MEDICAL INSURANCE IN KENYA IS IN ICU

The whole idea behind medical insurance is one of pooling resources into a common fund to protect against a future unexpected health emergency. This is truly noble and engrained in our cultures. A culture of helping someone in need and taking that responsibility as a community. But shockingly the uptake of medical insurance covers in Kenya is less than 2%, but if you were to include NHIF as a form of medical cover then 8% coverage. Most of the members of insurance schemes are employees in a fund mostly solely contributed by the employers. This has its origins in post-World war II America where the labour laws necessitated a cap on salaries but the benefits due to employees were not capped. This made it easy for big corporates to lure the workers through a good medical or dental plan. The same replicated itself all over the world and now the nascent Kenyan economy has to contend with a burden of medical care as a cost of production.

The insurance providers in the country are reeling from huge losses in their healthcare portfolios that it’s a miracle that we still have a medical insurance industry in this country. The mood in the industry is one of doom and gloom only covered up with a surplus in other portfolios they may hold. The factors responsible for all these chaos are many but the major ones are:

A medical insurance system based on a fee for service is the prevalent form. This is a demand driven system with the health service providers and payers and users of the medical schemes holding the ace. They dictate how much the cost of service will be though some legal and at times abhorrent behaviors. Many providers have not put in place mechanisms to contain the runaway medical bills because it is not in their interest to do so. As long as the gravy train continuous they are ok with it. This results in increased claim payments with no commensurate increase in premium values due to the muscle of the employers when negotiating a cover and undercutting and competition among the insurance players. The users for whom the insurance is procured are a lot that does not seem to understand the basics of how modern health insurance works and end up adopting a kamikaze approach. It is not a secret that as the financial year closes most employees make a queue to the nearest facilities to make use of the cover they never utilized because they were healthy throughout the year. The pathetic excuse given in most instances is that, “I am covered for Shs 1,000,000 and I have not been admitted even once, so I should make use of it because it will expire in 15days.” This said by someone who paid a premium of Shs 30,000 at most. This is truly baffling as this mentality is what may eventually kill the medical insurance industry in Kenya. I guess majority of policy holders do not realize they are slaying the goose that lays the golden egg until itself to late and the goose is already cooked and on the table. A last supper.

Of greater concern though should be the increase in non-communicable lifestyle diseases mostly in urban areas and especially among the insured portion of the population. This is because the principle of insurance works best when there is a large proportion of the population that is healthy and a small portion that is ill. So when the equation is tilted and the insured are the ill ones coupled with skyrocketing costs of medical care, the recipe is disaster.

I do not have foolproof answers to the challenges but I can only hope that attempts are made to reform the system as the current fee for service system is untenable. There is a need to study the Kenyan health seeking behavior and devise a system that takes this into consideration. One of the most successful systems that could use is one of capitation where the health service provider is entrusted with a fixed amount per scheme per period. This would enable cost containment and a level of sanity among providers. But without checks and measures the quality of care provided would be jeopardized. That is why a value-based system as espoused by the management guru Michael Porter is the only solution. Through such a system cost, quality and outcomes of healthcare are entwined and can be measured .There would be standardization of care and non-conformity to set guidelines would be tracked, documented and corrected. All these are not just verbose narrations but the truth that can set us free and get the industry from life-support. It’s been proven elsewhere.

In lays terms if one leads healthy lifestyle they would be given rebates on their next premiums and better weight management and healthy lifestyle like use of gyms and good control of blood sugars and blood pressure would be the targets to achieve rather than asking “how much is left in my cover?” and therefore attainment of health goals .All these can only be achieved if there is better coordination and cooperation among the industry players whereby the database of members would although controversial  be shared to prevent future non-disclosures of chronic conditions. There will also be need of standardization of care at all providers and incorporation of other useful features of a working health system.

The status quo can however be maintained if we seek to kill a useful feature of our health system and to cause a regression in attainment of international standards of life indicators. This is not so bad if we seek to promote the coffin industry and by extension the printing industry, for the obituaries will be many.

