Health sector needs a paradigm shift to escape morass

The Standard

Kenyans mourn for the people who have died in senseless road accidents even as the country celebrates its Golden Jubilee. It is regrettable that a country that was born out of bloodshed in the fight for independence should witness more deaths in hospitals due to the ongoing health workers’ strike.

Bad as the situation is, Health Cabinet Secretary James Macharia would do the country an enormous favour were he to think outside the box and identify the silver lining on the cloud cast by the ongoing health professionals’ strike. The place to begin is to acknowledge that the health challenges facing the country are so acute that they cannot be adequately tackled by conventional, business-as-usual policies, projects and programmes pursued since independence.

Put simply, the key challenge facing the country is to make healthcare available to all its citizens. With approximately half of its 43 million people living in poverty, Kenya struggles to provide access to basic healthcare services and medical treatment to its citizens, especially those living in the densely populated slums and in rural communities.

The irony of the current strike is that the health professionals are resisting the push to have them working in places where their services are needed most — the rural areas —where they would be answerable to county governments which would, in turn, pay their emoluments from funds transferred from the National Treasury. This resistance gives rise to the perception that the health professionals are afraid of being placed under closer supervision. Reports of ghost workers appearing on the payrolls of many counties give credence to these arguments.

Other reports suggest that the health professionals’ opposition to the devolution of their services to the county levels is based on their fears that they would lose the incomes they are currently deriving from moonlighting in private hospitals and clinics, many of which they own.

But whatever version is right, the inescapable conclusion is that the rural communities will not get the medical care they deserve unless there is a paradigm shift at the national and county government levels. This shift should involve two key factors.

First is the realisation that even a crash programme to increase the number of health professionals through an increased number of trainees will not solve the rural communities problem, unless the bulk of these trainees are drawn from these areas with a clear understanding, or even better, contract, to live and work there. This strategy could be enhanced by setting up health training institutions in these communities.

Second is reclaiming the public health initiatives practiced a few decades ago when it was mandatory for rural households to dig latrines, clear bushes and drain stagnant pools in villages across the country. These simple strategies did wonders in reducing incidences of cholera, diarrhoea, typhoid and malaria outbreaks, all of which are major killers today.

The Health ministry should admit that the fight against diseases, especially preventable ones, cannot be won unless more time and resources are devoted to preventive medicine. Fortunately, this initiative does not require large numbers of highly trained professionals.