DR ELESBAN KIHUBA
The cash transfer program has gained prominence in development circles as a tool for providing a buffer to the poor against adverse economic ripples.
At the heart of the program is a model that is precisely calibrated, from a development economic perspective, to assist the most poor meet their basic needs. These kinds of programs have recorded some success in Ethiopia and in Rwanda.
In Kenya, 3.3 million people will be enrolled in the program this year. This population in trouble is mainly composed of the elderly, persons with severe disability and vulnerable children. With the development partners’ support, the government plans to spend Sh22 billion in this financial year (2013/14) in the project.
As noted by the International Food Policy Research Institute, the money will expand their choices of consumptions but it’s unlikely to address their healthcare needs. A quick look at the trajectory of support for this program in other developing countries indicates that health needs will continue to be ignored. An odious situation one might say.
Should a just society allow healthcare to remain in the margins of these social security programs? If the idea is to improve access to the social services, why is the government looking away – ignoring their health needs? Can the implementation of the cash transfer program be done better in our set up?
The health needs are likely to dominate the consumption basket for the target population. For example, the poor and the elderly are associated with higher incidence of illness due to their poor living conditions. Access to quality and affordable services is a big challenge for this part of the population too. To call a spade a spade – their poor living conditions is a tinderbox for poor health and premature deaths.
To put this into perspective, our elders in the society visit hospitals at least four to six times in a year while those suffering from chronic illnesses such as cancers and diabetes make about 12 to 16 visits to a health facility each year. Due to their increased demand for health services, their total healthcare costs are three or four times higher than the ordinary healthy Kenyan (Sh1,300 for outpatient services and Sh1,850 for inpatient services)[1, 2]. In absence of a health insurance cover, most depend on donations from relatives, borrowed funds and sale of their household assets to offset the crippling medical debts. As a consequence, each year hundreds of thousands of our people fall deeper into the poverty dungeon.
While the real impacts of the cash transfer program are still a subject of dissection by the development economics, they should invariably aim to improve the health of the target part of the population through breaching their access and financial barriers to quality health services. A comprehensive social safety net cannot be complete without a health component. Unlike other developing countries in Africa, Kenya has a long history of a social health insurance targeting both the employed and the unemployed in the population.
The practical challenge of extending some form of health insurance to this group can be overcome in our setup. The NHIF premium rates for the poor in society range from Sh30 per month to Sh160 per month, which can be procured under this program. Such a cost effective cover can guarantee access to a comprehensive health package at any of our government health facilities which also happen to be the main source of services for this group.
Since the ministry of Health and Ministry of Social Security and Services have a shared interest of uplifting the health of the poor in society, an appropriate proportion of the budgeted funds should be set aside to go for payment of health insurance covers for the program beneficiaries. I project that it would cost less than 5pc of the current budget for the cash transfer program to procure medical covers with NHIF. By making health part and parcel of the larger process some non-economic impacts would be realized.
The two ministries efforts would also be integrated making the whole greater. Such a coherent single system would be a robust arsenal for improving the dignity of the most poor in the country as it’s locally tailored to meet their social and health needs. The Kenya National Safety Net Program (NSNP) should therefore consider incorporating health as one of the desired outcome as suggested by the respondents in a recent evaluation of the program.
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