Prioritizing health in Makueni County

Brighton was born in Makueni County, just a few hours drive away from Kenya’s capital, Nairobi. The county has served as a testing ground in the country for improving health care since 2013.

In 2010, Kenya’s new constitution enshrined the right of the nation’s population to the “highest attainable standard of health.” It also created a decentralized system that gave enhanced powers and financial resources to the nation’s 47 counties. In 2013, the first elections under the constitution were held. New county governments were formed, headed by governors.

“When we came in, we inherited a health system that was broken, a health system that was ailing,” said Dr. Andrew Mulwa, county minister for health services in Makueni County.

In 2012, Makueni County received about $116,000 from the federal government; under the devolved system, in 2013, it received $2.5 million, he said.

Dr. Andrew Mulwa, minister for health services in Makueni County, explains the county’s experiment with universal health coverage through its social health insurance program

With these new funds, one of the areas the county’s leadership prioritized was improving its health care system through a “bottom-up” approach, focusing on primary health care. Some of the initial investments included increasing the number of operational health facilities and improving its supply chain system. It also worked to increase the number of health workers from about 960 in 2013 to the current number of around 1,770, among other efforts, according to Mulwa.

“Our major success has been the sheer focus on the primary health care component, a step-wise approach, which has been bottom-up rather than top-down,” he said.

In 2016, the county also became the first in the country to launch a public insurance scheme that targets people who can’t afford the national insurance plan, which costs $60 per household, per year. About 37% of the population in Kenya lives under $1.90 per day.

Because of the insurance scheme, more patients are visiting health care facilities for preventative treatment, Mulwa said.