Community walk on World Cancer Day

Kicking off UHC in Kenya

What is Universal Health Coverage (UHC)?

Universal Health Coverage means that all people can benefit from quality health services, where and when they need them, without suffering financial hardship.

Building a people-centred health system

On the 12th December 2018, President Uhuru Kenyatta declared Universal Health Coverage (UHC) to be a national priority in Kenya, as part of his ‘Big Four Agenda’ for national sustainable development. Under this initiative, the Government of Kenya has committed to make strategic investments in health to ensure that all residents of Kenya can access the essential health services they require by 2022[1].

Kenya’s 2010 constitution provides an overarching legal framework for this rights-based approach to health and from this foundation successive national health strategies have focused investment on provision of services across five levels of the health system and trying to ensure geographical proximity to services for patients nationally[2]. In 2013 user fees were abolished at primary health care facility level to encourage uptake of services[3] but challenges remain. Out of pocket expenses still account for around 26.1% of total health spending nationally, which has implications for the willingness of patients to take up services or seek care, particularly for what is perceived to be more complex issues like cancer. This has been compounded by the variable capacities of devolved health systems in counties, with repercussions for the roll-out of essential interventions nationally.

Cancer control progress in Kenya

Kenya is in the midst of an epidemiological transition. The burden of cancer has risen to an estimated 47,800 cases and 32,900 deaths in 2018[4], and national forecasts suggest that cancer will be the second leading cause of mortality nationally by 2030 behind HIV/AIDS[5].

This rising burden and the impacts on patients and their families has been picked up on in national discussions with key high-level individuals coming out as cancer patients and regular articles in print and radio media on cancer across the 47 counties nationally. This is in part the result of concerted advocacy and training conducted with national media houses to improve the accuracy and sensitivity of reporting. The impact is that cancer is now firms on the radar of health planners nationally.

In response, the Government of Kenya has established the policy foundation for comprehensive cancer control. In 2017 the country transitioned to the second national cancer control strategy[6], aligned with the Kenya Vision 2030, and 2019 will see the launch of new cancer treatment guidelines to support in the standardisation of care. At county level, the prevalence of cancer in public discussions is driving demand for services; however limited health system capacities are curtailing the extent of service development. For example, not all counties have an oncologist which means that many patients are required to seek treatment elsewhere, often at their own expense.

More complex modalities, including radiotherapy, are only available at the national referral centre and some private hospitals in the capital city where some insurance coverage is provided through the expanded national hospital insurance fund[7], but this does not extend to the costs of travel or accommodation while in Nairobi. Cancer therefore remains a major and growing source of out of pocket spending nationally, and a challenge to the implementation of UHC nationally. 

Laying the foundation for UHC

The development of UHC has provided opportunities to build on national advocacy work to pursue the alignment of cancer priorities and existing services with the development of the national UHC package. Following the adoption of UHC, the Ministry of Health of Kenya (MoH) established a department for the strategic oversight and monitoring for UHC. This secretariat is responsible for coordinating overall implementation of UHC nationally and monitoring the UHC pilot. The MoH is working through this secretariat in conducting national stakeholder consultations on which services should be integrated into the national UHC package.

Using this opportunity, the Kenyan Network of Cancer Organisations (KENCO) focused their advocacy on aligning existing cancer services, including those identified in the updated national cancer control strategy. Coordinating with colleagues within their network and contacts in Government, KENCO members submitted proposals and suggestions on the place of cancer within the UHC framework during consultative forums involving multiple stakeholders.

A pilot package of UHC services was then developed for roll out in four pilot counties. The pilot counties were selected to represent the diversity of health challenges in Kenya, including one with a high burden of non-communicable diseases (NCDs). While several services identified are beneficial for cancer patients, including a commitment to deliver access to medicines on the national essential list and palliative care, a clear package of services was not well defined and prevention measures have not been well integrated.

KENCO, as a member of the NCD Alliance of Kenya (NCDAK) was part of key partners who participated in a roundtable discussion in March 2019 themed ‘Redefining UHC; the Opportunity for NCDs’. The forum brought together CSOs, government agencies involved in UHC, academia and service providers. The pilot counties shared their experience with UHC and how different NCDs including cancer are being integrated.

The report from this roundtable has been disseminated by NCDAK and counterparts in the MoH to seven counties and healthcare providers to help shape their UHC implementation process. KENCO has been represented in all these county dissemination meetings. This report has been well received and is forming the basis of useful conversations with health planners and providers across counties who recognise the unmet need for cancer services.  

Moving from pilot to national implementation

The national UHC pilot started on the 12 December 2018 and will run through to October 2019, at which point the Kenyan Government will undertake a review of progress made in order to determine in and how the national UHC package would need to be updated ahead of roll out to the remaining 47 counties. A national UHC conference will be convened to bring stakeholders together to explore progress and mark the start of the national roll-out.

