Kenya: Increase Domestic Health Financing For a Healthy and Sustainable Healthcare System
In 2001 African countries met in Abuja and solemnly vowed to increase budgetary allocation to health to at least 15% of their total budgetary allocation. This was in response to the serious health threats that had been found to be curtailing the rate of economic progress in these countries. This declaration was to be later backed by the Kampala Declaration of 2010 and later the Abuja+12 Declaration of 2013. However, whereas some nations, notably Rwanda have fulfilled this obligation, most African nations including Kenya have not given unto Caesar what belongs to Caesar.
In the last budget, Kenya allocated a mere 5.7% of its total budget to health. This wasn’t even half of the Economic Recovery Strategy (ERS) target of 12% of total Government allocations. The meagre allocation to health hasn’t been helped much either by the devolution of key health functions to the forty seven counties. The devolution itself has brought to the forefront the poor prioritization by the lower level of government, the devolution of graft and fiscal irresponsibility manifested in the form of low absorption rate of county budgets and sheer disregard for the provisions of chapter twelve of the Kenyan constitution and the Public Finance Management Act 2012 (PFM Act).
Health is a critical sector in the development of any nation. In fact at independence, the government recognized hunger, disease and poverty as the main challenges bedeviling the young nation. Fast forward to 2015, new threats such as HIV/AIDS, Cancers, Tuberculosis, Ebola, respiratory tract infections have among others combined with the old communicable and non-communicable diseases that caused havoc before 1963.
Now, more than ever, Kenya needs to substantially increase her allocation to the ailing health sector. It’s no brainer that an increased funding for health brings higher economic returns. A healthy society will be instrumental if Kenya is to meet the demands of being a new middle income country. But investing in health isn’t just a solution for today. Investing in health means investing in the future. Young people who make up the bigger percentage of the population in lower and middle-income countries are disproportionately affected by these negative health indicators. Investing in their health today provides a unique opportunity to ensure a healthy workforce for the future with associated effects on future economic development.
More domestic funding also means greater country ownership and sustainability. Whereas external funders may chip in from time to time, the biting reality is that they will not always be there. Their priority may not always be our priority and at times, the oil taps may run dry due to political reasons or economic realities.
The Global Fund that was set up in response to the HIV/AIDS, Tuberculosis and malaria triple threats, identified Kenya among six priority African countries that were allocated a total of US$ 3.5 billion during the period to the end of 2017. This amounted to more than 15% of their combined annual Government health spending and about a third of the total Global Fund allocation to Sub-Saharan Africa. Just as external funders are dipping their hands deeper into the pocket, the Kenya government must, even with competing and pressing concerns like security and infrastructure, give unto health a significant proportion from the public coffers.
As we prepare to start a new budget cycle, both levels of government must start thinking about realistic targets that edge us closer to universal access to comprehensive healthcare service. Governments have to start thinking about financial prudency. Little things that matter like bulk buying to save costs. This should not be the time to erect new facilities as nearby health facilities stand idle- without health workers and essential drugs. This should be the time that counties spend money on their core mandate such as health and not on the national government functions like security or national roads. This is the time to rid our public of misinformation.
But increased domestic health financing will remain a mirage if the public do not demand that their leaders from the constituency, county and national level put sustainable mechanisms anchored in policies and legislations to ensure that a cervical cancer patient from Homa Bay county does not have to travel all the way to seek treatment at Kenyatta National Hospital in Nairobi. Patients on free ARVs at government facility must ask their leaders to ensure that the supply of such vital drugs is sustainable. Counties must factor in their health budgets the grim reality of the healthcare sector.
This loud cry will not be complete without a call for fiscal responsibility. It’s disheartening, for example that the proposed revised Commission for Revenue Allocation (CRA) formula seeks to reduce the percentage for fiscal responsibility from 2% to 1% instead of significantly increasing it. How for example will we reward a county that spends a huge percentage of its little money on operationalization of youth friendly centers and punish one that spends its 78 million shillings on tea and flowers?
Increasing domestic health financing isn’t just a technocrat’s agenda, it is Kenya’s agenda, it is the youth agenda!