THE AFTERMATH OF THE WESTGATE ATTACK

I foresee a situation where

• Al Shabbab are emboldened by the act of terror that struck at the heart of Kenya's economic class.
• Victimisation of Muslims and Somalis,from the verbal attacks to most likely a retaliation from people who have had a pent-up anger at the acts of the terrorism and who associate the terrorists with either Muslims or Somalis,to physical assault on them in the form of gun-attacks and arbitrary arrests by the government forces.
• Increased funding and work of the Anti Terrorist Police Unit.This will be a means to neutralise the so-called terrosts.Funding can only from one source,external governments because we are too strained as a nation to stain a war on terror.
• Greater subjugation of the Muslims in Kenya and throughout the world as they try to fit in and fear reprisal for not towing the official line.All Imams will be warned,Muslim sermons monitored and the practice of Islam undermined.
• Kenya does not pull-out of Somalia,we are forced to bear the human cost of the war in Somalia and  economic stagnation as we focus solely on funding the military and forget all about economic development.
• Massive decline in tourists arrival and foreign investment in Kenya,resulting in diminished GDP growth and greater recipe for a human capital problem in Kenya due to masssssssive unemployment.
• Regional witch hunting where every country  will find it profitable to claim Al Shabaab attack in order to get funding from the powers that be.
• Crime rates will increase due to a combination of the above factors.

I hope and pray that am wrong on all the above,but seldom am I wrong in these matters of prediction.Currently am too affected and shaken by the events at the Mall that I cannot write a long treatise expounding on the above.All I can hope for is quick resolution of the stand-off and peace on earth.

DANGER-GLOBAL ALERT OVER MERS (Future Headline)

The most important news never make it on national or international press because of the editorial policy of those companies.Some headlines can be stranger than fiction and the more reason for you not to read them.
 So,do you know about the novel alpha-coronavirus?Do you care to know about it?Read on

DANGER-GLOBAL ALERT OVER MERS- November 5^th 2013
The World Health Organization has declared novel coronavirus infections MERS as a global pandemic.All countries with international flights connections and or recent arrivals from Mecca for the annual Hajj pilgrimage are considered potential hotspots.The Health regulatory authorities are urged to put in place measures to counter its spread through quarantine and thorough checks on arrival.Any person who may have come into contact with a case should report if they were suffering from any chest infections and or respiratory distress and treated for a flu in the last one week.The WHO and other international disease surveillance organizations urge the populace not to panic and to continue with their day to day activities but with caution.
 
The above scenario will potentially  happen .Pointers to this are the black-out given to news on the transmission,virulence and potential of the disease.Many of my friends and relatives will go for Hajj this year and I hope and pray that they are given enough information on how to protect htemselves from exposure to the virus.The dilemma though is the culture of secrecy in matters epidemic.By highlighting concerns of likeminded people as in the article below I hope some action is taken to ensure control of the spread of the disease.Imagine the outcome once MERS is a pandemic?Lets not just imagine and instead do something about it now to avert future catastrophe.

Below are two good reads on the matter,one from a scientist ehom i suggest you follow to understand more about the MERS and the other from a journalist


Virology Down Under-the blog for Virology Down Under. Info and opinion on viruses: what they are, how they tick and the illnesses they cause.

Censorship Doesn’t Just Stifle Speech — It Can Spread Disease By Maryn Mckenna http://www.wired.com/opinion/2013/08/ap_mers/
In October, Saudi Arabia will host millions of travelers on the hajj, the annual pilgrimage to Islam’s holy sites. The hajj carries deep meaning for those observant Muslims who undertake it, but it also carries risks that make epidemiologists blanch. Pilgrims sleep in shared tents and approach the crowded sites on foot, in debilitating heat. They come from all over the world, and whatever pathogens they encounter on the hajj will travel back with them to their home countries. In past seasons, the hajj has been shown to foster disease, from stomach flus to tuberculosis or meningitis.
The Saudi Arabian government has traditionally taken this threat quite seriously. Each year it builds a vast network of field hospitals to give aid to pilgrims. It refuses visas to travelers who have not had required vaccinations and makes public the outbreaks it learns about. This year, though, the Saudis have been strangely opaque about one particular risk—and it’s a risk that has disease experts and public-health agencies looking to October with a great deal of concern. They wonder if this year’s hajj might actually breed the next pandemic.
The reason is MERS: Middle East respiratory syndrome, a disease that has been simmering in the Middle East region for months. The virus is new, recorded in humans for the first time in mid-2012. It is dire, having killed more than half of those who contracted it. And it is mysterious, far more so than it should be—because Saudi Arabia, where the majority of cases have clustered, has been tight-lipped about the disease’s spread, responding slowly to requests for information and preventing outside researchers from publishing their findings about the syndrome.

