Leveraging Social Accountability to Include Family Planning in Country-Level Universal Health Coverage: Four Lessons Learned from PAI’s UHC Engage Project
Over the past two years, under our UHC Engage project, PAI and civil society partners in sub-Saharan Africa and Asia have focused on the opportunities to advance sexual and reproductive health and rights, including family planning, as part of universal health coverage reform. The challenge is that universal health care is multifaceted and country-specific in nature. Decoding the policy and financing reform environment for each country is key to illuminating the openings that exist for civil society to engage policymakers to increase access to sexual and reproductive health services for everyone, especially women and girls.
The details of emerging policies at the country level are not widely available at the global and regional levels and the country briefs in our Decoding Country-Level UHC Financing Policy series fill this critical knowledge gap.
In late 2018, Kenya’s national government unveiled a pilot program in four counties — Kisumu, Nyeri, Isiolo and Machakos — to expand access to health care and reach universal health coverage by 2022 so that every citizen has access to quality health services without facing high out-of-pocket payments.
Family Planning Advocacy in Kenya
The goal of universal health coverage (UHC) is inspiring landmark political and systemic change all over the world to guarantee access to the quality services people need — spanning preventive through palliative care — and financial protection to ensure they are not pushed into poverty by realizing their right to health care. However, the details of emerging policies at the country level are not widely available at the global and regional levels. Through the UHC Engage project, PAI and partners collaborated to develop a series of publications demystifying country-specific UHC financing policies to illustrate family planning (FP) advocacy opportunities and inform the international dialogue. As each country is in a different stage of UHC financing reform, these briefs deconstruct UHC policy processes in real time, illuminate multifaceted examples for advancing FP in UHC-oriented policies and offer insights across multiple contexts for sexual and reproductive health and rights advocates to strengthen global action.
In late 2018, Kenya’s national government unveiled a pilot program in four counties — Kisumu, Nyeri, Isiolo and Machakos — to expand access to health care and reach UHC by 2022. Following this year-long pilot, the national and county governments are honing UHC programs and policies to meet the needs of their communities. Kisumu Medical and Education Trust (KMET), a health care provider and civil society organization, is working among local leaders and government officials in both the pilot county of Kisumu and at the national level to ensure that these UHC policies and programs are evidence-based and prioritize increasing access to FP. Alongside a new coalition that the organization helped to form, KMET will continue using its service delivery and advocacy expertise to ensure expanded FP coverage through a dual national and subnational UHC strategy.
Kenya’s FP Snapshot
In its 2017 Family Planning 2020 (FP2020) commitment, the Kenyan government prioritized expanding high-quality FP access and choice, especially in areas that are low income, rural or overlooked in the current health care infrastructure. The government has also pledged to increase the modern contraceptive prevalence rate, reduce the number of adolescent pregnancies and strengthen domestic financing for FP at the national and subnational levels to fill gaps in service provision as well as decrease donor dependency.
In Kenya, FP commodities are financed primarily by donors, which has been a consistent trend since the country’s health system was devolved in 2013. Nationwide, the public sector is the country’s major source of contraceptive methods, providing contraception to 60% of current users. FP commodities are procured by the national government through the Kenya Medical Supplies Agency (KEMSA) and directly by development partners.
To bolster its support for FP, the government committed through FP2020 to include FP services and commodities in all health insurance programs. However, this is not the case in the national government’s new UHC scheme. As of August 2020, preventative and promotive care — and specifically, FP — were not listed in the draft benefits package. Instead, the draft benefits package focuses on curative care, and only included a limited subset of reproductive health services at the hospital level. Importantly, whatever is not included in the national benefits package will not be covered by the UHC scheme. This omission threatens important gains and future access to FP, especially since it may force women and girls to make up for gaps in the scheme’s coverage by paying out of pocket for FP commodities and services.
Kenya’s Commitment to UHC
Following a long record of promoting UHC, the government of Kenya publicly renewed its commitment to achieve this goal by 2022 so that every citizen has access to quality health services without facing high out-of-pocket payments. Policymakers have elevated UHC in core national development and policy frameworks, including the Big Four Agenda and overarching Vision 2030 Agenda. The Ministry of Health has also listed UHC as a key objective in the most recent Kenya Health Sector Strategic Plan.
Historically, Kenya’s National Hospital Insurance Fund (NHIF) was the government’s primary vehicle for delivering health care to all. The NHIF is a national, public institution established in 1966 that began as a mandatory program for formal sector workers to contribute through income-based payroll deductions and later expanded to become available for the informal sector, where membership is voluntary and contributions are set at a flat rate. Despite its goal of expanded population, service and financial coverage, the NHIF has had many challenges and fallen short of expectations. The benefits package is mostly limited to hospital-level care and there are gaps in primary health care and FP coverage. Only 16% of all Kenyans are registered under the NHIF and over time, these individuals have reported limited financial coverage of the services that are included.
To advance the UHC agenda, the government of Kenya has sought to implement reforms at the NHIF, KEMSA and the national referral hospital system as well as to train health workers to meet the standards set under the Healthcare Regulatory Framework.
