Is the ladder leaning on the right wall?

Kenya has set out in earnest to achieve universal health coverage in the next five years.

According to the World Health Organisation, universal health coverage is “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective, without exposing the user to financial hardship.”

Drawing from this definition, there is a consensus among stakeholders on how Kenya should implement UHC. First, there is need to define a basic minimum health services package that is logistically and financially feasible to deliver whilst shielding the patient from financial burden.

Secondly, there is need to quantify the finances, human resources and other inputs required to deliver the minimum package and lastly, there is need to establish the financing mechanism to implement it.

However, this approach does not seek to address why healthcare is so expensive in the first place. Paradoxically, Kenya boasts the highest quality of healthcare expertise and infrastructure in the region, yet Kenyans spend Sh8 billion annually on medical tourism to India, because the cost of local healthcare is prohibitive. It is also telling that some of the most exorbitant healthcare providers are registered as non-profit organisations.

Perhaps the question we ought to be asking is: What are the drivers of high costs and what must we do to fix this? What lessons can we pick from India, Cuba and other countries that have achieved significant health outcomes through cost-effective, high-quality health systems that are relevant for Kenya?

A continental perspective of the drivers of high cost of healthcare offers more food for thought. While Africa accounts for 15 per cent of the global population, it bears 25 per cent of the global disease burden, while employing only two per cent of the global doctor workforce.

EQUIPMENT

Could the high costs of accessing healthcare therefore be explained as a function of low supply of doctors against high demand for their services? But then again, it will take more than trained doctors to solve Africa’s healthcare crisis.

Doctors must be armed with the appropriate health technologies to effectively ply their trade. Again, statistics paint a grim picture. Africa’s population accounts for an underwhelming three per cent of the global pharmaceutical industry revenue, painting a broken system where the disease burden fails to translate into market-driven supply of appropriate health technologies.

Africa imports more than 90 per cent of the devices and equipment needed for its health system and sadly, the equipment is designed for the developed world and tends to break down within five years of purchase.

Often, it is not economically viable to maintain and repair the equipment locally. Consequently, we pay the steep price of relying on “hand-me-down” technologies and “Wanjiku” who typically pays out of pocket prefers to travel to India.

Therefore, a one-size-fits-all approach, or copying other countries in our quest for UHC may miss the mark. Moreover, achieving UHC is a broad discussion that should encompass more than just clinicians and financiers. Key players in various industries that underlie the healthcare delivery industry must be enjoined to ensure a cohesive sector-wide approach. 

Innovative business and regulatory models that are aligned with our market realities should be developed. Africa needs to invest in developing capacity to produce appropriate health technologies, as well as regulatory mechanisms for health technology assessment. Building on a vibrant local pharmaceutical manufacturing industrial base and our strong science and technology heritage, Kenya is positioned to lead the transformation of Africa’s health landscape.

Dr Karanja is CEO & Co-founder of Villgro Kenya, a business incubator for en-terprises with social impact in the health and life sciences sector