The Wall of Silence
To understand why MERS is so troubling, look back to the beginning of 2003. For several months, public-health observers heard rumors of a serious respiratory illness in southern China. But when officials from the World Health Organization asked the Chinese government about it, they were told that the countryside was simply experiencing an outbreak of pneumonia.
The wall of silence around what came to be known as SARS (severe acute respiratory syndrome) cracked only by chance.By mid-March there were already 150 cases of the new disease in seven countries. SARS wound up sickening more than 8,000 people and killing almost 800 in just nine months. Luckily, the disease was quelled in China and Canada (where travelers from Hong Kong touched off an outbreak in Toronto) before it had a chance to evolve into a more efficiently spreading strain.Many experts believe that given time to mutate in humans, SARS might have become a deadly pandemic.

For this disease too, the first notice was a posting to ProMED—this time by a doctor working in Jeddah, Saudi Arabia, describing a patient who had died several months before. That September 2012 communiquè, helped physicians in London realize that a Qatari man they were treating was part of the same outbreak. From there, MERS unspooled. People also fell ill in the United Arab Emirates, France, Germany, Italy, and Tunisia.
But Saudi Arabia, home to the vast majority of confirmed cases, remained far from forthcoming about what it knew. Announcements from the Ministry of Health supplied little useful detail and discussed illnesses and deaths that happened some indeterminate time in the past—possibly days, possibly even weeks.
So far the number of MERS cases is just a fraction of the toll from SARS, but health officials fear that the real count could be higher. Especially worrisome is the death rate among the afflicted: While SARS has been estimated to kill roughly 10 percent of its victims, MERS so far has killed 56 percent.
Certainly censorship about the spread of disease is nothing new. The largest well-documented pandemic, the great flu of 1918, is called the Spanish Influenza in old accounts not because it started in Spain (it may have begun in Kansas) but because Spain, as a neutral nation during World War I, had no wartime curbs on news reports of deaths.To this day, no one is sure how many people died in the 1918 flu; the best guess hovers around 50 million worldwide. Regardless, since the virus took 11 months to circle the planet, some of those millions might have lived had the later-infected countries been warned to prepare.

After SARS, no one thought that it would happen again. In 2005 the 194 nations that vote in WHO‘s governing body promised not to conceal outbreaks.And beyond that promise, public-health researchers have believed that Internet chatter—patterns of online discussion about disease—would undercut any attempts at secrecy. But they’ve been disappointed to see that their web-scraping tools have picked up remarkably little from the Middle East: While Saudi residents certainly use the Internet, what they can access is stifled, and what they are willing to say appears muted.
Nearly 100 years after the great flu, it turns out that old-fashioned censorship can still stymie the world in its ability to prepare for a pandemic.

So what now? The behind-door seething may be having an effect. A WHO team was finally allowed into Saudi Arabia in June, and the Saudi government has announced limits on the number of visas it will issue for this year’s hajj. Meanwhile, governments and transnational health agencies have already taken the steps that they can, warning hospitals and readying labs. With luck, the disease will stay contained: In July, WHO declined to elevate MERS to a “public health emergency of international concern.But the organization warned it might change its mind later—and if it does, we should fear the worst, because our medical resources are few.

 At present there is no rapid-detection method, no vaccine, and no cure.

While we wait to see the full extent of MERS, the one thing the world can do is to relearn the lesson of SARS: Just as diseases will always cross borders, governments will always try to evade blame. That problem can’t be solved with better devices or through a more sophisticated public-health dragnet.The solution lies in something public health has failed to accomplish despite centuries of trying: persuading governments that transparency needs to trump concerns about their own reputations. Information can outrun our deadly new diseases, but only if it’s allowed to spread.

Tawakal’s note:
Choices have consequences and the choice to do nothing in the face of MERS will only lead to disaster.We can wait until WHO yells,Fire!! but it might just be too late and more costly to contain the pandemic by then.Let the innternational media pick on this chatter on the fringes of cyberspace and transform into a public health awareness campaign without the delirium of SARs and H1N1 interventions which were later found to have been overblown,to the benefit of Roche?
Those outbreaks taught us to be cautious in the face of news of imminent epidemics.This may lead to complacency in our response to MERs and with dire consequences.
On another note,am just wondering if the MERS outbreak was not in the Middle East and specifically Saudi Arabia,what would have been the response?Hmmmh!!!!Food for thought!!!!

