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Like many other developing nations, Kenya has embraced the idea of universal healthcare coverage (UHC), envisioning a system that promotes affordable and comprehensive care for all its citizens. However, several challenges must be addressed to transform this vision into a reality.
Dr. Bevin Likuyani from Pharvers Kenya highlights that “compared to countries like the United Kingdom, where the National Health Service provides government-funded healthcare without requiring premiums from citizens, Kenya faces significant challenges in successfully implementing UHC.”
Universal healthcare
On June 14, 2023, President William Ruto expressed the government’s commitment to the successful implementation of Universal Health Care. The government, Ruto said, intends to prioritize preventive healthcare by leveraging community health workers, reforming the National Health Insurance Fund (NHIF), and ensuring the provision of medical supplies and equipment for UHC.
The president has thus proposed a flat rate gross salary deduction of 2.75 percent from Kenyans allocated toward NHIF cover to further his ambitious UHC goals. However, this move will create additional financial burdens for Kenyans, as they already face new tax laws effective from July 1, 2023, following the controversial Finance Bill 2023 signed into law by the President on June 26.
The new tax laws include increased taxes on essential commodities such as fuel (from 8 percent to 16 percent), a housing levy at 1.5 percent, non-refundable taxes, and a tax on commercial vehicles at Ksh 5000.
Massive corruption at KEMSA and NHIF
While universal healthcare aims to improve accessibility and affordability for all individuals by reducing financial constraints, implementing this system in Kenya is proving daunting due to massive corruption and cartels’ influence in institutions like KEMSA and NHIF.
Health Cabinet Secretary Susan Nakhumicha acknowledges robust and influential cartels within KEMSA and the ministry, but she is determined to confront them head-on.
“I know I am treading on dangerous ground, and I need your prayers to complete my mission of cleaning up the mess at the medical authority,” Nakhumicha said.
During a meeting with Global Fund Executive Director Peter Sands earlier this month, Ruto emphasized the need for improved service delivery at Kemsa.
“KEMSA is an integral part of the equation. They must fulfill their role. The agency has had issues, but we are addressing them,” Ruto said.
The President also pledged to weed out corruption and predatory practices at the NHIF to enhance efficiency.
KEMSA has been caught in the middle of several corruption scandals, the latest being th multi-billion shilling scandal that led the Geneva-based Global Fund to cancel a Ksh 3.7 billion tender for insecticide-treated mosquito nets after reports of unfair exclusion of a Chinese firm meeting all the tender requirements. Additionally, the NHIF has faced compelling concerns and allegations regarding its top management’s involvement in a defrauding scheme that siphoned billions of shillings from the national hospital fund through select private hospitals.
Reports indicate the scheme offered unnecessary and potentially harmful surgeries to elderly Kenyans. As investigations continue, branch managers in the affected areas have been suspended.
Poverty, high cost of medical attention, and over-the-counter (OTC) culture
When seeking medical attention, a common question arises: when should individuals visit a hospital, and what’s the appropriate time to consult a pharmacist? According to the World Health Organization (WHO) and the Kenya National Bureau of Statistics (KNBS), the decision largely depends on the nature of the ailment and the expertise required for proper diagnosis and treatment.
However, poverty and the high cost of medical attention have greatly influenced the over-the-counter prescription culture. Likuyani attributes the decision to the patient’s financial situation.
“Why do individuals first seek healthcare at a pharmacy or chemist? It’s simply because, in the third world, we are poor. Yes, we are poor. Poverty is the reason,” Likuyani said.
He emphasized the profound impact of poverty on healthcare access.
“We cannot afford accessible healthcare. So, as much as we may be labeled,” Dr. Likuyani added.
Dr. Ismael Lutta, a medic in Kakamega County, cites chronic headaches as a typical example where individuals often resort to self-medication with over-the-counter painkillers like paracetamol. Dr. Lutta, however, said such cases should be addressed by healthcare professionals who can assess eyesight and prescribe appropriate treatment.
“Attempting to self-medicate may not provide a lasting solution. Individuals experiencing persistent headaches should consult healthcare providers to rule out other underlying conditions such as dental caries, which can contribute to unending headaches,” Dr. Lutta said.
Healthcare funding
In the 2023-24 budget statement presented before Parliament on June 15, the Health Ministry allocated Ksh 141.2 billion, down from Sh 146.8 billion in the 2022-23 financial year.
