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A new universalism? Universal health coverage and debates about rights, solidarity and inequality in Kenya

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  • Muinde, Jacinta Victoria S.
  • Prince, Ruth Jane

Abstract

The rise of universal health coverage (UHC) as a global policy endorsed in the Sustainable Development Goals (SGDs) appears to signal new directions in global health as it introduces a progressive language of inclusion, solidarity and social justice and advocates the right of ‘everyone’ to access the healthcare they need ‘without financial hardship’. Since 2018 the Kenyan government has attempted to widen access to healthcare by experimenting with free health care services and expanding health insurance coverage. Such progressive moves are, however, layered onto histories of healthcare, citizenship and state responsibility that in Kenya have been dominated by forms of exclusion, differentiation, a politics of patronage, and class inequality, all of which work against universal access. In this paper, we follow recent attempts to increase access to healthcare, paying particular attention to how a language of rights and inclusion circulated among “ordinary citizens” as well as among the health workers and government officials tasked with implementing reforms. Despite being clothed in a language of universalism, solidarity and inclusion, Kenya's UHC reforms feed into an already fragmented and struggling healthcare system, reinforcing differentiated, limited and uneven access to healthcare services and reproducing inequity and exclusions. In this context, reforms for universal health coverage that promise a form of substantial citizenship are in tension with Kenyans' experiences of accessing healthcare. We explore how, amid vocal concerns about healthcare costs and state neglect, the promises and expectations surrounding universal health coverage reforms shaped the claims people made to accessing care. While our informants were cynical about these promises, they were also hopeful. The language of universality and inclusion drew people's attention to entrenched forms of inequality and difference, the limits of solidarity and the gaps between promises and realities, but it also generated expectations and a sense of new possibilities.

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  • Muinde, Jacinta Victoria S. & Prince, Ruth Jane, 2023. "A new universalism? Universal health coverage and debates about rights, solidarity and inequality in Kenya," Social Science & Medicine, Elsevier, vol. 319(C).
    • Handle: RePEc:eee:socmed:v:319:y:2023:i:c:s0277953622005640
    DOI: 10.1016/j.socscimed.2022.115258
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    References listed on IDEAS

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    1. Paula Saikkonen & Minna Ylikännö, 2020. "Is There Room for Targeting within Universalism? Finnish Social Assistance Recipients as Social Citizens," Social Inclusion, Cogitatio Press, vol. 8(1), pages 145-154.
    2. Kate Meagher, 2021. "Informality and the Infrastructures of Inclusion: An Introduction," Development and Change, International Institute of Social Studies, vol. 52(4), pages 729-755, July.
    3. Carsten Jensen & Michael Bang Petersen, 2017. "The Deservingness Heuristic and the Politics of Health Care," American Journal of Political Science, John Wiley & Sons, vol. 61(1), pages 68-83, January.
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    1. Lone Riisgaard & Nina Torm & Godbertha Kinyondo & Winnie Mitullah & Anne Kamau & Aloyce Gervas & Raphael Indimuli, 2024. "Challenging the formality bias: The organization of informal work, working relations, and collective agency in Kenya and Tanzania," Development Policy Review, Overseas Development Institute, vol. 42(1), January.

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