DEVOLUTION WILL KILL THE KENYAN STATE

Coming soon,pros and many cons of the devolved system of governance.

DEVOLUTION-A RECIPE FOR ECONOMIC RUIN

In all honesty I am in brace position,ready for the impact of the Kenyan economy hitting rock bottom and social unrest exacerbating the capital flight and reversal of the good fortunes of the last few years of foreign investor confidence.
I do feel that the excessive taxation by the central government and not far from now county government local taxes and cess it will be untenable to do business anywhere in Kenya unless the black market.Our nation is at a crossroads as to the path to choose for progress.A majority of people(me not included) decided that introducing devolution will magically solve our problems of inequality and inequity of resource distribution.But what are the pros and cons of devolved governance?and how do we reach a consensus of the most appropriate governance system?This is not really a simple question as we each have our own experiences that has shaped how we perceived the old system of central control.This  clouded peoples judgement and noone want to hear control from a single entity in Nairobi anymore

Ever since independence we distorted central leadership to be a source of self-engradisement of a few  privileged and influential who amassed as much land,property and wealth and formed the elite class.The pyramid then had its body of middle class in a rat race to aspire to achieve enough to live on the same level and never think of anyone else.The base was made up of the greater largesse of the population,the slaves.For their is no other term to call one who is subservient and under the yoke of poverty, destitution and despair.The best that they can hope for is to be on the good books of the middle class in order to feed off the crumbs that are left for them.In this system ,honor and respect depends on ones wealth status and so you can guess the honor and respect that the poor and the marginalized had.

The elite and middle class in the pyramid resided in Nairobi and other major towns and dictated how the majority of the people would live.The cronyism that started has not stopped but has instead increased over time.The little assets we had was given away or lies bare and unattended while there are poor people willing to till the land.The poor need not be just statistics like the livestock which one brags about..The inequality perpetrated by the elite and consolidated by the bourgeous  polarized this nation to the extent that the gap between the haves and have-nots widened.

The poor people in the periphery of power were promised redemption and salvation once a devolved system was set up.Therefore they overwhelmingly voted to have a system with a de-centralised structure which would be governed at their doorstep.Little did they know that they were just devolving greed,corruption,nepotism and misuse of public resources.ore so it becomes very difficult in the African culture to stop your tribesman who is doing anything wrong lest you be termed a traitor.So unbeknown to them,the previously marginalized village folk stand to be marginalized and made poorer by the devolved system.

In the meantime the tax paying,middle class has not increased and so any source of funding for development of the counties can only come from the countable middle-class who are already burdened with heavy taxation.The other options are very limited in the form of domestic and foreign borrowings.Inviting foreign investment in Kenya,to me is not the solution.The gains from such a move are illusory.The foreign owned companies will always repatriate the profits gained from local operations leaving the government with minimal collection in the form of tax from the ventures.The foreign companies and nationals get to come over and invest,pillage and plunder and disappear as soon as the resources are exhausted but we are only to get special arrangement to penetrate their markets.Any move to attract foreign investment should also target reciprocal arrangement ot allow Kenyan products and entrepreneurs penetrate those markets.The solution lies in giving locals financial muscle to compete in the export market.Nothing more,nothing less.

The nett economic effect of a county system of governance is one of uncertainty and ambiguity.No two counties will have similar policies and this will lead erosion of investor trust in doing business in a nation of 48 governments.There may be a few stand out counties where logic and good leadership may prevail and result in better returns for the locals of those counties,but those would be few and countable.In the end for the economic progress of Kenya as a nation and to increase our competitiveness internationally we cannot rely on this devolve system to spurse economic growth.

In conclusion I wish to state that devolution does not make an economic sense to the Kenyan state and we should click the undo button and revert to central governance but with amendments.

THE POLITICAL CIRCUS IS STILL ON

The clowns have put on the suits and adjusted the flippers ready to come on stage.Hardly three months after the last elections and people have started politics of us against them.In the mind of the Kenyan politician there is never such a thing as time-out.Time-out to reflect on the effect of their politicking on economic and social progress of this nation.