Of the allocation, Sh116 billion would go to the Medical Services Department and Sh24.6 billion to public health standards.
Sh 21 billion was allocated for curative and reproductive health, while Sh 7.3 billion was set aside for preventive and promotive health services.
Meanwhile, Ksh 4.9 billion will go towards health research and innovation, Sh1.8 billion to health policy, standards, and regulations, and Sh15 billion to health resources development and innovation.
Ksh 63.5 billion will go towards national referral and specialized services. The government allocated Ksh 121.09 billion towards health in the 2021-22 budget, an increase from Ksh 111.7 billion the sector received in the 2020-21 budget.
Accurate Diagnosis
Becky, a 36-year-old journalist, mother, and healthcare enthusiast, sheds light on several factors contributing to self-medication and the high medication cost in Kenya. She highlights the excessive number of tests patients undergo when seeking medical treatment. Becky shared her experience of being admitted to the hospital last year due to a bacterial infection that started as tonsillitis.
Despite being put on antibiotics for three days, her fever persisted, and she developed severe headaches and migraines. When she questioned her treatment and the blood samples’ purpose, the doctor informed her that she had a viral infection, not a bacterial one. The medication was adjusted accordingly, and she eventually recovered after spending seven days in the hospital.
Becky also recalled an incident involving her five-year-old child, who had been prescribed antibiotics multiple times within a short period for tonsillitis and fever. However, a pediatrician advised her to try home remedies before taking antibiotics.
The excessive number of tests and the financial burden of healthcare pose significant challenges for individuals seeking treatment. Exploring approved alternative solutions and ensuring that medical interventions are necessary and practical is essential to promote affordable and quality healthcare.
Dr. Lutta suggested that Becky’s situation could have been avoided if proper protocols had been followed, such as collecting blood samples for culture and sensitivity tests. These tests help determine the presence of bacteria and identify the most effective treatment. However, it is essential to note that not all healthcare facilities have the necessary resources, like culture and sensitivity tests, to facilitate targeted therapies.
Another pressing concern is the availability of skilled healthcare workers. Kenya faces a significant shortage, with a doctor-to-patient ratio of 1:10,000. The WHO recommends a ratio of 1:1,000 to ensure adequate coverage. Therefore, to achieve the goals of UHC and enhance public confidence in government hospitals, it is imperative to invest in increasing the number of qualified healthcare professionals.
Success of UHC
Furthermore, the success of UHC depends on the readiness of the healthcare infrastructure. Adequate resources, including medical supplies and well-equipped facilities, are essential for comprehensive care. The government must prioritize equipping hospitals with the necessary commodities and infrastructure to meet the population’s needs effectively.
In addition, another key player that warrants attention is the Pharmacy and Poisons Board. It is entrusted with specific responsibilities in the pharmacy field and controlling hazardous substances. The Pharmacy and Poisons Board implements the guidelines, standards, and regulations that ensure the quality, safety, and efficacy of medicines. They also regulate the profession of pharmacy.
This regulatory body has the crucial task of enforcing these guidelines and staying vigilant to ensure that pharmaceutical practices are carried out correctly. They must also implement strict and punitive measures against medical professionals and unqualified individuals who engage in practices that undermine the standards.
Lastly, policymakers and politicians play a vital role in successfully implementing UHC. It is crucial to garner their support and commitment to allocating sufficient time and funding toward realizing UHC. Dr. Likuyani concludes by urging citizens to hold their elected representatives accountable for ensuring that universal healthcare remains a top priority on the national agenda, adding that the responsibility lies with the patient.
“At the heart of it all, the patient holds a central position. While trust in healthcare professionals is important, individuals must also empower themselves to take charge of their health and actively engage with healthcare providers,” Dr. Likuyani said.
Kenya’s journey towards effective universal healthcare coverage involves addressing various challenges. Parallel programs such as boda boda care, launched on 24th July, raise questions about whether policymakers believe UHC will achieve its objectives.
It is important to note that adequate numbers of skilled healthcare workers, improved infrastructure, and the unwavering support of policymakers are vital components for success.
By investing in these areas, Kenya can enhance access to quality healthcare, mitigate financial burdens on individuals, and achieve its vision of universal healthcare coverage for all its citizens.
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