One of the major challenges identified so far has been the demand for care. Patients are required to register for UHC in the pilot counties in order to access services free at the point of use. This registration has been impressive and initial reports suggest that medical facilities are struggling to respond to the increased demand for care, particularly in counties where health facilities are less well developed. This generates some concerns regarding the capacity of some counties to identify cancer cases and effectively refer through to high levels of the health system. The potential for patients to be lost to follow-up and delays in starting the treatment is very real.   

These discussions have also highlighted an underlying issue in the prioritisation of funding for health nationally. While successive Kenyan Governments have committed to meeting the Abuja Declaration of 15% GDP spending on health, the current figure stands at around 5.7%[8]. While the Government has committed to invest further, including allocating 15% of the health budget to NCDs, there is a clear need for further advocacy to raise the profile of health promotion and disease prevention measures within the current UHC package in addition to providing access to essential treatment and care.

Advocacy next steps

In response to the growing burden of cancer and other NCDs nationally, KENCO has identified the need to drive improvements in public education, particularly around health promotion and disease prevention to reduce the long-term burden on health facilities and systems. Using World Cancer Day as a platform, KENCO intends to highlight the critical importance of prevention and early detection to bringing down the national cancer burden to saving lives and advancing progress towards UHC nationally.

Alongside this, the team intends to use their existing relationships with the technical teams in the MoH and other civil society organisations to track the inclusion of core cancer services within both the essential UHC package, financing and procurement plans. While a current package is not clearly demarcated there is a reasonable foundation for action, so long as existing services are not dropped. The implementation of these services by county health authorities will present a long-term advocacy plan for KENCO’s network in order to ensure that no cancer patient is left behind under UHC.

Reflecting on the work to date, it is possible to identify several success factors which have contributed to the progress so far:

  • As a network, KENCO has brought together numerous civil society organisations nationally to advocate with one voice. This has significantly improved the reach and credibility of their advocacy nationally.
  • Over time KENCO has worked to build relationships with key technical teams across the Ministry of Health, including as a technical advisor for the development of the national cancer strategy. This has enabled them to position as a ‘trusted voice’ on cancer, it helped lend further credibility to their submissions within the UHC process and enabled them to make connections across Government to support their advocacy work.
  • KENCO has excellent media relations and conducted a media workshop on cancer in June 2017. The media shared the challenges they have in reporting on cancer and how they would like the cancer organisations to support them. KENCO brought in oncologists and policy specialists to facilitate the workshop which laid a strong foundation for using the media to highlight the importance of integrating cancer services in UHC packages nationally.
  • KENCO is an active member of NCDAK and is represented on the board. Together they have been able to leverage on collective strength to push for relevant interventions in the wider NCDs space. Cancer Survivors contributed significantly to the development of the Advocacy Agenda for Meaningful involvement of People Living with NCDs with gives a roadmap on how survivors and patients can contribute to keeping NCDs in the UHC priorities.
 

[1] Ministry of Health of Kenya (2019) Refocusing on quality of care and increasing demand for services; Essential elements in attaining universal health coverage in Kenya. Available from http://www.health.go.ke/wp-content/uploads/2019/01/UHC-QI-Policy-Brief.pdf [Accessed 24.07.2019]

[2] Ministry of Health of Kenya (2014) Kenya Health Policy 2014-2030. Available from https://www.afidep.org/?wpfb_dl=80 [Accessed 24.07.2019]

[3] World Health Organization (2017) Primary health care systems (PRIMASYS): case study from Kenya, abridged version. Available from https://www.who.int/alliance-hpsr/projects/alliancehpsr_kenyaabridgedprimasys.pdf?ua=1 [Accessed 22.07.2019]

[4] Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today/data/factsheets/populations/404-kenya-fact-sheets.pdf [Accessed 18.07.2019]

[5] Ministry of Health of Kenya (2014) Kenya Health Policy 2014-2030. Available from https://www.afidep.org/?wpfb_dl=80 [Accessed 24.07.2019]

[6] Ministry of Health, Kenya (2017) National Cancer Control Strategy 2017 – 2022 Available from: https://www.iccp-portal.org/system/files/plans/KENYA%20NATIONAL%20CANCER%20CONTROL%20STRATEGY%202017-2022_1.pdf [Accessed 18.07.2019]

[7] World Health Organization (2017) Primary health care systems (PRIMASYS): case study from Kenya, abridged version. Available from https://www.who.int/alliance-hpsr/projects/alliancehpsr_kenyaabridgedprimasys.pdf?ua=1 [Accessed 22.07.2019]

[8] World Health Organization (2017) Primary health care systems (PRIMASYS): case study from Kenya, abridged version. Available from https://www.who.int/alliance-hpsr/projects/alliancehpsr_kenyaabridgedprimasys.pdf?ua=1 [Accessed 22.07.2019]

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Last update: 
Wednesday 29 July 2020