Indicators for Universal Health Coverage: can Kenya comply with the proposed post-2015 monitoring recommendations?

Obare et al. International Journal for Equity in Health Indicators for Universal Health Coverage: can Kenya comply with the proposed post-2015 monitoring recommendations? Valerie Obare 0 Claire E Brolan 0 Peter S Hill 0 0 School of Population Health, The University of Queensland , Public Health Building, Herston Rd, Herston, Brisbane, QLD 4006 , Australia Introduction: Universal Health Coverage (UHC), referring to access to healthcare without financial burden, has received renewed attention in global health spheres. UHC is a potential goal in the post-2015 development agenda. Monitoring of progress towards achieving UHC is thus critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank discussion paper in December 2013. The aim of this study was to determine the feasibility of the framework proposed by WHO/World Bank for global UHC monitoring framework in Kenya. Methods: The study utilised three documents-the joint WHO/World Bank UHC monitoring framework and its update, and the Bellagio meeting report sponsored by WHO and the Rockefeller Foundation-to conduct the research. These documents informed the list of potential indicators that were used to determine the feasibility of the framework. A purposive literature search was undertaken to identify key government policy documents and relevant scholarly articles. A desk review of the literature was undertaken to answer the research objectives of this study. Results: Kenya has yet to establish an official policy on UHC that provides a clear mandate on the goals, targets and monitoring and evaluation of performance. However, a significant majority of Kenyans continue to have limited access to health services as well as limited financial risk protection. The country has the capacity to reasonably report on five out of the seven proposed UHC indicators. However, there was very limited capacity to report on the two service coverage indicators for the chronic condition and injuries (CCIs) interventions. Out of the potential tracer indicators (n = 27) for aggregate CCI-related measures, four tracer indicators were available. Moreover the country experiences some wider challenges that may impact on the implementation and feasibility of the WHO/World Bank framework. Conclusion: The proposed global framework for monitoring UHC will only be feasible in Kenya if systemic challenges are addressed. While the infrastructure for reporting the MDG related indicators is in place, Kenya will require continued international investment to extend its capacity to meet the data requirements of the proposed UHC monitoring framework, particularly for the CCI-related indicators. Universal health coverage; WHO/World Bank framework; Monitoring; Indicators; MDGs; Chronic conditions and injuries; Kenya - Introduction Background on Universal Health Coverage Universal Health Coverage (UHC) has been defined as providing access to needed health services without incurring financial hardships for the whole population [1], and is receiving renewed attention at both global and national levels. In 2005 the Member States of the World Health Organization (WHO) adopted a resolution encouraging countries to develop health financing systems aimed at achieving UHC [2]. Recently, the quest for countries to achieve UHC has received significant support from key global players, with the WHO, World Bank and United Nations General Assembly all making commitments to the UHC agenda [3,4]. The fact that millions of people still lack access to basic health care services motivates this attention [5]. Similarly, the costs associated with utilising health services place an immense financial burden on many households. Global estimates indicate that every year, nearly 150 million people experience catastrophic health expenditure where household out-of-pocket payments for health care consume such a proportion of their income that it forces them to forego other goods and services [6], while 100 million are pushed into poverty [1]. UHC is increasingly embraced at a global level as a priority in the post-2015 development agenda [3,7]. Health is acknowledged as essential for human welfare and sustained economic and social development [1]. When people have poor health, with lack of health service being a one of the contributing factors, they often are vulnerable to poverty. At the same time, people seeking health services may incur impoverishing health costs [1]. This paradox provides an affirmation of the critical link between health, sustainable development and economic growth [8]. Ill health affects productivity and diverts households income to seeking health services, thus negatively impacting on economic and social development [5,9]. Achieving UHC is primarily an issue of equity, ensuring that people can access the health services they need to keep them healthy and productive, while at the same time, safeguarding them from being pushed into poverty due to out-of-pocket health expenditures [3]. UHC strategy will contribute to improving health as well as reducing the vulnerability to poverty; thus contributing to the post-2015 agenda on sustainable development. To progress towards UHC, countries will need to concurrently undertake health financing reforms as well as comprehensively address health systems service delivery challenges [8,10]. According to the WHO 2010 report, the UHC target is to progressively expand the range of health services offered, the proportion of the population covered and the proportion of health cost covered to reduce the financial burden on households [1]. The WHO 2010 report identified three critical areas for health financing reforms. These reforms require raising necessary health funds to offer health services, shifting to viable pre-payment methods and improving efficient and equitable use of available health resources [1]. The strategies that countries adopt to achieve UHC vary [11]. Country-specific contexts i.e. disease burden, health system, economic as well as political factors, will greatly influence the policy choices, but in spite of the varied approaches to achieving UHC, the three dimensions of UHC will apply across all contexts[12]. These cross-cutting aspirations of UHC form the foundation for measuring progress. For WHO, monitoring progress towards UHC is one of its research priorities, and will facilitate assessment and tracking of strategies implemented and their outcomes. A global monitoring framework will allow joint learning and sharing of experience and knowledge on UHC implementation across different contexts, and a common and comparable approach in assessing UHC progress is currently being developed [11,13]. In recent years, consultative meetings have been conducted to develop a common mechanism of monitoring progress towards UHC. These meetings addressed the concepts of UHC that will be measured, and described the potential indicators to be utilised [14-16]. There (...truncated)