Article Text

Download PDFPDF

Measuring progress towards Sustainable Development Goal 3.8 on universal health coverage in Kenya
  1. Edwine Barasa1,2,
  2. Peter Nguhiu1,
  3. Di McIntyre3
  1. 1 Health Economics Research Unit, Centre for Geographic Medicine Research Coast, Nairobi, Kenya
  2. 2 Nuffield Department of Medicine, University of Oxford, Oxford, UK
  3. 3 Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
  1. Correspondence to Dr Edwine Barasa; EBarasa{at}


Background The inclusion of universal health coverage (UHC) as a health-related Sustainable Development Goal has cemented its position as a key global health priority. We aimed to develop a summary measure of UHC for Kenya and track the country’s progress between 2003 and 2013.

Methods We developed a summary index for UHC by computing the geometrical mean of indicators for the two dimensions of UHC, service coverage (SC) and financial risk protection (FRP). The SC indicator was computed as the geometrical mean of preventive and treatment indicators, while the financial protection indicator was computed as a geometrical mean of an indicator for the incidence of catastrophic healthcare expenditure, and the impoverishing effect of healthcare payments. We analysed data from three waves of two nationally representative household surveys.

Findings The weighted summary indicator for SC increased from 27.65% (27.13%–28.14%) in 2003 to 41.73% (41.34%–42.12%) in 2013, while the summary indicator for FRP reduced from 69.82% (69.11%–70.51%) in 2003 to 63.78% (63.55%–63.82%) in 2013. Inequities were observed in both these indicators. The weighted summary measure of UHC increased from 43.94% (95% CI 43.48% to 44.38%) in 2003 to 51.55% (95% CI 51.29% to 51.82%) in 2013.

Conclusion Significant gaps exist in Kenya’s quest to achieve UHC. It is imperative that targeted health financing and other health sector reforms are made to achieve this goal. Such reforms should be focused on both, rather than on only either, of the dimensions of UHC.

  • health economics
  • health systems

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from


  • Handling editor Seye Abimbola

  • Contributors EB conceptualised the study. EB and PN analysed the data. EB wrote the first draft of the manuscript. All authors contributed to subsequent revisions of the manuscript.

  • Funding This manuscript is published with the permission of the Director of KEMRI. EB is funded by a Wellcome Trust Research Training Fellowship (#107527). Additional funds from a Wellcome Trust core grant awarded to the KEMRI-Wellcome Trust Research Program (#092654) supported this work. The funders had no role in study design, data analysis, decision to publish, drafting or submission of the manuscript. The views expressed in the papers are for the authors and not for the organisations they represent.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The KEMRI Scientific and Ethics Review Unit approved this study under KEMRI SSC No.3087.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This manuscript is based on secondary data that are publicly available. Readers can hence get access to all the data that were used in this study.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.