Does the distribution of health care benefits in Kenya meet the principles of universal coverage?

Jane Chuma,John Ataguba,Thomas Maina

doi:10.1186/1471-2458-12-20

Abstract

BackgroundThe 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Universal coverage involves ensuring that health care benefits are distributed on the basis of need for care and not on ability to pay. The distribution of health care benefits is therefore an important policy question, which health systems should address. The aim of this study is to assess the distribution of health care benefits in the Kenyan health system, compare changes over two time periods and demonstrate the extent to which the distribution meets the principles of universal coverage.MethodsTwo nationally representative cross-sectional households surveys conducted in 2003 and 2007 were the main sources of data. A comprehensive analysis of the entire health system is conducted including the public sector, private-not-for-profit and private-for-profit sectors. Standard benefit incidence analysis techniques were applied and adopted to allow application to private sector services.ResultsThe three sectors recorded similar levels of pro-rich distribution in 2003, but in 2007, the private-not-for-profit sector was pro-poor, public sector benefits showed an equal distribution, while the private-for-profit sector remained pro-rich. Larger pro-rich disparities were recorded for inpatient compared to outpatient benefits at the hospital level, but primary health care services were pro-poor. Benefits were distributed on the basis of ability to pay and not on need for care.ConclusionsThe principles of universal coverage require that all should benefit from health care according to need. The Kenyan health sector is clearly inequitable and benefits are not distributed on the basis of need. Deliberate efforts should be directed to restructuring the Kenyan health system to address access barriers and ensure that all Kenyans benefit from health care when they need it.

Highlights

The 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost
In 2005, the World Health Organization (WHO) resolution called for health systems to move towards universal coverage, where everyone has access to “key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access” [1]
This paper addresses some of these challenges by conducting a system-wide analysis of the distribution of health care benefits in Kenya and compares changes in the distribution over two time periods

Summary

Introduction

The 58th World Health Assembly called for all health systems to move towards universal coverage where everyone has access to key promotive, preventive, curative and rehabilitative health interventions at an affordable cost. Findings from these studies revealed that public health care funds hardly reached the poor in most countries [4,8,9] While these studies were instrumental in highlighting the distribution aspects of various health systems, they have been criticized for using unreliable data sources and applying crude estimation techniques, with limited attention to methods consistency [10]. These studies were conducted close to two decades ago, making it important to conduct more rigorous analysis at a time when countries are considering implementing various reforms to support universal coverage. Most BIA studies do not assess whether benefits are distributed on the basis of need [7]

Objectives

Methods

Results

Discussion

Conclusion