Okech Timothy Chrispinus, Lelegwe Steve Ltumbesi
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Glob J Health Sci. 2015 Dec 18;8(7):218-27. doi: 10.5539/gjhs.v8n7p218.
Kenya has made progress towards universal health coverage as evidenced in the various policy initiatives and reforms that have been implemented in the country since independence. The purpose of this analysis was to critically review the various initiatives that the government of Kenya has over the years initiated towards the realization of Universal Health Care (UHC) and how this has impacted on health equity. The paper relied heavly on secondary sources of information although primary data data was collected. Whereas secondary data was largely collected through critical review of policy documents and commissioned studies by the Ministry of Health and development partners, primary data was collected through interviews with various stakeholders involved in UHC including policy makers, implementers, researchers and health service providers. Key findings include commitment towards UHC; minimal solidarity in health care financing; cases of dysfunctionalilty of health care system; minimal opportunities for continuous medical training; quality concerns in terms of stock-outs of drugs and other medical supplies, dilapidated health infrastructure and inadequqte number of health workers. Other findings include governance concerns at NHIF coupled with, high operational costs, low capitation, fraud at facility levels, low pay out ratio, accreditation of facilities, and narrowness of the benefit package, among others. In lieu of these, various recommendations have been suggested. Among these include promotion of solidarty in health care financing that are reliable and economical in collecting; political will to enhance commitment towards devolution of health care, engagement of various stakeholders at both county and national government in fast tracking the enactment of Health Act; investment in health infrastructure and training of human resources; revamping NHIF into a full-fledged social health insurance scheme, and enhancing capacity of NHIF human resources, enhanced awareness amongst members, enhanced benefit package among other recommendations.
自独立以来，肯尼亚在全民健康覆盖方面取得了进展，这在该国实施的各种政策举措和改革中得到了体现。本分析的目的是批判性地审视肯尼亚政府多年来为实现全民医疗保健（UHC）而发起的各种举措，以及这对健康公平产生了怎样的影响。尽管收集了原始数据，但本文严重依赖二手信息来源。二手数据主要是通过对政策文件的批判性审查以及卫生部和发展伙伴委托进行的研究收集的，而原始数据则是通过采访参与全民医疗保健的各种利益相关者收集的，这些利益相关者包括政策制定者、实施者、研究人员和医疗服务提供者。主要发现包括对全民医疗保健的承诺；医疗保健融资方面的团结程度极低；医疗保健系统存在功能失调的情况；持续医学培训的机会极少；在药品和其他医疗用品短缺、破旧的医疗基础设施以及卫生工作者数量不足方面存在质量问题。其他发现包括国家健康保险基金（NHIF）的治理问题，以及运营成本高、人头费低、医疗机构层面存在欺诈行为、赔付率低、医疗机构认证、福利套餐范围狭窄等问题。鉴于这些情况，提出了各种建议。其中包括促进可靠且经济的医疗保健融资团结；增强对医疗保健权力下放的承诺的政治意愿，让县和国家政府的各利益相关者参与加快《健康法案》的颁布；投资于医疗基础设施和人力资源培训；将国家健康保险基金改组为一个成熟的社会医疗保险计划，增强国家健康保险基金人力资源的能力，提高成员的认识，扩大福利套餐等建议。
