Universal health coverage (UHC) is often discussed in terms of insurance enrolment, new health facilities and reforms to healthcare financing. But there is a more fundamental test: can a Kenyan who develops diabetes, hypertension, cancer or heart disease get the care they need without being pushed into financial hardship?
If the answer is no, then UHC remains unfinished.
This is particularly important as Kenya confronts a rapidly growing burden of non-communicable diseases (NCDs). According to the World Health Organization, NCDs accounted for 38 per cent of deaths in Kenya in 2021, with an estimated 115,900 NCDdeaths that year. Kenya’s Ministry of Health has also reported that NCDs account for more than half of inpatient hospital admissions.
These numbers are a representation of families spending money on medicines, transport, consultations and diagnostic tests; workers losing income while seeking treatment; and households struggling with conditions that often require care for years, not days.
That is why Kenya cannot achieve meaningful UHC without putting NCD financing at the centre of health financing reforms.
The nature of NCDs makes them fundamentally different from illnesses that require a short episode of treatment. Someone living with hypertension or diabetes may need regular consultations, laboratory tests and medicines for decades. A cancer patient may require diagnostics, surgery, chemotherapy, radiotherapy or palliative care.
When these services are unavailable or inadequately covered, people delay seeking care or pay out of pocket.
Kenya already has a warning sign. The Ministry of Health reports that 24 per cent of adults have hypertension, while about 78 per cent of those diagnosed are not on treatment.
The problem is therefore not simply that people are becoming sick. It is that the health system must finance a continuum of care capable of finding people early, treating them consistently and preventing complications.
We should shift focus from financing illness to financing health. Primary healthcare and community-based services can play a critical role. Community Health Promoters (CHPs), for example, can help identify people at risk and link them to care before conditions become severe.
There are already signs of what this can achieve. In Murang'a county, CHPs screened 174,000 people for diabetes and 141,000 for hypertension, referring thousands for further care.
There is also a compelling economic argument for acting now.
A World Bank investment case estimated that the cumulative economic losses associated with seven NCDs and related conditions in Kenya amounted to about Sh5.8 trillion over the period analysed. Healthcare expenditure represented only a fraction of this burden; productivity losses from premature death, absenteeism and presenteeism accounted for the overwhelming majority.
In other words, failing to finance NCD prevention and care is not a saving. It simply shifts the cost elsewhere; to households, employers and the wider economy.
Kenya has made important commitments to UHC and is implementing reforms through the Social Health Authority. The government has also recognised NCDs as a priority, with current reforms covering chronic conditions, including diabetes and hypertension.
The next question is whether financing will match that ambition.
The country needs predictable public financing for NCD services, stronger inclusion of essential medicines and diagnostics in health benefit packages, and greater investment in primary healthcare. Counties and the national government must also use data to identify where access gaps are greatest and direct resources accordingly.
The country should also invest in the interventions that prevent people from becoming patients in the first place. These include tobacco control, healthier diets, physical activity, reduction of harmful alcohol use and early detection.
The choice is clear. We can continue paying more when NCDs become complicated and expensive, or we can invest earlier in prevention, detection and affordable long-term care.
UHC is not achieved when someone is registered in the Social Health Authority portal. It is achieved when that person can actually use SHA when they need it.
For Kenya, financing the fight against NCDs is therefore not an optional addition to UHC. It is one of the tests of whether the government will deliver on its promise for affordable and accessible healthcare.
Development and science communications practitioner. [email protected]
