Artemis Kenya +254 20 231 5530

+254 20 231 5530
Tue, 9th Aug 2022

Affordable, good quality healthcare is an elusive pursuit for both developed and developing economies.

The cost of providing good quality healthcare through government healthcare systems weighs heavily on government expenditure, leading many governments to experiment a variety of public-private health investment, insurance and management systems.

The vast implications of suppressed, or otherwise deprived healthcare national economies nonetheless maintain healthcare as a top priority all over the world.

The healthcare industry the world over is driven and impacted upon by three key concerns:

  • Affordability of healthcare More
  • While governments in developed economies such as the United States of America that spends USD4,437 or the UK, which spends USD 2,928 per person per year, are able to maintain comparably better government allocations  to healthcare, most other countries have a lot less to spare for healthcare.

    In Kenya, for example, budgetary allocation for the 2011/2012 financial year was KSh 31.6 billion (USD 368.9M), which at a population of 39.5 million, translates to only Ksh. 800 (USD 9.3) per person per year.

    This simply puts healthcare beyond what most of the country’s citizens can afford.  In addition to prevalent self-medication, because medicines especially are not available free, poor families often go without treatment when they are ill.  Common diseases also take their toll on the health of children, lowering their ability to do well in school and to make a living later on.

    A major consequence of the high cost of healthcare in primary health is the sacrifice of preventive healthcare, with the little resources available being left for curative healthcare.  In Kenya, for example, non-communicable and lifestyle related diseases, which can often be arrested in regular medical checkups, contribute more than half of the top twenty morbidity cases, with the prevalence of high blood pressure estimated at 37% among those aged twenty-five years and above.

    Public financing of healthcare through national insurance funds is a common model that could significantly lower the cost of healthcare, but which is most times faced with many challenges relating to governance, management, reach and the underlying conflict with private healthcare  insurance providers.

    Still, national health insurance schemes remain the only way to sustainably make healthcare affordable, without burdening governments.  In this regard, the reach and operational efficiency of such schemes is critical, and must remain a priority in considering affordability of healthcare.

    The National Health Insurance Fund (NHIF) in Kenya, for example, has grown its revenue base to Ksh. 9.4B (USD 110M), reduced administration costs to 32% from 50%, and achieved a payout ratio of 62.5%.

    Today, the Fund provides affordable health insurance cover for 20% of the country’s population at monthly contributions of between Ksh. 80 (USD 0.9) and Ksh. 320 (USD 3.7).

    Despite its relative affordability, majority of Kenya’s population, like in most other African countries remains excluded from both access and affordability of healthcare.

  • Accessibility of healthcare More
  • The World Health Organisation WHO sets the optimum doctor-patient ratio at 1:600.  This is still way far off for most countries, with Malaysia, thought to have one of the best doctor-patient ratios at 905, and other countries such as Congo in Africa, at 17,642, and Malawi at 88,321.

    Kenya has a doctor-patient ratio of 4,659, which translates to approximately 19 doctors for every 100,000 citizens – arguably the best in East and Central Africa.  Still, even with the country graduating an estimated 1,300 medical doctors annually, and a similar number of Clinical Officers, with a correspondingly increasing population, bringing down the doctor-patient ratio and therefore making quality healthcare more accessible is still a big challenge.

    This acute shortage of trained medical personnel is made all the more severe by the huge number of locally trained medical professionals who leave the country to work abroad.

    It has been estimated that the total cost of educating a single medical doctor from primary school to university in Kenya is USD 65,997; and that for every doctor who emigrates, the country loses about USD 517,931 worth of returns from investment.  The total cost of educating one nurse from primary school to a college of health sciences is approximately USD 43,180; and for every nurse that emigrates, a country loses about USD 338,868 worth of returns from investment.  These are huge economic losses that continue to burden much of Africa, in addition to the acute shortage of healthcare professionals. 

    The most affected in this shortage are rural populations, who due to poorly resourced district health systems that lack equipment, medicine and trained medical professionals have extremely limited access to high quality healthcare.

    To address this problem, many countries, such as the Republic of South Africa, have introduced a new mid-level healthcare provider, the Clinical Associate, similar to Physician Assistant in the United States.  Clinical Associates are university trained medical professionals who work primarily at district hospitals throughout South Africa to try and raise the level of access to healthcare in rural communities.

    Though these mid-level healthcare providers effectively respond to inaccessibility of healthcare, they are variously limited by lack of opportunities for continuing education and training, which would see them even more effectively respond to healthcare needs within local communities.

  • Sustainable management of halthcare More
  • Both in public and private healthcare, sustainability is a major concern.  The pressure for governments to provide affordable healthcare has sometimes led to overambitious health financing policies, which the same governments find difficult to sustain.

    In private facilities, high startup costs including the cost of land and buildings, equipment, pharmaceuticals, hospital or clinic inventory, as well as the high operating expenses relating to labour, consumables and utilities render the sustainable operation of good quality healthcare facilities a rare occurrence.

    While healthcare facilities do not entirely collapse, it is the quality of healthcare they are able to provide that consistently declines over time.  Key among the reasons why many public and private healthcare facilities – including individual practices end up being unsustainable include the following:

    • Lack of essential drugs and medical supplies
    • Lack of continuous professional education and training
    • Inability to keep up with changing medical technology
    • Inadequate renewal of existing facilities
    • Inability to hire adequately trained and experienced medical and non-medical personnel.

    These and several other factors ultimately compromise sustainability of operations in many health facilities.

We work with healthcare institutions in three main areas:

  • Strategy More
  • High capital investment, complexity of management and operations and the need to balance divergent stakeholder expectations makes strategic planning in healthcare somewhat unique.  Our work in Strategy provides healthcare institutions suitable approaches to the development of growth and sustainability strategies.

  • Benchmarking More
  • We provide performance and operational Benchmarking in healthcare, through which institutions are able to measure and evaluate individual and collective performance in the interest of advancing the quality of healthcare they are able to provide.

  • Learning and development More
  • Building on our work in Learning and Development, we provide tailored solutions within the healthcare sector around the following areas:

    • Leadership
    • Finance
    • Service delivery

Making universal healthcare coverage affordable through National health insurance

Between 2006 and 2012, the National Hospital Insurance Fund (NHIF) in Kenya increased its member contributions from Ksh. 3.1B (USD 36.2M) to Ksh. 9.59M (USD 110.9M), with a payout ratio of 62.5% .

Currently, the Fund provides affordable health insurance cover for 3.3 million principal members, and over 7.8 million dependants, representing 20% of Kenya’s population, through some 883 accredited health providers across the country, with an estimated bed capacity of 43,662.

The NHIF is set to be a key vehicle to the attainment of universal coverage of critical healthcare services in Kenya over the next fifteen years.


Enhancing Organisation at District Health Services

Apart from the provision of medical supplies and equipment, several other factors relating to the management of health facilities considerably influence the quality of healthcare public health facilities are able to deliver to local communities: records and information management is one of these.


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