October 21, 2015. This month Allan Maleche, a visiting scholar at Harvard FXB Center, was elected chair of the Global Fund Board’s Implementer Group. Maleche, a passionate human rights advocate, has been working in the field of health and human rights in Kenya, his home country, since 2007. Since 2010 he has served as executive director of KELIN, an award-winning NGO that works to protect and promote health-related human rights. Below, Maleche describes the current moment in Kenya in terms of access to health care and describes how he hopes to use his time at Harvard to contribute to the larger project of making health care for all a reality.
What is the status of Universal Health Coverage in Kenya?
In Kenya, health was not a Constitutional right until August 2010. Before that, paying out-of-pocket for health services was how most people were able to access any type of health care at all. As a low-income country with a heavy disease burden and relatively small resources for health, Kenya is struggling to achieve universal health coverage.
With both national and county governments accountable for ensuring access to this newly recognized right, we are in the process of developing and enacting laws, transferring functions from one level of government to another, and setting context-specific priorities.
Not surprisingly, the major barriers we face include lack of transparency and accountability, poor service delivery, exclusion of vulnerable groups, and increased out of pocket payments.
How does this status affect efforts to treat and prevent HIV & AIDS in the country?
While there has been a steady decline in HIV prevalence rates in Kenya, over 80 percent of the country’s HIV programs are funded externally. In other words, our own government has little financial input, and this does not bode well for sustainability. In fact, this creates another barrier to achieving universal coverage, particular for treatment and prevention of HIV & AIDS. The inability to ensure that vulnerable groups are protected from human rights violations further contributes to their exclusion from such services.
Especially in cases of human rights violations, what access do the poor typically have to legal aid?
Five years after adopting the new Constitution, Kenya still does not have a legal aid act. The poor mainly rely on free legal aid services, which have largely been driven by civil society organizations. Although CSOs do reach many people, serious funding challenges mean that only a small percentage of those needing assistance actually get it. Most legal aid offices are not accessible to people living in rural areas.
In human rights cases, the poor also reach out to national human rights institutions. But these instruments face similar resource challenges as those the CSOs are confronting and may not have health rights as their primary focus.
What are you working on here at the Center?
I am working on a journal article that will focus on what steps policymakers and funders can take towards realizing universal health coverage in East Africa using a rights-based approach. The article seeks to persuade policymakers that if they adopt an approach that takes into account human rights principles such as participation, accountability, non-discrimination and empowerment, they are more likely to achieve universal health coverage and the targets set out in the Sustainable Development Goals, and consequently realize the right to health for all.