Access to healthcare is a right, not merely a Big Four agenda

As the advisory panel on the Universal Health Coverage appointed by President Uhuru Kenyatta in June 2018 is winding up its mandate, it is imperative that the panel establishes a framework anchored on human rights standards.

Although universal health coverage is one of the Jubilee government's Big Four agenda, it should be remembered that this is the government’s obligation and not a political campaign tool.

 Article 43(1) of the Constitution guarantees every Kenyan the right to the highest attainable standard of health. This comprises the right to healthcare services, including reproductive rights.

This perspective is important as the panel has pointed out that not every service will be available to everyone immediately.

DISADVANTAGED GROUPS

Health Cabinet Secretary Sicily Kariuki, in an interview with the Daily Nation on July 10, 2018, made similar assertions. These assertions are problematic as universal health coverage is being rolled out in a context where vulnerable and disadvantaged groups such persons with disabilities, women and youth contend with various barriers while accessing healthcare services.

They face an economic barrier because healthcare services are unaffordable. Although the government has undertaken efforts to provide free maternity care as envisaged in the Free Maternity Care Services Policy 2013 via ‘Beyond Zero’ Campaign, a vast majority of women are unable to access high quality maternity services.

Women have been detained after delivery for failing to pay medical bills, rendering free maternity rhetoric.

SEXUAL VIOLENCE

Similarly, survivors of sexual violence are illegally charged for Post-Rape Care Forms and P3 Forms, notwithstanding the provisions of the National Guidelines on Management of Sexual Violence in Kenya, the Sexual Offences Act No. 3 of 2006 and the Sexual Offences (Medical Treatment) Regulations 2012 that stipulate these should be free.

Because a vast majority of the survivors cannot afford the illegal fee, they do not receive medical treatment and justice.

Although Kenya has the Access to Information Act No. 31 of 2016 that would enable the vulnerable and disadvantaged groups to exercise their right to seek, receive and impart information and ideas concerning health issues, the groups contend with an information barrier.

This information barrier leads to human rights violations and medical negligence with fatal outcomes.

PHYSICAL BARRIERS

A proportion of women living with HIV/AIDS have been sterilised without their free and informed consent at public and private health facilities and are currently, with the legal assistance of Kenya Ethical Network for HIV/AIDS, seeking relief in court.

Physical barriers persist due to the few quality healthcare services countrywide, a severe shortage of health workers and poor conditions for health workers that include ill-equipped healthcare facilities, poor infrastructure, long working hours and poor pay.

Although everyone bears the consequences of physical barriers, women of childbearing age bear more severe consequences as they are subjected to abuse and disrespect by health workers.

In the context of these barriers, where do we go from here? Fortunately, the panel can be guided and bound by human rights standards upon which to anchor the UHC.

Human rights standards require UHC to be accessible, affordable, acceptable and of good quality.

MARGINALISED

In this regard, UHC should be within safe reach. It should also be affordable.

The panel should stipulate a category of the vulnerable and marginalised who will access healthcare service free of charge as the recommended Sh500 is exorbitant. Of significance, UHC should include free healthcare services for survivors of sexual violence.

The health services covered under UHC should be designed and delivered in a language and a format that users understand.

Perhaps the greatest barrier to the realisation of universal healthcare is the disparate standards of healthcare service and discrimination enabled by the government.

The discrimination is manifest by the fact the government has allowed the existence of both private and public healthcare facilities, and both public (National Health Insurance Fund) and private medical insurance, without any effort to improve the state of public healthcare facilities.

MEDICAL TREATMENT

It is ironical that public and state officers seek medical treatment in private facilities and receive medical cover from private insurers at the expense of tax payers, while the vast majority of the populace have to contend with poor services and bare minimum public insurance.

Non-discrimination mandates quality affordable public health services to be utilised by both State and public officers and as well the populace. Otherwise the UHC will remain mere rhetoric.

The writer is an Advocate of the High Court of Kenya. She is a researcher on human rights and gender.