DOES THE DISTRIBUTION OF HEALTH CARE BENEFITS IN KENYA MEET THE PRINCIPLES OF UNIVERSAL COVERAGE?

Friday, 11th of May 2012

DOES THE DISTRIBUTION OF HEALTH CARE BENEFITS IN KENYA MEET THE PRINCIPLES OF UNIVERSAL COVERAGE?

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/12/20

Jane Chuma1,2*, Thomas Maina3 and John Ataguba4

* Corresponding author: Jane Chuma Jchuma@kilifi.kemri-wellcome.org

Author Affiliations

1 Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, P.O Box 230, Kilifi, Kenya

2 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Headington, Oxford, UK

3 Ministry of Medical Services, Kenya

4 Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, Rondebosch, 7701 Cape Town, South Africa

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

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. 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.

Methods

Two 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.

Results

The 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.

Conclusions

The 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.

International Journal of Epidemiologyije.oxfordjournals.org

1.First published online: April 24, 2012