An Examination of the Legal, Policy and Institutional Framework for Universal Health Coverage in Kenya

Abstract

Kenya has recently adopted universal health coverage (UHC) as one of the ‗big four‘ priority agenda. The goal is that by 2022, all persons in Kenya will be able to use the essential services they need for their health and wellbeing through a single unified benefit package, without the risk of financial catastrophe. However, there are glaring inconsistencies and incoherence in the legal, policy, and institutional design to realize the dream of universal health coverage. For instance, whereas the ‗big four‘ agenda designates the National Hospital Insurance Fund (NHIF) as the institution to deliver universal health coverage by 2022, this new mandate is not enshrined in the National Hospital Insurance Fund Act (1998). Further, while the Constitution devolves the health function with county governments mandated to deliver the bulk of health services, the ‗big four‘ agenda does not clearly articulate the place of universal health coverage in this devolved setting. This study argues that the absence of a clearly defined legislative, policy, and institutional framework has contributed to the failure to realize the dream of universal health coverage in Kenya. The study interrogates the following three interrelated issues: Is the ‗big four‘ agenda anchored on a policy framework that will realize the dream of universal health coverage? Is the legal and policy framework aligned to define an appropriate architecture of universal health coverage? Are institutions like NHIF and County governments properly positioned to steer Kenya towards UHC? The study applies the doctrinal research methodology to identify and examine whether the laws, policies, and institutions critical to universal health coverage can support its realization in Kenya. The research establishes the need for reforms to the existing policy, legal, and institutional arena, given that: first, policies have not comprehensively defined the design of universal health coverage. Second, laws, for instance, the National Hospital Insurance Fund Act, are yet to be aligned to the Constitution and to design a suitable legal architecture of UHC. Moreover, the identified institutions such as NHIF are wallowing in challenges that hinder their effective delivery.