Universal healthcare cannot, and shouldn’t, be a mirage

Friday February 23 2018


Surgeons perform brain surgery at Embu Level Five Hospital on January 26, 2018. More specialised medical personnel have been attracted to work in the counties and improved medical equipment is increasingly available. PHOTO | CHARLES WANYORO | NATION MEDIA GROUP 

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When the Constitution came into force after the 2013 elections, transfer of functions were rolled out, leading to the present situation where the Ministry of Health provides policy development and manages the national referral hospitals.

Effectively, the responsibility of public health service delivery for primary and secondary health services was devolved to the 47 counties.

The ultimate goal for devolving the health function is to enhance equity in resource allocation, resulting in improved service delivery for majority of Kenyans – especially those in rural, marginalised and underserved areas.

The Senate plays a critical role in promoting Universal Healthcare (UHC) and has continually supported the management of health services by county governments through legislation, processing of petitions, statements and conducting inquiries.

In 2015 for instance, there was increased push to revert health management to the national government.

The Senate stood its ground and opposed the plan, which had gathered momentum in the National Assembly.

The Senate indeed showed itself strong as a true protector of devolution.

In terms of legislation, the Senate passed a mediated version of the Health Bill, which was subsequently enacted (Health Act, 2017).

The progressive law formalises collaboration between the county and national governments, mandates the provision of specialised and emergency care and obligates the state to address the health needs of the vulnerable in society – women, the aged, persons with disabilities, children, youth, and members of minority or marginalised communities.

The first ever cesarean section in Northern Kenya was conducted in Mandera County on October 2014.

On July 2015, Mombasa County recorded its first ever open-heart surgery as Embu conducted its first ever brain surgery only in January this year.

A cursory glance at the foregoing would indicate that devolution is working.

From a closer look, one would draw the inference that more specialised medical personnel have been attracted to work in the counties and improved medical equipment is increasingly available.

It is evident that there are concerted efforts to take quality healthcare services closer to the people — progressively.

But the milestones achieved are fraught with challenges.

Having lauded the efforts and gains made in the public health sector, we must frown upon and openly discuss the inefficiencies that mar it, if we are to succeed in achieving UHC.

Inefficiencies in the healthcare system can be generalised into a combination of managerial, organisational and financial problems.

A vicious cycle of pay disputes between county bosses and health practitioners coupled with crippling strikes have severely affected service delivery.

In addition to the biting strikes, staffing levels in public hospitals remain very low.

Our country’s doctor-patient ratio is presently estimated at one to 16,000, which lags behind the World Health Organization recommendation of one doctor per 300 patients.

Like many African countries, we have not highly prioritised the provision of healthcare services.

To put this into perspective, Kenya is yet to realise the Abuja Declaration committed to on April 2001 where African governments promised to dedicate 15 per cent, at minimum, of their annual national budgets to healthcare.

When limited funding is coupled with bureaucratic fiscal processes, adequate and modern equipment cannot be purchased and maintained, hospitals struggle to stock up with essential medicines and medical supplies and health facilities cannot function optimally.

On a more positive note though, several indicators show that Kenya may soon join the league of countries that have met the Abuja Declaration.

When President Uhuru Kenyatta announced the ‘Big Four’ Agenda, provision of affordable healthcare for all featured.

Being a priority area for the Jubilee Government, a significant bump in allocation is expected when the budget is read out in June.

Other challenges include: politicising healthcare, corruption and poor governance.

Promotion of UHC is unapologetically provided for in Kenya’s Constitution [Article 43 (1) (a)], international laws, statutes, declarations and global goals.

The most recent of these being the Sustainable Development Goals, which were adopted on September 2015 by the United Nations General Assembly to guide global development by 2030.

Dr Michael Mbito is senator for Trans Nzoia County and chairman of the Senate Committee on Health.