Devolution of Public Health care Services in Kenya and its Implication on Universal Health Coverage

Abstract

-Quality and affordable health services at a health facility and access toward the same by those who need continue to be pursued by Kenya government as progress towards achieving Universal health coverage. The government has over the years endeavored to provide a strong, efficient and a well-run health system with sufficient capacity of well-trained, motivated health workers and a system for financing health services. This is evidenced in the various policies and strategies including devolution of public health care to county governance units. In the paper, an empirical analysis is undertaken to provide situational analysis on how these initiatives particularly has impacted on universal health coverage in terms of health equity concerns of access, quality of care, distribution of health resources including health workers, finance and infrastructure, among others. To accomplish this, both primary and secondary data were collected. Whereas secondary data was collected from published documents and reports, primary data was collected through in-depth interviews with key stakeholders. The analysis reveals government commitment towards universal coverage through increased revenue allocation in absolute terms, pooling of resources, investment in both health infrastructure and personnel over the years, that is, however uncoordinated and unplanned. Others findings include cases of health inequity in terms inadequate health facilities; lack of comprehensive investment plans; stock-outs of drugs and other medical supplies, inadequate skilled and skewed distribution of the health workers, catastrophic health spending, limited solidarity in financing of health care. Other equity concerns relate to inadequate and dilapidated health infrastructure, skewed distribution of health resources, disease burden, and differences in health outcomes across the country. Various recommendations are made including concerted efforts towards solidarity in health care financing, political will towards the development of a comprehensive health sector investment plan, revising and implementing the infrastructural norms and standards; fast tracking the enactment of Health Act; Procurement Bill for drugs and pharmaceutical supplies. Other recommendations include enforcement of standards in the public health sector with respect to infrastructure, human resource, skills and supplies, civic education for all for purposes of enforcement demand for quality care; and finally, enhance the pharmaceutical management information system for purposes of proving accurate and reliable evidence based information for estimation of Essential Medicines and Medical Supplies needs and well as enhancing quality assurance and quality control activities.