Of vision 2030, the SDGs and Back tracks on the Alma-Ata Declaration: Healthcare Problems in Kenya are Political and so are their Solutions.

Nearly 40 years ago, in Almaty (then Alma-Ata) city of present day Kazakhstan, an international conference of nearly 3000 public health experts took place in an effort to shape global public health. At its conclusion, the delegates adopted ten resolutions dubbed the ‘Alma-Ata Declaration’ of 1978.

Four decades later, a look at all the resolutions of this declaration will ring as true today as it was then.

Developed countries have established state of the art disease surveillance, diagnostic and treatment technologies beyond ordinary imagination. Yet at the same time, disease challenges that brought the likes of Prof Miriam Were and other delegates to Alma Ata retain the enormity. Other global goals such as the millennium development goals (MDGs) and the Abuja declaration for African states have come and gone. Our performance as a country has been suboptimal on these two in particular.

It partly could be that the signatories to these goals did not have sufficient insight into the magnitude of the financial investment required for such undertakings.

Universal Health coverage

The Kenya vision 2030 is a blueprint that aims to propel us into a middle income country by 2030. The social pillar deals with health. Unfortunately though it is apparent health is taken as part of the rest of the social development. And that is where we miss the point. Health should be the requisite for other social improvements. Meaning you need a population that is healthy for it to be economically productive, for it to be educated enough to drive the economy.

The biggest challenge with health is guaranteeing a people universal health coverage. We have to ensure the most vulnerable in our society are assured of health care. As Dr Tedros, the WHO director general quips, “Do we want our fellow citizens to die because they are poor? Or millions of families impoverished by catastrophic health expenditure because they lack health protection?” He observes that Universal health care is a human right!

Set on the same 2030 deadline at the global level are the United Nations’ Sustainable Development Goals (SDGs) - 17 global goals by UN to end poverty, protect the planet and ensure people live in peace and prosperity. Whereas health is anchored under the social pillar of the Kenya’s Vision 2030, there is one SDG directly on health (SDG 3-Good Health and Wellbeing) and several others indirectly related (e.g. SDG 6-Clean Water and Sanitation). Both these blueprints imply intense investing into health to afford every citizen the highest attainable standard of health.

It will be incumbent upon Kenya to make the necessary investment in health to achieve these goals. Even more important will be the investment of political goodwill followed by concrete words beyond the rhetoric. The two key determinants will be funding of health care and increasing health coverage. It is not enough to merely endorse policy documents. Global estimates indicate that for the world to achieve the health related SDG, the government will on average need to spend an additional 58$ per citizen per year. If we look at our health funding from the exchequer, we all realize there is need to work harder!

Health Service Commission

Health care needs to be politicized. It is the only way to get it on the agenda at the same gusto with which we are discussing food prices, education and corruption. Universal health coverage is eventually going to be a must. And it is a political challenge more than an economic challenge.

Since 2014, there have been 17,579 cases of cholera reported in Kenya! The latest being in high end establishments in the capital involving the high and mighty in the society. We all know where the rain started beating us! After devolution, doctors advised that it would be prudent to manage the human resources for health from the central government. Political leaders, especially those of the devolved governments have seen this as an upfront on their power. The results have been disproportionate populist staffing and haphazard handling of the payroll in numerous counties. Who remembers a month when Kenya went without some healthcare workers industrial dispute? As we speak the nurses are strike. And I know a county referral hospital which has only one nurse assigned to the main theatre! This is absurdity! I never saw it before devolution.

Healthcare may not be a popular sector to invest in because most of the returns are not quantifiable. You cannot easily measure improved quality of care and tag a figure on it at the bottom line. There might not be much of a project to launch if you are pumping money into more staff. But the converse is catastrophic. When statistics start showing up in medicine, it is too late. Outcome measures like increasing mortality rate are not topics you want to discuss. They manifest eons after the train has left the station.

Unfortunately we have now reached there. Why are we surprised at recent outbreaks of cholera? Who runs the primary health care facilities? But they are always on the streets. And now the even scarier bit is that the recent outbreaks reek of a public health system that is failing. And we cannot fix it by burying our heads under the sand, calling cholera cases food poisoning even when the infected have shared their laboratory results with the world!

So while the world wants us to get to the next level of Universal Health Coverage, the little we have been gaining since the Alma-Ata Declaration seems to be crumpling down. It is time to politicize health care in Kenya. And it has to begin with the health care providers. Otherwise the lay are ignorant of the intricacies therein, and the entrusted political class may hardly walk an unpopular path, even if it’s the right one. The journey will start with establishing a Health Service Commission to handle human resources for health. Let’s get back to where we were in 2013, and then scale up from there by sequentially allocating more and more money to health. And making sure money allocated for health from the national government only goes to health at all the counties. Not re-allocated as deemed appropriate by the county regime.

Dr Stanley Aruyaru is a General Surgeon at Consolata Hospital, Nyeri and an assistant editor of The Annals of African Surgery