Universal healthcare cannot be mere rhetoric
What you need to know:
- The government has determined, after a long, often acrimonious entanglement with our health workforce, that a drastic solution is required to ensure all Kenyans have access to health workers.
Unfortunately, over the past few years, health workers have been up in arms over their terms and conditions of service.
UHC will be carried by an honest, people-focused leadership that spurns populist politics and focuses on evidence-based health priorities.
President Uhuru Kenyatta has dedicated his second term to the so-called “Big Four Agenda”, which includes a commitment to achieve affordable health care by the time the next election comes round in 2022. His administration, therefore, has fixated on a number of initiatives aimed at plugging gaps in the system that have hampered previous attempts to reduce the burden of ill-health in this country and improve our overall health.
The first priority relates to financing. The government has identified the National Hospital Insurance Fund (NHIF) as the vehicle for adequately financing the sector. Government officials are working to ensure that all Kenyans have financial cover to ensure that their health needs are taken care of and to reduce the risk of catastrophic health expenditures. The World Health Organisation’s push for Universal Health Coverage (UHC) seems to have come at the right time, even though our interpretation seems to have ended at more money through an insurance mechanism.
THIRD COMPONENT
The second priority being addressed in the health sector is availability of facilities. A corruption-ridden initiative in the first Uhuru administration resulted in many health facilities being saddled with state-of-the-art treatment and diagnostic equipment with no one to operate them. This is one of the risks of politics-led health decision-making, since it becomes a hit-or-miss affair in which the administration wins big if they get it right, but the country loses enormous resources if they get it wrong.
However, this particular experiment may yet prove useful if the third component is addressed satisfactorily. This is the human resources aspect. The government has determined, after a long, often acrimonious entanglement with our health workforce, that a drastic solution is required to ensure all Kenyans have access to appropriate, well-trained health workers. Unfortunately, over the past few years, health workers have been up in arms over their terms and conditions of service. They have formed unions that have been a constant nuisance to an administration unaccustomed to a questioning health workforce and more familiar with a workforce whose own hierarchical training demands obedience to authority in most circumstances.
SHORT-TERM
The result is that in the government’s urgency to increase the numbers and improve the distribution of health workers, especially the highly specialised ones, someone must have mentioned that Cuba specialises in training and exporting highly specialised medical personnel. Quite fortuitously, or perhaps by design, the president had a Cuba visit on his itinerary, and one of the items discussed was Cuba’s assistance to improve our health system towards achievement of UHC.
It would of course have been best for the health workforce to be reorganised and redistributed in order to meet our population’s health needs. Unfortunately, this will take lots of work and time. One thing political promises cannot abide is lots of work, and the absence of time defines the politics of our time, predicated as it is on five-year cycles at the end of which proof of achievement must be presented. Cuba, therefore, presents a very handy, if short-term, solution to the problem of shortage and poor distribution of human resources for health.
PEOPLE-FOCUSED
While in 2022 the government may be able to show that medical specialists have touched every corner of this republic, and that they are working insane shifts in their quest to keep our people healthy, it is a fact that UHC will not be achieved on the back of an expatriate workforce, donor funding for a corruption-ridden unsustainable equipment purchase scheme, and a health insurance scheme with an undefined minimum package of care that is in some instances differentiated based on socio-economic status.
UHC will only be achieved on the back of real hard efforts at increasing domestic health expenditures, especially on infrastructure and training and recruitment of health workers at all levels, from primary healthcare to super-specialised services. Above all, UHC will be carried by an honest, people-focused leadership that spurns populist politics and focuses on evidence-based health priorities.
Atwoli is an associate professor and dean of Moi University School of Medicine. [email protected]
