Kenya’s President, His Excellency Uhuru Kenyatta has committed his government to attaining the “Big Four” agenda on 1) Food security, 2) Affordable housing, 3) Manufacturing, and 4) affordable healthcare for all by 2022. This agenda is linked to Kenya’s Vision 2030 which sought to achieve Universal Health Coverage (UHC) by 2030 as part of the social pillar which seeks to maintain a healthy and skilled workforce necessary to drive the economy, and ultimately creating a healthy, productive, and globally competitive nation.
To this end, the Government of Kenya, through the Ministry of Health, is testing out health financing reforms in 4 of its 47 counties from December 2018 to December 2019: Isiolo (pop. 184,768), Kisumu (pop. 1,182,320), Machakos (pop. 1,216,120), and Nyeri (pop. 830,296). At the same time, health systems strengthening activities will be undertaken in the other 43 counties in anticipation of scale-up reforms and lessons learned from the pilot phase.
The Government of Kenya and the Thai Government have been engaging on UHC over the past year. One of these engagements is through the collaboration between the Health Intervention and Technology Assessment Program (HITAP), a semi-autonomous research unit in the Ministry of Public Health, Thailand, and the Health Economics Research Unit at the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme (KWTRP). Both HITAP and KWTRP are core partners of the International Decision Support Initiative (iDSI); a global network of health, policy and economic expertise, which supports countries to make decisions about how to spend money on health services more efficiently and enable them to achieve UHC and the health Sustainable Development Goal (SDG 3).
The collaboration between the two programs resulted in a study visit in November 2018 for MoH staff and some members from the Kenya Health Benefits Package Advisory Panel (HBAP) which has been tasked with developing a benefits package for UHC. Through the visit, the HBAP aimed to learn about the Thai health system and how to integrate evidence into decision making drawing on the example of the HITAP in the Ministry of Public Health, Thailand.
The study visit was followed by an official visit by Kenya’s Cabinet Secretary for Health, Honorable Mrs. Sicily Kariuki accompanied by members of the health committees of the Kenyan Parliament and officials of the Kenyan Ministry of Health that coincided with the 2019 Prince Mahidol Award Conference. The collaboration between the two countries on UHC matters was formalized through the signing of a Memorandum of Understanding (MoU) on February 1st, 2019. A visit to Kenya to gain an understanding of the Kenyan context and help in actioning the MoU was also planned and on 18th – 23rd March 2019, Thailand’s Minister for Public Health, Prof. Emeritus Piyasakol Sakolsatayadorn, delegates, and a technical team travelled to Kenya.
5-Days of: capacity building, stakeholder engagements, UHC advocacy, and site visits in Nairobi, Kenya
2-Day HTA Trainings
A two-day “Introduction to HTA Course” was held on 18th – 19th to support the use of health technology assessment (HTA) in evidence informed decision-making such as in the development of the benefits package. The training was conducted by a technical team from Thailand comprising HITAP and the National Health Security Office (NHSO) and KWTRP with support from the Kenyan Ministry of Health (MoH). Sixty-two participants from local universities, research organizations and health departments and agencies entities at national and local level attended the training held at Strathmore University, in Nairobi, Kenya. The training involved lectures, discussions, and hands-on exercises on topics such as priority setting, HTA, topic selection and selecting the right approach, health economic evaluation, Budget Impact Analysis, costing, outcomes, and evidence synthesis. Overall, participants were well engaged, recognized the importance and need for HTA studies, were delighted to be involved and were happy with the content, specifically on the costing and economic evaluations. The participants are looking forward to future trainings and opportunities and would like to keep this community active.
1 day of Stakeholder Engagements and Visits to Nairobi health facilities
On 20th March, various stakeholder meetings between the Kenyan MoH UHC Department, the National Hospital Insurance Fund (NHIF), Kenya’s social health insurer, HBAP, the Expert Taskforce on the NHIF, and HITAP and NHSO from Thailand took place. The meetings provided a chance for all stakeholders to learn about each other’s work, how each organization is involved with the implementation of UHC and how they are placed within the health system of respective countries.
In parallel to the stakeholder meetings, Dr. Suwit Wibulpolprasert, advisor to the Thai Minister, and two HITAP colleagues visited two health facilities in Nairobi district. The visits were to Langata health center and Mbagathi referral hospital, with Dr. Elizabeth Wala from the African Medical and Research Foundation (AMREF).
“We will join hands with Kenya to take the journey towards achieving UHC together” – The Minister for Public Health, Thailand.
1 day of Action Plan Discussions and High Level UHC Advocacy Meetings
Morning of the 21st involved all Thai partners and Kenyan partners discussing the activities in the action plan drawn from the MoU. Based on the MoU the five areas of work are: (1) universal coverage of health insurance and health care financing; (2) priority setting on the benefit package for UHC and applying HTA; (3) human resources for health development; and (4) health system strengthening based on primary health care as a foundation for UHC implementation, and (5) other areas of cooperation as mutually determined.
At noon, the Thai Minister of Public Health and high-level delegates paid a Courtesy Call to the Cabinet Secretary for Health at Afya House, Ministry of Health Kenya.
In the afternoon, the Ministers and high-level delegates drawn from a range of stakeholders including politicians, professional associations and development partners convened to share Kenya’s and Thailand’s experience towards UHC; policy and service delivery interventions, the transformation of the NHIF into a strategic purchaser in the context of UHC, and the role of the NHSO in UHC in Thailand. Additionally, the action plan agreed on earlier was endorsed by the two Ministers
Pilot County Health Facilities
To gain a better understanding of Kenya’s UHC pilot phase, the Thai delegation traveled to Machakos County, one of the pilot counties about 1.5 hour by road south-east of Nairobi. In Machakos, the delegation visited Athi River health center, a primary care facility, and Machakos Hospital, a county-level referral hospital. Additionally, the delegation paid a Courtesy call visit to Governor of Machakos county, Dr. Alfred Nganga Mutua.
Over the next few years the Thai Ministry of Public Health and the Kenyan Ministry of Health along with respective partners will continue to work together to on the activities laid out in the action plan.