This slides looks at the legal and policy bases for universal healthcare coverage in Kenya. It considers the manner in which the law and policy supports or hinders the attainment of UHC in Kenya.

1. Legal and policy frameworks for
UHC in Kenya: opportunities and
constraints
Prepared for the KMA@50 Annual Scientific Conference,
19th-21st April 2018, Nyali Sun Africa Beach Hotel & Spa,
Mombasa
MAURICE ODUOR

3. What does UHC entail?
• Access to necessary promotive, preventive, curative,
rehabilitative and palliative health services without
exposure to financial hardship (WHO, Health Systems
Financing: The Path to Universal Coverage, 2010).
Equity Quality
Financial risk
protection

4. Elements of UHC
Efficient well-run
health system
Health financing system
Access to essential
medicines and
technologies
Well-trained, motivated
health care workers
UHC

5. Legal bases of UHC
Dignity
• Preamble to the Constitution provides that
Kenya is committed to “nurturing and
protecting the well-being of the
individual”, and also, “the enhancement
of human rights”
• Human dignity forms part of the “national
values and principles of governance.”

6. • Human dignity is a core value in the human rights
framework-art article 19(2) provides that “[t]he
purpose of recognising and protecting human rights
and fundamental freedoms is to preserve the
dignity of individuals and communities and to
promote social justice and the realisation of the
potential of all human beings.”

7. • Human dignity is a right on its own –as set out in
art 28 of the Constitution: every person has
“inherent dignity and the right to have that dignity
respected and protected.”
• Dignity inures in human beings by virtue of that fact
alone: that they are human, period, with no
qualifications (art 19(3) “The rights and
fundamental freedoms in the Bill of Rights-(a)
belong to each individual and are not granted by
the State;”)

8. Health as a right
• Art 43(1)(a) “Every person has the right—(a) to the
highest attainable standard of health, which
includes the right to health care services, including
reproductive health care;” and…
• (2) “A person shall not be denied emergency
medical treatment.”
• Broad interpretation under international law
(ICESCR and GC 14)

9. Health Act (No 21 of 2017)
• Sets up a “national health system” s 3
• Defines obligations of the different players (national
government, county government, HCPs, users) (ss 4,
15, 20)
• Defines the components of the right to health (ss 5,
6, 7, 8, 9, 11, 14)

10. On UHC financing
• Health Act, s 86(1) “The department of health shall
ensure progressive financial access to universal
health coverage by taking measures that
include…”
1. Developing a national
health insurance system
2. Regulating all health
insurance providers
3. Developing policies and
strategies for UHC
4. Developing cost-sharing
mechanisms for public services
5. Defining public financing of
health care
6. Price controls for pharm and
non-pharm products
7. Developing a standard health
package

11. “The law is very clear….” Or not.
• Devolution: do we know what we have devolved?
National gov’t
1. National referral
health facilities.
2. Health policy.
County gov’t
County health
services, including,
in particular-
(a)county health
facilities and
pharmacies
(b)ambulance
services;
(c)promotion of
primary health
care;…

12. • Devolution of health was meant to be programmatic
taking a period of years
• Health was “parachuted” and landed on a ground
already peppered with inefficiencies…. AND with no
substantive legislation
• Counties were not ready (in one county, personnel
records were eaten by rats!)

13. The result?

15. Is the law any clearer? e.g. regulatory quagmire in
HRH
National institutional
framework on HRH
National Government
CS
DGH
Supervise
directorates:
(i) medical
services
(ii) nursing
(iii) pharm.
services
(iv) public
health
(v) admin
services
(vi) Any other
Provide
guidelines for
registration,
licensing,
certification, &
gazettement of
all health
facilities
Responsible for
internship for
health workers
KHHRAC shall
review policy and
establish uniform
norms & stds for:
(i) posting of interns
(ii) horizontal and
vertical HR transfers
(iii) welfare and scheme
of service for HCPs
(iv) mgt and rotation of
specialists*
(v) maintain master
register for all HCPs
In the counties
KHPOA
(i) Duplicate register
of all HCPs in the nat’l
& county health system
(ii) Promote & regulate rship
btw reg bodies
(iii) Coordinate joint
inspections with all reg bodies
(iv) Receive and facilitate resoln
of complaints from patients,
aggrieved parties and reg bodies
(v) Oversee all reg bodies and
ensure they don’t compromise stds
(vi) Arbitrate disputes btn reg
bodies, boards and councils
*Note: all specialists shall be treated as a
national asset (s 107(3))

16. County HRH institutional framework
County Executive
Governor
& deputy
CECM Health
Chief Officer
Health
County Public Service Board
County Assembly
County Assembly Speaker
MCAs
County Assembly committee
County Executive Department
for health s 19(1)
County Director
of health
Technical advisor
Unknownrelationship
CDH: functions
-technical advisor
on all health matters
in the county
-technical advisor to
Governor & CECM Health
-supervise all health
services in the county
-promote public health
CDH-functions
-prepare and publish reports
on county public health
-report to DGH on
public health issues
CDH-qualifications
-medical practitioner regd by MPDB(?)
-Masters in PH, Med or other related
-5+ years experience in
mgt of health services

17. The regulatory dung-heap
Before the HA
Internship
Practice
Registration,supervision,
regulation,discipline
Ministry
Statutory reg
bodies
(MPDB,
Nursing
Council,
PPB etc.)
After the HA
Internship
Practice
1. Ministry (CS)-s
15(g),(j),(l)-(policies
& s18
directorates)
2. s 14 complaints
3. DGH s16
4. KHHRAC s31
5. KHPOA s48
6. Statutory reg.
bodies (s 60(1) &
(2))
7. Health products
& technologies
(s62-67) (for
pharms)
1. Governor + CA
(policy and legn)
2. CECMH + Chief
officer
(implementation)
3. Public service
board
(recruitment)
4. s 14
complaints
5. s 20
facilitation of
regn, licencing
and accreditation
of providers and
facilities
6. Staffing in
marginal areas
National Gov’t
County Gov’t
Registration,
supervision,
regulation,
discipline
County Executive Dep’t
of Health
County Director for
Health (supervises ALL
health services within a
county)

18. • Do we know who does what in the context
of devolution?
• What do counties do?
• What implications does this have on the
quest for UHC?

19. So where are we?

20. The consequences of a lack of clarity:
buck passing

21. Focus on insurance for UHC
• WHO contemplates a whole range of
measures-where is our focus?
NHIF CURATIVE
SUSTAINABILITY?

22. Policies?
• Vision 2030
• NHP 2012-2030
• Big Four Agenda-UHC

23. • No shortage of law (despite its flaws)
• No shortage of policy
• Risk of haphazardness (e.g. 4b for insuring
high school students)
• Prioritisation

24. Thank you!
Interactive