Health sector can still be reformed despite hiccups

Five years ago, when 67 per cent of Kenyan voters endorsed the new Constitution, their excitement was palpable.

Those who had voted for the new document were eager for change promised by the new constitutional dispensation.

With the Constitution came the creation of 47 new counties, under which much political and economic power was devolved.

Health care was among the sectors that were devolved with a view to enhancing service delivery.

Devolved units in Kenya have been organised in such a way that they are responsible for three levels of care, namely community health services, primary care health services and county referral services.

The national government is responsible for national referral services.

A KPMG report titled Devolution of Healthcare Services in Kenya: Lessons learnt from other countries, published in 2013 indicates that since independence in 1963, centralisation has been at the core of the country’s governance.

As a result, the country has been marked by spatial inequalities during this period.

Devolution was expected to correct this anomaly, especially in the health care sector that deals with matters of life and death.

Devolution of the health care system, however, remains a mixed bag. It has brought both positives and negatives.

There are counties that are making huge strides and have in the process greatly improved healthcare for their people.

They have been able to install necessary equipment and bought right and adequate medicines for their facilities.

PARTNERSHIP BENEFITS

Others are battling serious challenges such as inadequate infrastructure, workers’ unrest and salary delays, lack of medicines and supplies, poor working conditions and limited skills.

All these are a hindrance to the achievement of quality health care for all.

But in a growing devolved system, these are challenges that can be overcome with time.

However, borrowing from the World Health Organization, good health services are able to provide effective, safe, personal and non-personal care of good quality.

These services should be prudently provided whenever they are required.

The government alone cannot deliver the optimal services required in health care.

That’s why private-public partnerships should be encouraged to fill in the gaps left by the public system.

From experience, Public Private Partnerships (PPPs) can help reform national and county governments’ health systems and drastically improve the quality of life for all Kenyans.

The PPPs are backed by the Public Private Partnership Act, 2013, which is designed to provide for the participation of the private sector in financing and in other avenues where they can add value.

Through the intervention of non-state actors, Kenyans in remote areas and other disadvantaged areas are able to receive quality health care at affordable rates.

The national and county government should create a framework that increasingly accommodates private-public collaboration to hasten gains in health care devolution.

QUALITY AND RELIABILITY

As it stands, only sections of communities closer to formal heath facilities benefit from public health care, leaving out a huge population that has to make do with either traditional medicine men, or pay the high costs at private healthcare service providers.

Over the past three years, for instance, Mission for Essential Drugs & Supplies (Meds) has helped 38 counties access affordable and quality drugs through the County Government Partnership Initiative, providing more people with improved healthcare services.

This is just one example and the impact would be greater if more space is opened for non-state actors to play a more pronounced role in enhancing access to quality health care.

In the end, access alone is not enough; the services have to be of quality and reliable enough to improve health or save lives.

Paschal Manyuru is the managing director of Mission for Essential Drugs & Supplies (Meds)