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.
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