LEARN TO BE COMPASSIONATE

Ever since I was a young boy growing up,I was fascinated by the dedication and selfless actions of the community I lived in.,where i was assure of security,shelter,food and a reasonable education.But as i matured and became an adult, i've seen a change that i do not like and would like to stop.This is a painful moment that i have to unleash the vernom of a common man on to the leadership and largasse of the great nation of Kenya who have allowed this to happen.

It is simple really,All-mighty had the Wisdom to raise prophets among the nations of the world in order to propagate the message of hope,justice,peace and equality.This was sufficient reason to obey and follow.But no,we are a wicked and lost people.Once upon a time,justice,equality,brotherhood of mankind and good neighbourliness were high ideals to aim for.But not any more.

Our conduct as a community is anything but religious.Not a day passes that we do not hear of horiffic killings,utterly shocking defilement of minors by close relatives who are entrusted with their care or mass killings and ethnic clashes that leave thousands homeless and internally displaced(but never referred to as refugees).The religious people that we are,we forgive the wrong doers and hope that they do not repeat.We even accept compensation of a goat for the rape of a 2 yr old by the neighbour.Just because it was "shaitani alimuingia".It is time the people of Kenya realised that tolerating injustice and crime on a section of community is wrong and should not be accepted.But how do we start.?
We could declare a month of national and even international prayers with guess speakers from as far afield as China,but we shall still remain the same.We could build temples of gold and hope that this makes us holy,but if the wickedness has been deeply implanted into our national psyche,nothing can help us.
I dont want to be an apocalyptic prophet of doom,but if the truth be told,we have sunk too low as a nation. There are many causes for humans to sink this deep and its all out of our own making.We have failed to understand that the belief in God implies respect and compassion for other human beings regardless of station in society.Every day the cries of the Aids orphans go unheard,the bandits of the frontier districts dessimate villages and instill terror,with the pleas of the helpless falling on deaf ears.We indulge in illegitimate acts and believe in paying bribes even before they are solicited and simply look out for our personal interests only at the expense of the greater good.We select our leaders based on wealth and ethnicity and they do not dissapoint us,for they live up to the tribal cliches.
Dear Kenyans it is time we truly soul-searched and reflected on our perverted and immoral life.We should live up to the high ideals of Godliness and have genuine concern for humanity.We should seek redemption and repentance for our double lives and save our nation.Let us tackle the root causes of hopelessness and despair.Lets think of the possibility of living in a peaceful,just and equal society.We should stop deluding ourselves with our material possesions and should act humbly and modestly always.May this be the reality of our nation and inspiration for all generations.Because if we do not,we shall have broken the covenant and should live with the consequences.

LIVING BEYOND YOUR MEANS-A CASE STUDY OF A BANANA REPUBLIC

So the government of Kenya has decided to implement the VAT Act and impose VAT on wide range of products previously exempt.This is despite a hue and cry from a cross section of citizens on the adverse effects of such a move.My people,this is just the beggining.Much is in the offing if the status quo continues.

 The government has a cash crunch.Plain and simple.In June a very ambitious "growth" budget was proposed by the central government.Not to be left behind,counties started to outdo each other with outlandish and unrealistic estimates of expenditure.What noone ever asked them is how they were going to fund the expenditure?Its not as if the government suddenly started laying golden eggs.(As a flashback we already slew the bird which used to lay the golden eggs in 2007,through sales of govt stake in cash cow firms).
So with a trillion shilling budget,one needs to ask,where do you fund it from?With no clue as to the most approriate way to fund,the easier answer was,taxation.Over the last decade there has been a consistent and unstoppable tax demand placed on Kenyans that its difficult to figure out for how long the trend would continue without it caving in.

To understand the current cash crunch in government one needs to have a flash back of the last ten years of economic growth.There wasn't anything magical in the growth,nor were there above average returns on any of the growth sectors.No new avenues to create economic growth has been found except the sale of government stake in all cash cow firms like Safaricom and Kengen.After the sales,the government was at least able to meet immediate short term needs of funding a bloated coalition government.Now few years down the line,the government is soooooo broke that it had to delay salaries of state workers for the month of July 2013.

