On June 30th 2015, the Ministry of Health launched two key healthcare financing documents – the Kenya National Health Accounts (NHA 2012/13) and the 2013 Kenya Household Health Expenditure and Utilisation Survey (KHHEUS 2013).
The National Health Accounts is a mechanism used by countries to monitor the flow of funds in the health sector. It therefore provides a good framework for measuring total public and private health expenditures.
Some of the key findings in the newly released NHA 2012/13 show a general increase in government expenditure on health as a percentage of total government expenditure from 4.6% in 2009/10 to 6.1% in 2012/13. In real terms, Total Health Expenditure (THE) rose from 163 billion Kshs in 2009/10 to 234 billion Kshs in 2012/13. Total health spending accounted for 6.8% of GDP up from 5.4% in 2009/10. Out of pocket expenditure (OOP) still remains high at 26.6% up from 25.1% in 2009/10. In terms of expenditure by disease conditions, the top positions were taken by HIV/AIDS (18.7%), reproductive health (12.9%) and Malaria (9.8%).
The Household Health Expenditure and Utilisation Survey on the other hand sought to record the health-seeking behavior, use of healthcare services, out of pocket health spending and health insurance coverage of Kenyan households.
The KHHEUS 2013 documented results of a national and county representative sample survey involving 33,675 households. The survey showed that the public sector continued to be the main provider of both outpatient and inpatient care accounting for about 58% and 56% of visits and admissions respectively. A steady increase was observed in the proportion of people seeking outpatient healthcare services from 83.3% in 2007 to 87.3 in 2013, while inpatient service utilisation remained constant at 2.5%. Unmet need for healthcare services (persons needing but not accessing care) fell slightly from 16.7% (2007) to 12.7% (2013). The survey indicated that only 17.1% Kenyans had some form of health insurance coverage, with 88.4% of these being under the National Hospital Insurance Fund (NHIF). Service utilisation among the insured versus the uninsured did not show significance difference for outpatient services (3.2 and 3.0 visits respectively) but showed huge difference for inpatient care (76 versus 30 admissions per 1,000 population).
The findings from the two reports are indeed very important for policy makers and will be important in shaping policy dialogue and process. As the country works towards achieving universal health coverage, it is important to note that coverage under prepayment schemes still remains low, while out-of-pocket expenditure is high.
Increasing insurance coverage especially among the poorer persons could help in reducing out-of-pocket expenditure that has the potential of perpetuating poverty. GIZ health sector programme (GIZ-HSP) is working very closely with the Ministry of Health and with NHIF to come up with effective and sustainable strategies of financing health especially for those in the lower economic quintiles.
The reports are available at www.health.go.ke:
National Health Accounts (NHA 2012/13)
Kenya House Hold Expenditure Utilisation Survey (KHHUES 2013)