Let's listen to the people on issues healthcare

Every single article on healthcare in Kenya currently starts and end with Universal Health Coverage as if it’s an event just like the World Cup with ribbon cutting and pomp and colour to mark the occasion. Players from various sectors have already weighed in on the issue to the extent that conversations has been reduced to a chorus of “Do this, do that” and a scramble to be on the table of policy formulation, such that it now looks more like a pie-eating contest than a visionary approach to better healthcare. For all intent and purposes UHC is a people process that requires careful planning, consultation and implementation. In my opinion, UHC is not about what the president wants in his BIG 4 agenda but what the common man needs in their day to day health seeking and wellness.

Already various bodies have forwarded their vision of how the UHC can be implemented and while some remain noble attempts at achieving results, most tend to be a hyena pack with kizungu mingi ready to focus on innovation, complex process costing approaches and very few seek to demystify the agenda.

In my opinion a logical approach would be to handle the UHC agenda as we would any social issue by involving the people and understanding their local needs before pushing for a top down approach of implementation.

Most of us have had to be involved in various Whatspp fundraising campaigns to fund medical bills for a family member, colleague, acquaintance and even random strangers who have access to your number and are pulling a moonshot hoping you will help in alleviating their problem. From interactions in those fundraisers, it’s easy to understand the challenge people face to get best care possible with limited resources. As healthcare management and policy experts, let’s take a backseat for a while and understand the drivers of burden on mwananchi.

Most of the anecdotal reports do point out to lack of available government or subsidized care, both primary and specialized closest to the people. In such scenarios, people are forced to seek care from profit motivated care facilities whose most important goal is better returns for shareholders. Thus the care will be provided, but at a cost that is astronomical, uneconomical and downright depriving.Like the shylocks they are,private facilities and even government ones now claim their pound of flesh by detaining already discharged patients or even dead bodies in order to claim their dues. The cause of such private based system is even more shocking bearing in mind the outcomes are often unsatisfactory and the payment system utilized an archaic, provider centric fee-for-service.

So let’s remember this, more than half of the people of this country live in abject poverty and the current state of healthcare is a perdition that they live here on earth. We have to come up with a people centric health system reform that ensures dignity, better care and sustainability of the system that is to be designed to achieve UHC. Let’s also remember that the middle class and working poor of this country may have a level of cushion against the drawback of the current health system since they may be members of a voluntary health insurance scheme or they may benefit from the NHIF as it presently constituted. So to expect NHIF to be the vehicle of choice in achieving UHC through contribution from a population who remain uninsured due to poverty is not a viable way to enhance the road to UHC. Furthermore the providers of NHIF services are currently mostly private providers (In monetary compensation) who would not care about reducing the charges to NHIF patients covered as indigents. Since the burden of the cost of NHIF would still go back to the state, it would prudent for the powers that be to ensure a functional government hospital system rather than just focus on increasing health insurance uptake as a path to UHC. Failure to strengthen the government health system will lead to a collapse of the Healthcare agenda of the president and a great loss for this country.

If we are to devise any system for attainment of UHC then the path to take is one of government led and subsidized public health system that is available closest to the people.

We already have the policies, regulations and structures for a referral system from the community level to the tertiary level. Now is the time reform them to achieve what they were intend for, better care for the poor of the country. But again we would need the personnel equitably distributed in the country to run the system and some Cuban doctors to boot. But that’s a story for another day.