There has been no move to address the concerns of the populace on the heavy taxation that we are forced on.The root cause of the heavy taxation is the increased spending due to double layer of government and legislative structures of the new Constitution,and an appetite to do things on a grand scale at all times,trying to outdo what the previous regime did.Prudence dictates that you do not live beyond your means and this is a lesson the regime is yet to learn.The state needs to reduce expenditure and look for avenues to increase economic growth rather than taxation.The government is in a catch 22 situation and more woes are bound to arise.

My crystal ball can see a looming sequel of delayed state workers salaries in September or October.Then the government will raid the local banks and result in an increase in interest rates above 30%,and an economy on the verge of collapse.We shall be forced to dig deeper and deeper into our tattered pockets.I can only hope that am wrong and that all this are just rants of an insomniac.

SPEARHEAD YOUR LIFE TO GREATNESS

I beg to ask,what is greatness?Is it riding in a BMW convertible on a perfect summer afternoon with the breeze gently stroking your bald held?Is it breakfast in Paris lunch in London and dinner in NY.? Or is  it to pulverizing  chicken wings and washing it down it fresh passion juice?I believe we each have a defination of what greatness is.I think its in living a life of congruence with your values and making a positive difference in the life of someone in this world that we can truly be great.

I guess there are many ways to look at our lives and the impact our existence in this world.Ever since the beginning of mankind,man has always questioned himself on the rationality of goodness and the principle of altruism.But as we slowly became more advance technologically our human connections were lost and replaced with forlorn looks of a flock of sheep chewing curd and just being.

We live in a concrete jungle that makes it difficult to do good and to thank God.Many a time as we wake up in the morning we forget that even the breath of air that we enjoy is a gift from a Supreme Being.We need to give back something to society in order to show thanks to the Almighty.This way our dealings with humanity will lead to peaceful,joyous life and you will have better returns when you are called to account for your life in the Hereafter.

You may be experiencing anguish,sadness,lost and loneliness in your life but remember "baada ya dhiki,faraja".Knowing that someone else has it more rough than you could be the impetuous to live like a human being.In so doing you will shed your outer shell of fear and pessimism and it will be replaced with positivity and happiness.(But again that could be the effect of ganja,which will also leave you smiling sheepishly).

Trials and travails visit upon humanity not because of a curse or upsetting a rain-god somewhere but as a trial to check whether you will still be happy with what you have in spite of all the challenges.Many are lying on hospital beds breathing their last,others are in war zones running away from fighting to a life of destitution but you are in peace and security.Drinking a cuppa as you browse the net for some class assignment or movie za Mombasani.Cheer up!! realign your goals and live your life and show a single act of kindness today(or tomorrow morning).

Just do good because you want to do good and the positive energy you have will rub off all around you.Cheer up and Dont worry!!!

GOOD HEALTHCARE MODEL

I have been wondering and sometimes aloud as to why our health system in Kenya ails. have been in conversation with many in the field and we each have our own take as to the problem and its solution.What if we are all right?and our solutions all wrong?
The perspective am looking at is one of social justice and equity.What do you think?

VOLUNTEERING SPIRIT

All human beings are born equal. But due to varying circumstances, some are born in poverty, riches, joy or sadness. In the end, the cycle of life makes its way and claims the less adept and thus, the most at risk of being overcome by misfortunes are the under-privileged.So a profession that has as its core principle the doing of good should be in the forefront of championing equal opportunity in this very unequal world.

Healthcare workers, being in a calling akin to propagation of moral standards and virtue associated with religious belief, should always strive to do the right thing.Using our skills and knowledge to spread useful health and lifestyle information to the public and the under-privileged should be our priority in social justice programmes. Government should provide healthcare, but who is the Government?

HOW MANY OF US WORK FOR government institutions, drawing a salary for our work but like mercenaries we only do so when paid.With no hope of helping directly in our calling, yet we have the skills and degrees to boot? Volunteering at a community health clinic for five hours a month could help reach the disadvantaged and improve service provision.

Thus the healthcare worker should think twice before insisting on a consultation fee of thousands of shillings for a skill that is God-given. Every healthcare worker has a duty and a covenant to protect lives. When a majority of the people in a country is ailing so will its economy. Diseases place a huge burden on the nation in lost work hours while seeking treatment. The 56 per cent who earn less than a dollar a day and cannot have access to basic health facilities are bound to get sicker and poorer while the middle and upper class watch.An alternative way of handling this crisis is by organising health clinics which are not-for-profit and are run in a transparent and accountable manner. We can have one or two specialists volunteer for a six-hour shift to attend to cases related to their area of specialization.

