Health and Healthcare Systems

How access to sustainable health services is being accelerated for refugee communities in Kenya 

Turkana women carry fire wood on their head within Kalobeyei Settlement outside the Kakuma refugee camp in Turkana county, northwest of Nairobi, Kenya February 1, 2018. Kenya hosts more than 500,000 refugees, 200,000 of whom are located in Turkana Kenya, in rural Northwestern Kenya.

Kenya hosts more than 500,000 refugees, 200,000 of whom are located in Turkana Kenya, in rural Northwestern Kenya. Image: REUTERS/Thomas Mukoya

Neema Kaseje
Founding Curator and Alumni, Kisumu Hub, Surgical Systems Research Group
Kefa Ojwando
Medical Officer in Charge, International Rescue Committee
Patrick Ikileng Oguti
Health Officer, UNHCR
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  • Over 100 million people had become refugees by the end of 2022 due to conflict, violence, persecution and climate disasters.
  • Refugees and rural host communities face greater barriers to accessing health services, despite frequently experiencing greater health needs.
  • On World Refugee Day, we look at the importance of long-term policies and frameworks in helping achieve socioeconomic progress and well-being of displaced populations and their host communities.

By the end of 2022, more than 108 million people were forcibly displaced as a result of conflict, violence, persecution and climate disasters. Old conflicts continue, and new conflicts continue to emerge. The recent conflict in Sudan, for example, has displaced more than 1 million people.

Adding to the number of those displaced are climate disasters. The Horn of Africa, for instance, is experiencing its worst drought in 40 years, with 1.4 million Somalis displaced already this year.

Image: UNHCR Global Trends Report June 2023

Population displacement trends are accelerating: 19 million people were added from 2021 to 2022, translating into more than 1 in 74 forced to flee. Moreover, today, displacement is no longer temporary. According to the World Bank, by the end of 2021, 74% of refugees had been displaced for five or more years, increasing pressures for educational and economic opportunities in host countries that are also struggling to deliver on their developmental goals.

Furthermore, refugees and rural host communities face greater barriers to accessing health services, despite frequently experiencing greater health needs due to conflict, violence and climate disasters. Key barriers to healthcare access include poverty and under-resourced health systems with limited infrastructure, equipment, primary care, and specialist workforce.

Consequently, long-term policies and frameworks that foster sustainable approaches to achieving socioeconomic progress and the well-being of displaced populations and their host communities are critical. A key example is the Kalobeyei Integrated Social and Economic Development Programme (KISEDP) launched in Kenya in 2018.

Kenya hosts more than 500,000 refugees, 200,000 of whom are located in Turkana Kenya, in rural Northwestern Kenya.

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A transformational intervention anchored in the KISEDP integrated and inclusive approach was the recent rollout of the National Health Insurance Fund (NHIF) for refugee and host communities in the Kalobeyei. The NHIF aims to provide affordable and accessible healthcare services to communities and is based on a contributory scheme.

The Kalobeyei settlement in Turkana has 60,000 refugees and 20,000 host community members. This year, households from both communities were enrolled on the NHIF programme as part of a pilot programme to demonstrate its feasibility and effectiveness. Since enrollment, community members from both communities have benefited from primary and specialist care services. For example, we were able to provide surgical care for children with birth defects without families having to worry about economic barriers to care.

This approach will undoubtedly increase access to lifesaving care by reducing economic barriers to accessing health services. It could serve as a model for other countries with significant refugee populations struggling to access comprehensive and sustainable health services. It is a tangible mechanism for achieving Universal Health Coverage and Sustainable Development Goal 3 for refugee populations by 2030.

Although we are making progress, challenges persist. First, the proportion of patients with insurance coverage is still low. For instance, less than 10% of those seeking surgical care are insured. Second, solutions for sustainable payments of monthly premiums are needed. This dimension contributes to arguments for increased educational and economic opportunities for refugees and host community members. Third, to serve the growing need for health services, there is a need for more healthcare workers, equipment and supplies. Attracting and retaining health workers, including specialists, to serve in these areas is challenging because of the relative isolation, the high workload, limited resources and limited opportunities to further train and build skills.

The next steps should first focus on building trust in the insurance system to increase the health insurance coverage rate among all community members. As demand for health services increases with higher health insurance coverage rates, it would be important to further strengthen the health system with more equipment, infrastructure and a workforce for both primary and specialist health services to increase access to care for all.

Second, the health workforce, being the most important component of any health system, should be encouraged to remain and serve in these areas by ensuring they have opportunities to further build their skills and for career development.

Third, lessons should be shared across platforms and stakeholders, because displacement is a global challenge and health needs remain unmet for many. Other hosting countries, particularly in low and middle-income countries (LMICs), are facing similar challenges and there could be opportunities for joint learning and creating a global movement for achieving health for all, inclusive of displaced and refugee communities.

In conclusion, significant populations continue to be displaced by conflict, violence and climate disasters; displacement is prolonged and socio-economic opportunities and access to comprehensive health services are limited. Inclusive and integrated policies with health insurance coverage, as done in Kalobeyei, can serve as a model for accelerating access to essential and sustainable health services for refugee and host communities regionally and globally.

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