This financial year has not been a rosy one for the Ministry of Health. From industrial action by health workers that has no end in sight to financial scandals of mammoth proportions and withdrawal of financial backing by development partners, the ministry has been hit hard. The health sector is in a very difficult place and there seems to be no clear roadmap to reverse the situation.
This calls for soul-searching, including thinking about what donors supporting the key pillars of our health means for us as a country. Babies have been able to access life-saving vaccines and HIV-positive patients have gotten life-saving anti-retroviral drugs. Tuberculosis patients continue to get medicine that keeps death at bay and malaria prevention, treatment and research has been sustained for years, all through door funds.
However, some of these donor-backed interventions could be interpreted as outright discriminatory. Why? Because health interventions are classified according to economic regions. Therefore, the so-called “First World” gets the best evidence-based interventions adopted as guidelines, then variants are made for low-income countries.
This implies that if you are deemed to be poor, you do not have the right to the highest attainable standards of care, but rather, you are made to do with what you can afford. This has been entrenched in our country as public hospitals and low-level private and faith-based institutions adopt what are deemed as cheaper healthcare alternatives, while international good practice is only available in high-end private facilities.
A pregnant woman attending ante-natal clinics in a high-end private hospital will have at least two ultrasound imaging tests done as part of standard care, but a woman who attends clinics at a public hospital will only find out that her baby has an abnormality after birth. Even healthcare workers switch mindsets when they move from public hospitals to private ones.
SPEND ON NEEDS
This bias is evident in cervical cancer screening. First World screening protocols depend on the Pap smear (cytology), human papilloma virus (HPV) screening and biopsy of abnormal lesions as the gold standard.
However, in the “Third World”, we were told we don’t have the capacity to do the same because we do not have enough pathologists to read our biopsies and we cannot afford HPV testing. Instead, donor money was spent on promoting a visual inspection method as a cheap alternative and thousands of health workers were trained to do it.
Thereafter, the “see-and-treat” method was adopted as a one-stop shop to prevent cervical cancer – A woman would come for screening and the health worker would visualise the cervix, and if it appeared abnormal, the woman was treated instantly with a hand-held freeze gun that killed off the abnormal cells (cryotherapy).
This method has been widely justified as being cheap, with better compliance, providing on-the-spot diagnosis and subsequent immediate treatment. The development partners gave themselves a pat on the back for enabling low-cadre health workers to do what is otherwise the preserve of specialists in their world.
So, why are specialists not warming up to this cheap grand invention? Because they are left cleaning up the mess. No self-respecting female gynaecologist will opt for cryotherapy treatment because medical training taught them to rely on scientific evidence. Cryotherapy destroys the abnormal lesion and does not give the doctor something to take to the lab to confirm that indeed it was not cancer (which is the whole purpose of screening). Now cases of women who have undergone cryotherapy coming back to the gynaecologist with full-blown cervical cancer are on the rise.
What does this say? Cheap is not necessarily best. The Ministry of Health needs to call the donor bluff. If there is money to be spent, let it be spent where there is need, to attain the highest attainable standard of care.
A patient is a patient irrespective of their geographical location and economic background. The world hasn’t invested in all that expensive research so that we can selfishly water it down for those we regard as third-rate patients. It is immoral, discriminatory and goes against the very basic foundation of human rights.