It is possible to attain these health goals. But a team is better than an individual effort because of the synergy inherent in our collective experiences and knowledge. This is why there is need for the formation of a team to coordinate the activities and brainstorm on how we can help in the provision of health benefits. These volunteer activities are an investment in the future of our nation. This is a fact, as we shall end up spending less on curative healthcare as in a preventive system the economically active portion the population is able to produce more to help realise Vision 2030.

With our small interventions here and there, we can give proper guidance and reach a stage where the Government would be offering preventive healthcare on a regular basis rather than when floods wreak havoc in the low lying areas.Identifying the health needs of various sections of society will ensure proper procurement of drugs based on need. This should serve as a wake-up call to health professionals to act with more compassion for the poor. For the general population, good health is a blessing, hence the need to prevent diseases.

WE'VE ALL HAD DEEP MOMENTS OF reflection in our lives and guided by our sense of purpose and altruism we can surely achieve our goal.Kenya can only be built through community partnerships and not individualistic pursuits spurred by the Western capitalistic mindset of what is in it for whoever does something for the community.

(Opinion piece share on Daily Nation in April 2007) by me.
Nostradamic??Hmmmm.

FEEDBACK ON MY POSTS

Hello.
Sometimes in life we seek feedback and criticism on what we post.I guess I am asking whoever has read my blogs to comment on how you find the posts.I will greatly appreciate the feedback.

NATIONAL HEALTH SCHEME FOR KENYA IS POSSIBLE TODAY

I believe that the more we keep quiet and do nothing to clamour for change of the way we are governed,the more the government will perpetuate the status quo.In healthcare the status quo is NOT an option.So i beg to ask what happened to the famous Ngilu bill?I guess many of you have questioned that too..This is what i think happened,and how we can reclaim our health system from the doldrums.

A degree of sceptism and cynism is good,but overly worked up frenzy can lead to witch hunting and retrogressive development(quite ironical really).The cynical and suspicious nature of Kenyans has been embedded so deeply in the psyche that all we ever see when we look at a lush green field are the weeds. It is this stereotype that has been well propagated and accepted that we always are the first people to not see the benefits of some visionary planning in government or in the private sector.This has been perpetrated so fully that it’s the stereotype of the typical Kenyan. It is so acceptable that the most memorable character portrayals of a Kenyan on TV and films is of a nosy, curious and inquisitive neighbour(Mother-in-Law?),always poking more holes into affairs than an anxious woodpecker on a cypress tree. Some stereotypes lead to labeling, and labeling makes one to associate with the trend that they are thought to exhibit. Lord forgive me for thinking of the perceived stereotype of the nationals of a major West African nation we all have and how it more than always is true as they live up to it. Anyway this discussion is not about stereotype but rather more critical matters of health care and what we make of it.

You see, Madam Charity Ngilu when serving as a Minister of Health called for the formation of a national social health insurance fund. The next thing we heard were voices all over the media up in arms on how unworkable the formula was. But we all knew what they meant was actually “Gee, its more political mileage to so and so if it succeeds and I have to stop it” or the thought that “someone wants to eat here”. So hear me out on what I truly think of the health scheme.

First,the name. We all too ignorantly think of insurance as a way getting rich through profiting from work not done.Far from it,In fact it’s a scheme of protection against an unlikely occurrence.Even the islamic culture i belong to had a maritime insurance of sought which cushioned the travellers against misfortunes likely to occur in the journey(i bet you didnt know that).We need to re evaluate the title of any proposed scheme of health "cushion" to a more benign and socially acceptable word - National Health Service perhaps.?

