Obstacles In The Path to Universal Health Coverage In Kenya (Part One)

UHC logo by WHO-EMRO

In order to overcome any challenge its’ important to understand the major factors involved, their strength and capability. Once you have understood that, remember that its in the challenges that lie the opportunities for success. In pursuit of universal health coverage the challenges are many and vary from country to country. In the Kenyan context, several key obstacles stand in the way.

Lack of political patronage and commitment

Due to the myriad other possible campaign promises to be made, healthcare seldom features as a major tool for politicians other than the medical camps that are prevalent during the campaign period. In June 2013 I saw a glimmer of hope and change due to the presidential decree to waive maternity fees in all public healthcare facilities. This was a turning point in the fight against maternal mortality which drags the country back in attaining development milestones. Earlier in the decade the previous regime in collaboration with international partners including GAVI,The Vaccine Alliance expanded the scope of government provided childhood vaccines to include Pneumococcal vaccine, a leading cause of infant mortality.

Later in 2014 the government in partnership with GAVI introduced Rotavirus vaccine in the immunization package for Kenya. Rotavirus,I a leading cause infant mortality due to diarrhea. But that was the end of the goodwill and what ensued was an offscript rendition of Oliver Twist which has culminated in the health-workers industrial actions of 2016/2017.

With lack of intervention by the president in cooling down the heat of the strike, the ruling party has lost goodwill of the masses in its handling of the strike. No political party has taken up healthcare and healthcare-related challenges as a major campaign issue but instead they have concentrated on polarizing the nation along tribal lines with non-issue based politics. The official opposition too is not without blame for not coming out in force against the government inaction to the doctors strike the same way they were active in advocating for changes in the electoral commission composition and leadership. This shows the lack of importance both major political groupings in the country place on healthcare. This could be because the ruling elite DO NOT utilize public healthcare facilities and DO NOT KNOW what it means to wait in the queue for the few doctors to attend to patients in deplorable working conditions. Other Universal health coverage advocates such as Wandia Njoya have already elaborated on the disconnect between the ruling elite and the rest of Kenyans in their healthcare service provision.

Read #LipaKamaTender Our politicians and public healthcare

For as long as healthcare and universal health coverage in particular does not attract a Raila kitendawili or an Uhuru-dab we shall not achieve much in reforming and saving our healthcare system.

But the choice for all Kenyans is clear, let’s make healthcare a priority for the major political parties through various ways.

One way such way is to create an awareness through A petition to have political parties declare their stand on Universal Health Coverage as an agenda item in their manifesto and we hold them accountable to it when they come to power after August elections.

Read:Make Universal Healthcare Coverage a campaign issue in Kenya 2017

I hate to be a buzz kill but to expect a complete resolution of the health workers strike and improvement in services in public healthcare facilities before next elections is untenable as the gear has shifted to electioneering and any solution found to the issues raised may be temporary as there is no assurance of follow up by the next administration that comes to power. Not to dampen the spirit of doctors calling for #LipaKamaTender but remember whatever promises you get now might not be fulfilled in September so you are better off asking for a long term binding process that will ensure universal health coverage and better healthcare provision to all Kenyans. Maybe a compromise temporary solution could be what could calm the situation while you team up with other Kenyans of goodwill to shape the path to Universal Health Coverage in two years’ time.

Vested interests

The vultures hanging over the slowing dying public healthcare system have patronage in high places and have a fixed agenda. They seek to reduce government involvement in healthcare to just to policy and regulatory framework formulation. Regulatory framework formulation process which they will still seek to be a part of.  Confusing? It shouldn’t be.

The private sector arm in healthcare backed with resources from international investors and foreign countries seek to slowly influence public policies that favour private investment in healthcare as opposed to government service delivery through the devolved units.The international healthcare investors have identified Kenyan middle class as a sweet spot for them. These private healthcare investments have at their core return on investments and not better health access for all Kenyans. So, they should not be let to dictate the path of healthcare reforms and policies changes in the country but should be made to adhere to a standard of practice for private investment in healthcare.
In various forums, they have made this clear and its’ only a fool who will not listen to the grunts of hyenas on the prowl. So, next time you hear overemphasis on private-public partnership or encouragement for private investment in healthcare service delivery and government role being just policy formulation shout “hyena”.

Another set of vested interests are the local health insurance companies which stand to lose a lot if universal health coverage with emphasis of public healthcare service provision.Although the health insurance penetration rates in the country is low,there is a concentration of high per capita expenditure on healthcare in the major urban areas and especially government run parastatals and corporations with unlimited medical covers. The cumulative medical expenditure for the top parastatals and corporations could easily fund the Ministry of Health budget twice over. This can only mean that the health expenditure has massive disparity that can only be corrected through a National Health system.

Part two:Coming soon