by Megha Rana
As mentioned in Part 2, a large portion of Kenyan healthcare financing comes from out-of-pocket (OOP) payments. OOP healthcare payments worldwide are estimated to push over 100 million people into poverty annually. Kenya can ill afford this – with a population of 25.5 people living at some level of poverty, this means a sick nation unable to reach its potential.
In fact, the economic burden that results from OOP payments is inversely related to income level. In other words, the poorest are often the ones who have the highest OOP fees, spending on average 10-15% of their budget for proper health. This is not only a form of catastrophic health spending (i.e., when the amount a household pays out of pocket is greater than the capacity of the share kept for healthcare purposes), but also creates several barriers to receiving proper healthcare.
Government spending on healthcare in Kenya is one of the lowest in Africa with only 9.1% of the government’s budget allocated towards the healthcare sector. This contrasts the 2001 Abuja Declaration on healthcare in Africa, that all governments must allocate at least 15% of their budget to healthcare sectors. In 2020, Kenya’s health expenditure per capita (i.e., the amount a country spends on health) was $83 or KES 11,806. This compares to Eygpt’s $151 or KES 21,478, Equatorial Guinea’s $237 or KES 33,711 and South Africa’s $490 or KES 69,698.
While other African countries are increasing their funding for the healthcare sector, Kenya is lagging. Although taxes and tax revenues are increasing (one Kenyan recently complained that soon the air will be taxed), the public healthcare sector is not benefitting. The political and economic danger here is if the poor and middle class are seeing less income because of increased taxes but still squeezed with OOP healthcare payments, the financial burden on those in need will only increase. Again, those needing care will not have the means to access it.
In essence, health equity can only be achieved in Kenya when there is a greater investment into healthcare sectors to provide support for those unable to care for themselves. An investment in healthy citizens means an investment in a healthy economy and greater political stability.
References:
https://www.who.int/data/gho/indicator-metadata-registry/imr-details/4989#:~:text=Catastrophic%20health%20spending%20occurs%20when,to%20pay%20for%20health%20care.
Chuma, J., Okungu, V. Viewing the Kenyan health system through an equity lens: implications for universal coverage. Int J Equity Health 10, 22 (2011). https://doi.org/10.1186/1475-9276-10-22
https://blogs.worldbank.org/africacan/remaining-ahead-curve-what-should-kenya-do-achieve-its-universal-health-coverage
Barasa, E.W., Maina, T. & Ravishankar, N. Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya.Int J Equity Health 16, 31 (2017). https://doi.org/10.1186/s12939-017-0526-x
Salari, Paola et al. “The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya, 2018.” BMJ global health vol. 4,6 e001809. 24 Nov. 2019, doi:10.1136/bmjgh-2019-001809
Mwenda, Ngugi et al. “What Drives Outpatient Care Costs in Kenya? An Analysis With Generalized Estimating Equations.” Frontiers in public health vol. 9 648465. 22 Sep. 2021, doi:10.3389/fpubh.2021.648465
https://www.who.int