PHM-Exch> Global Health Check: alternatives for health care financing

[Claudio Schuftan]

Dying to live: Kenya’s search for universal healthcare
<http://www.globalhealthcheck.org/?p=1407>
Posted by Tabitha Mwangi <http://www.globalhealthcheck.org/?author=47>
excepts
http://www.globalhealthcheck.org/?p=1407<http://globalhealthcheck.us5.list-manage.com/track/click?u=1cf4b203990bc28d05e9f0295&id=360ad40401&e=8990abdd17>

The question of how to raise domestic revenue for health is something that
policymakers across Africa continue to grapple with. In recent decades
different options have been tried and tested –user fees, small-scale
community based health insurance, private insurance schemes, and taxation.
Today Kenya, like many countries in the region, is left with a complicated
patchwork of different schemes offering different levels of coverage to
different population groups. Merging these into a single national risk pool
which uses public financing to provide for all citizens will improve access
to healthcare and reduce administrative costs.

One way of raising more money for health would be to introduce an earmarked
tax on diaspora remittances. “According to the Central Bank of Kenya, money
remitted by the diaspora is growing monthly,” says Dr Jane Chuma, a health
economist and senior research scientist at Kenya Medical Research Institute
in Kilifi. “Last year, over $1 billion (Sh85 billion), higher than the
revenue earned from coffee or tourism, was remitted to the country. Putting
a little levy on foreign transactions could raise significant money for
health. In 2009, Gabon raised $30 million (Sh2.6 billion) from diaspora
remittance tax, which they put into health care.”

Another option is to merge existing funds to create a single National
Social Health Insurance Fund which pools all the resources that are
currently available for health into one pot and stop the duplication of
effort. “Tax funds allocated to health, NHIF contributions, community
health insurance schemes and donor money, if pooled together, can create a
large enough single pool. This will ensure that both the rich and the poor
are covered while reducing administration costs. As there will only be one
organisation buying services, it will have bargaining power.”

There was some discussion about starting a National Social Health Insurance
Fund in Kenya. It was passed by Parliament but the president did not sign
it. ‘The big boys’ ‘shot it down’ including private health insurance
schemes and private hospitals.

What Kenya needs are leaders who are willing to put the private sector to
task.  What we lack is political will and leadership.

Whatever the means of raising money, people need to be confident that the
money will not be misused. With corruption there is little trust in the
public.

Public health facilities need to be closer to the people, be well equipped
and charge no fees. In this way, each citizen in the country will be able
to walk into any health facility, get whatever treatment is required and
walk out without paying a shilling. However, removing charges alone will
not be enough to keep patients coming. The public health facilities have to
be fully staffed and well stocked with medicines. It is not enough, for
example, to say that giving birth at a maternity ward is free and then
expect mothers to buy gloves, cotton wool and drugs because there are none
available at the facility.
To reduce costs of payments for treatments, the government will need to
invest heavily on preventive measures to reduce the heavy burden of
infectious diseases. At the moment more money is going to curative rather
than preventive health care. Providing safe water and improved waste
disposal is key. The provision of essential vaccines and use of
insecticide-treated bed nets are key as well.

Politicians make appealing promises during campaigning. The situation is
urgent, as annually, about 1.5 million Kenyans are pushed below the
national poverty line due to health payments.

*Tabitha Mwangi is a freelance science journalist based in Kenya. Her
articles have appeared in The Daily Nation and The East African. She has a
PhD in epidemiology and worked in the Kenya Medical Research Institute for
10 years before becoming a writer.*
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