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CHATTERJEE & JARAMILLO: NHIF reform critical to affordable health for all in Kenya

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By SIDDHARTH CHATTERJEE
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By FELIPE JARAMILLO
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Consider this. One million Kenyans fall into poverty every year due to catastrophic out-of-pocket health expenditures.

For the almost four in every five Kenyans who lack access to medical insurance, the fear that they are just an accident or serious illness away from destitution.

Ill health is easily the most destructive wrecking-ball to any country’s plans for sustainable development, which validates President Uhuru Kenyatta’s commitment to deliver Universal Health Coverage (UHC) by 2022, as part of his Big Four development agenda.

The number of Kenyans who continue to suffer from communicable diseases such as HIV/AIDS, malaria and TB, as well as the increasing burden of non-communicable diseases like diabetes, cancer and hypertension, present formidable challenges to the country.

Among the poorest in Kenya, only three percent have health insurance, which is provided by the National Hospital Insurance Fund (NHIF). Among the wealthiest, many who also have private cover, this rises to 42 percent, indicating again that the poorest are at risk of being left behind even further, and do not have an appropriate safety-net to fall back on.

Investing in UHC is a moral obligation and a very smart investment because it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost and prevention of malnutrition and ill health will have enormous benefits in terms of longer and more productive lives, higher earnings, and averted care costs.

But delivering quality affordable healthcare for all comes at a cost. And this cost should certainly not be carried by those who cannot afford it.

The delivery of UHC requires robust financing structures. When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness. Pooling funds from compulsory funding sources (such as mandatory insurance contributions) can minimise the financial risks of illness across a population.

Health Cabinet Secretary Sicily Kariuki recently unveiled a team of experts to spearhead radical reforms at the NHIF. This new initiative will build on past efforts at reforming NHIF, which were only partially implemented. The team will analyse the financial sustainability of NHIF, oversee legal and regulatory reforms among other proposed organisational reforms to reposition NHIF as a national social health insurance provider and ensure its accountability and transparency.

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UHC will only be realise in Kenya only if the Government of Kenya will increase its budget allocation towards health and lead solid health system strengthening initiatives – for example the NHIF reform – to increase efficiency, effectiveness and accountability within the health sector.

The health system strengthening initiatives currently on their way in Kenya are critical, yet exciting, and require ”all hands-on deck” and much collaboration.

The Government of Kenya can count on the support of the World Bank, and United Nations family as its development partners.

Within the United Nations Development Assistance Framework (UNDAF) 2018-2022 for example, the human capital development pillar (which includes health) is receiving the largest share of human and financial resources – and rightly so, as we recognise the importance of supporting the country to realise the vision of UHC by 2022.

The World Banks’ Transforming Health Systems for Universal Care Project for Kenya is improving utilisation and quality of primary health care services with a focus on reproductive, maternal, new-born, child, and adolescent health services. Supporting health financing reforms is a key component of this project. Under the recently approved Kenya Social and Economic Inclusion Project (with Sh25 billion IDA credit and Sh7 billion of DFID grant), the Bank is supporting the Government to systematically enrol and register National Safety Net Program beneficiaries in the NHIF through an established referral mechanism.

The Government of Kenya is aligning forces as well with the private sector. Through the United Nations’s SDG Partnership Platform, the Government has already been identifying and scaling up transformative primary health care partnerships through galvanising support from the private and philanthropic sectors.

The successful delivery of the NHIF reform will demonstrate Kenya’s ability to efficiently pool resources to cover for a healthcare package with essential services for all Kenyans, at all ages. This again will enhance confidence to join and invest in NHIF and create opportunities within the health sector to develop new partnership models for the delivery of care which all will help the Country to make rapid strides towards the realization of UHC.

Kenya can lead the way in realising Universal Health Coverage – and we stand with Kenya to ”Deliver as One” and leave no one behind.

Siddharth Chatterjee is the UN Resident Coordinator to Kenya. Twitter: @sidchat1

Felipe Jaramillo is the World Bank country director for Eritrea, Kenya, Rwanda and Uganda, based in Nairobi. Twitter: @CFelipejaramil1



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Public officers above 58 years and with pre-existing conditions told to work from home: The Standard

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Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.

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However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.

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Uhuru convenes summit to review rising Covid-19 cases: The Standard

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President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow

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Drastic life changes affecting mental health

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Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.

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Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.

Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.

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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.

In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020.  It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.

A study by Dr. Habil Otanga,  a Lecturer at the University of Nairobi, Department of Psychology says  that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.

The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.

KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.

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Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.

As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.

“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”

Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.

“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.

Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.

“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”

Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.

“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.

Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.

Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.

She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.

Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.

“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added

Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.

“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and  also engage in   reading that would  help expand their knowledge.

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