Secondly, a well run healthcare system with most minimal problems best works where the level of vested interest is minimal and the concerns of the majority dorminates.Any vested interest like big pharmaceutical companies(Big Pharma) would cringe at the thought that branded drug sales be restricted after the attainment of a certain percentage of profit. This would involve full disclosure of the research and development costs(which can be substantial and important in innovative product formulation),operational costs and the mark up they put on the final drugs,visa a vie the prices in the Western world bearing in mind the limited purchasing power of the commom Mwananchi. The recovery of their capital layout and development costs should be markers of the expiry of a product’s patent akin to mining of resources in a country by leasing the land for a number of years and not the wholesale purchase of all the land in a country. This would stop the endless exploitation of generations of (Just an aside here, did you know that some drugs are more expensive here in Kenya than in U.K? I bet you didn’t know).Since the national health scheme would limit their influence in the purchase of branded drugs they will oppose it by all means. You see, the scheme is more of a reform of the health sector to ensure the best structure for the provision of services that Kenyans crave. Thus, the second thing to do is rein in the runaway train of vested interest so dormant in all spheres of our lives that not a person is immune from its repercussions. Be it the pull of prescribing the branded drug from Western multinationals,by a naive-doctor who attended its launch in the rather dreamy comforts of a five star hotel.

Thirdly, for the scheme to work the healthcare body management should be from the ground level catering for local needs and not imposed on the people from Central government.With the devolved system of government and the President's commitment to its effective achievement i do think its possible.An emphasize on meritocracy at all levels and selection on the basis of ability and passion to serve and not from the political or social affiliations. The administrative structure should be based on the concept of performance contracts system so well utilized by the other target of my wild tirades against the west, the multinational organizations.With their aesthetically appealing logos and catchy mottos that promise nirvana and (36 hours of Pleasure!). With this clear set up of transparent body for the operations, spurred by a need to provide quality ,affordable(even free to the unemployed) healthcare to the people with the sole intention being operational efficiency and not greed for profit or self engradisement.Such a system can work if we shed cynism and mistrust we have of one another and sit down to chart the way forward to free healthcare system molded on the Cuban example.

So, what is the worst case scenario if we do implement the system? Well,operational inefficiencies and a bit of bureaucratic hitches over the disbursement of payments and rebates to the private health institutions would be one major one.Thus,the opposition by the private health institutions lobby. But again why would we have to go to private health providers if the public health system works. The insurance firms anyway have more restrictions in the medical insurance covers they offer than the corset of a Victorian maid. This does not justify the premium paid. Yet its all legal as you sign on the dotted line out of own volition and not compulsion by anyone. But again, why pay for healthcare if the public service works. The vested interests thus have been vocal in the challenge to this development and will continue to be so till they have their way. By now you will understand why I cannot be a poster-boy for any for-profit organization. So, I rest assured that I won’t get sponsorship to the professional association symposiums. But again symposiums held in posh hotels and heavily sponsored by Big Pharma is not my type of occasion to schmooze and confer with colleagues. I would rather it be a simple affair at public venues with regular meetings and professional development activities and awareness and social programs regularly. That way, the piper doesn’t get paid.

Am not wholly against Big Pharma because they offer some nices goodies, like the pen I used to draft the first copy of this bitter pill on paper (pardon the pun).So, all am asking is that we listen with an open mind to all reasonable voice of reason and reach a consensus to save our people.The new Minister of Health should guide us forward towards the achievable goals of Healthcare for all by 2010!!! or anywhere close to that year.2050 perhaps.(I will be 75yrs then and in need of a good nursing home.That is if hypertension,diabetes,Prostate issues and arthritis dont get to me).

For there to be effective healthcare reforms we have to listen to the healthcare personnel in their quest for better service for the people they took an oath to heal.Kenya Medical Pratitioners,Pharmacists and Dentists Union (KMPDU) has been vocal in bringing attention to the utterly deplorable conditions our health institutions are in.With there zeal to correct the ills of years gone by,the Minister will surely have to listen to them and nurses who tend after the sick in difficult circumstances and at minimal wage.Also varied opinions from people with expertise in various sectors of management, social services should be welcome.

As a parting shot I have to remind all of us that the magic of modern medicines,Penicillin was discovered accidentally by Fleming in that very famous morsel of bread on laboratory table story.Thus we never know,maybe Ngilu may have had a an idea way before its time and its now time to actualise it.

I am a rather naïve and Quixotic fellow, willing to believe in the power of the possibility of achieving much through altruism and empathy with actions that are not selfish in the least, if such a thing exists.To conclude I hope the venom of my anger is not all rage but useful in shaping a policy that can help this nation for now and eternity.



Thank you. God Bless Kenya.