the county level?
We are targeting to have level Two and Three hospitals equipped with basic equipment to address matters of skilled delivery. We are also targeting level Four and Five health facilities to be able to have working theatres. Right now we have build theatres in all our sub counties, except one, and are trying to equip them. This is one way of making skilled delivery complete. It’s not enough to just train a just train a midwife.
Homabay county ranks highly in terms of maternal mortality. How are you addressing this?
I want to believe that the high maternal mortality rate in Homabay is partly linked to facilities that don’t function adequately and are unable to provide the total skilled attendants.
What do you mean by skilled personnel?
It is not just about the nurse. The blood pressure machine must be there. The anesthetist must be there. The ambulance must be there. All this, put together, is what we call skilled delivery. It is not just about the midwife or the nurse. The midwife, for example, can make a decision but when there is no way of transferring the patient to another point of care, then it is not skilled attendance.
We want to target Level 2, 3 and 4 hospitals to be properly equipped to offer skilled attendance then we can have referral hospital for serious cases. This, coupled with public education will take healthcare to a better level.
This is one of the high priority issues we have in our five-year plan in addition to HIV care. We are currently having a HIV prevalence rate of 26 per cent, which is the highest not only in the country but also in the region. This is not something we take pride in. We have just finished the county integrated development plan and in it we have targeted all these interventions for maternal child health challenges. Then we are going to develop the 5-year strategic plan for the department and we are currently working in the annual work plan.
Community health workers have been an important component of healthcare in Kenya and other countries. How do you plan to involve them in this entire process of improving healthcare in the county?
The only person who enters into a household to deliver health messages is a Community Health Volunteer (CHV). I have proposed the Community Health Services Bill to the county assembly. In the bill, we have created a pot and are asking any partner who wants to support CHVs to put money in that pot. The county government will also put money in that pot. From that pot we will be able to pay stipends to the CHVs for the time we have used them. If it is two or three hours, we will pay the CHV for that time. Then they can go about their other business the rest of the time. This is the mechanism I am proposing. If the bill is approved, we will set up the fund. We are hoping that partners will agree to put money to this pot.
Are there any specific partners you are working with in the process of achieving UHC for the county?
One key player in UHC is the National Hospital Insurance Fund (NHIF). Today in our county, we have set aside a budget line that includes talking to households to register in NHIF and have the elderly recruited. With Amref Health Africa and NHIF, we are working to have the elderly recruited in NHIF. The governor has accepted to pay premiums for those very poor households who cannot afford. We will work with Amref Health Africa and NHIF and other partners to move this. We believe once this is done, everyone in Homabay County should be able to access the basic package.
We are going to target the fisher folk. One tilapia is going for Sh800. This is able to pay for medical insurance for an entire household. I believe that we should go for such innovative approaches.
How about the very poor people who cannot afford to pay the Sh500 to NHIF every month?
For us to achieve UHC, we need to pay for the very poor households. Two weeks ago we signed a memorandum of understanding with NHIF and Amref Health Africa. I have already put in our budget for the next financial year, some seed fund which we are going to use to support the poor house holds. Every household pays SH500 per month. But NHIF has come up with modalities where one can pay in instalments as little as Sh50. The governor has already pledged to pay for 2,000 households in the county.
What will be your legacy in Kenya’s health sector, and especially in Homabay County?
I have been in the sector for long. I have decided to give back to our people since I was born in this county. I want to see that Level 2 and 3 health facilities are working. I am also working on a Level 6 in the county. When these are done and we have financing, I want to see that Homa Bay has attained at least 50 per cent of universal health coverage.