Forget 100 doctors; this is how Cuba can help us

Recently, President Uhuru Kenyatta visited Cuba accompanied by officials from the national and county governments.

Among the many goodies negotiated between the two governments was the offer by the Cuban government to send 100 doctors to help Kenya deal with a perceived skill deficit.

The Ministry of Health later clarified that all these doctors being “imported” would be specialists covering areas where we have shortages in this country.

Apparently, the number was arrived at by calculating that each of the 47 counties would receive two specialists and the remaining six specialists would be sent to the national referral hospitals.

This sounds quite reasonable on the face of it, save for the fact that we are treating this Cuban doctors as commodities to be imported.

HEALTH SYSTEM

However, the recent clarification by the Council of Governors on the content of the agreements gives a more interesting perspective to the whole affair.

The Cuban doctors will ‘train county health workers on malaria vector control, and the management of HIV, hepatitis, and additionally, the National Government has undertaken to pay their salaries while the County Governments will “provide furnished housing facilities, security, and transport”.

While it is undeniable that Cuba enjoys one of the best health systems in the world with enviable health indicators, it is crazy to think that we can import their efficient health system by hiring 100 (or even more) of their doctors and transplanting them into our healthcare system.

This demonstrates a complete misreading of the problems bedevilling the sector, and a continuation of our quick-fix mentality to chronic problems.

The problem with Kenya’s health system is not solely about an absolute shortage of specialised staff. The problem is one of organisation.

FUNDING

Our disorganised procurement of equipment without considering need has meant that essential equipment is left out in some centres in favour of more advanced equipment that nobody knows how to use.

Our medications and commodities are very expensive, contributing to the high cost of care in this country.

We are also setting aside very little funding to support training and research in order to produce more specialised staff and the new knowledge necessary to face modern health challenges.

Finally, our haphazard recruitment and distribution of human resources for health has resulted in significantly skewed service availability in this country.

The sum total of these shortcomings is that there are places in this country where for the right price you can access better care than you can get anywhere in the world, while in other areas you would die of diseases that were eradicated elsewhere in the middle ages.

MEDICAL SUPPLIES
This is the very antithesis of universal health coverage, which I conceptualise as “public funds spent on public facilities and services to keep the public healthy, ensuring the public doesn’t become or remain poor because of disease”.

How can Cuba help Kenya to achieve universal health coverage?

Firstly, the Cubans can help us acquire equipment and supplies at lower cost.

Given the many innovations in the Cuban health system, we can learn a thing or two about locally manufacturing our own equipment, medications and other consumables, and controlling the prices so that they do not impoverish the users, thus ensuring that every tax shilling goes further in helping Kenyans remain healthy.

TRAINING
Secondly, we can learn from the Cubans how they have managed to continuously fund research into innovations that help them deal with both traditional and emerging health challenges, and how their health managers have convinced the politicians to maintain this funding stream despite competing needs.

Perhaps we can organise student and staff exchange between our institutions of health worker education, in order to crystallise these tricks and get us into the first world of health research.

Finally, perhaps the Cubans can help the Kenya government to design a corruption-free health financing mechanism in which government health expenditure approaches 15 per cent of budget, and addresses the important healthcare needs of the population.

Atwoli is Associate Professor and Dean, Moi University School of Medicine [email protected]