High medical costs leave half the world without health care

Sunday December 31 2017

A doctor checks the health of an elderly man at

A doctor checks the health of an elderly man at a medical camp in rural Kenya. Health care is unaffordable for many Kenyans. FILE PHOTO | NATION 

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Half of the world’s population cannot access basic health care, a new report says.

The 2017 Tracking Universal Health Coverage Report by the World Bank and the World Health Organisation (WHO) released last week says that although the coverage of essential services has increased by about 20 per cent from 2000 to 2015, 3.8 billion people across the world still cannot access essential health services.

“It is unacceptable and it is unnecessary,” said WHO Director-General Dr Tedros Ghebreyesus. “A solution exists. Universal health coverage allows everyone to obtain the health services they need, when and where they need them, without facing financial hardship.”

According to the report, Eastern Asia leads in coverage of essential services, scoring 77 in the index, and sub-Saharan Africa is ranked lowest, at 42.

High costs are among the key factors limiting access to health, with about 800 million people spending at least 10 per cent of their household budgets on medical expenses.

These costs, the report says, are high enough to push 100 million people into extreme poverty, surviving on just $1.90 or less a day.


In Africa, other challenges facing accessibility of health care include lack of prioritisation and underfunding of the sector.

As at 2011, less than 10 African countries had achieved the targets pledged in the 2001 Abuja Declaration to allocate at least 15 per cent of their annual budget to the health sector.

“The report makes clear that if we are serious about better health outcomes and ending poverty we must urgently scale up our efforts on universal health coverage,” said World Bank Group president Jim Yong Kim.

“We need a fundamental shift in the way we mobilise resources for health and human capital, especially at the country level.”

Medical products

The report comes only a month after the Global Surveillance and Monitoring System report by the WHO found that at least one in 10 medical products in low- and middle-income countries is substandard or falsified, costing the global health system $30 billion per year.

According to McKinsey, Africa’s health care market is worth about $35 billion, with half of the continent’s expenditure coming from out-of-pocket payments.

In Kenya, budgetary allocation to the health sector stands at seven per cent, much of which goes to health insurance.

The government says it intends to gradually raise it to 10 per cent by 2022.

Out-of-pocket expenses at point of treatment in Kenya make up a third of the country’s total health expenditure, far above the World Health Organisation’s suggested 15 to 20 per cent.

As at 2014, only 20 per cent of Kenyans had access to some sort of medical cover. A quarter of total spending on health care comes from out-of-pocket expenses, according to the WHO.


During his inauguration for his second term in office, President Uhuru Kenyatta announced plans to reconfigure the National Hospital Insurance Fund(NHIF) and reform the laws governing private insurance companies in order to provide 100 per cent universal health care coverage for all households, in line with Kenya’s Vision 2030 and the UN Sustainable Development Goals.

“The cost of health care still stresses our families. We can end that pain by providing medical insurance cover for every Kenyan within the next five years,” President Kenyatta said.

Currently the NHIF, which accounts for about 88 per cent of the total health insurance in Kenya, covers 6.8 million citizens.

The government aims to double the figure to 13 million by 2022. Beneficiaries of the NHIF pay a minimum of $5 per month, way below the $30 to $40 per person that the WHO estimates for a basic medical system.