Our new governors must rethink public health system to serve all

Council of governors chairperson Anne Waiguru flanked by other governors in a press conference. [Wilberforce Okwiri,Standard] Recent global concerns with a new Covid-19 variant, new county health reforms thinking and the calling off a national health workers strike suggest that rethinking the right to health is timely. Three years after the world's attention on China and Covid-19, the year closed with another dangerous spike in China. The new #Covid-19 variant (#XBB15) is another offshoot of the 2021 Omicron variant. This variant, while less virulent and dangerous than the Alpha, Beta, Gamma and Delta coronavirus variants, has lasted longer. A week ago on January 6th, the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) announced that after discussions with the Health Ministry and Council of Governors and conscious of the impact a strike would have on the right to health, it had suspended a 30-day strike. The union is concerned that the 2017-2021 Collective Bargaining Agreement (CBA) still has not been met. Within the agreement, are unmet promises to adjust doctor's basic salaries, recruit more doctors and improve working conditions for doctors and medical interns. Knowing that many households face high living costs, raging communicable and non-communicable diseases and a heavy disease burden on financially strapped national and county governments, a few county governments are already rethinking health service delivery. In September, Governor Abdullswamad Nassir announced a taskforce to reboot healthcare systems across Mombasa County. This month, Governor Johnson Sakaja received the Health Reforms Taskforce report on Nairobi County. The 112-page report is explicit on the reforms needed. National health rights financing has changed dramatically over the last two decades. Public financing has doubled to 52 per cent with donor funding halving (now 18 per cent) and household contribution dropping by 6 per cent (now 24 per cent). However, despite increase in government financing, contrary to Public Finance Management Act, Nairobi health finance spending is only a third of what should be spent on development. Too few Nairobi residents are registered or effectively using the National Health Insurance Fund (NHIF). Many do not know the difference or advantages of Supa cover, Linda Mama, Edu-Afya or civil servants programmes publicly available. Too few of Nairobi's 119 public health facilities receive adequate and timely disbursements. The consequence is indebtedness for our institutions, emergency services not accessed, patients detained in hospitals, and family budgets imploding under health bills. Chaired by AMREF Africa CEO Githinji Gitahi, the four major recommendations of the Health Reforms Taskforce explore budgetary and organisational constraints and new strategies. Nairobi county government suffers inadequate financing streams, weak financial accountability, planning and data monitoring systems and sub-optimal utilisation of the National Health Insurance Fund. The report is significant in several ways. Nairobi health facilities probably serve nearly 13 per cent of the national population. Elevating access and quality particularly for those living in the capital's expansive informal populations offers new models for counties like Mombasa, Kisumu, Eldoret and Nakuru with high density urban populations. Thirdly, while non-communicable diseases such as cancer, diabetes and others are responsible for 27 per cent of deaths and 50 per cent of hospital bed admissions, the drivers are to be found in water, food and air pollution, congested and poorly ventilated homes and workplaces, alcohol and substance abuse and poverty. To reduce the health burden, Nairobi and other county governments must also declare a broad war on impunity. Closing the loopholes for lawlessness in the built environment is as important as shutting down access to self-interested procurement. In this, governors will have the support of resident associations and civic lobbies. Leadership integrity is critical. Convening diverse thought-leaders is also important given those narrow state, business, and civic echo chambers. While our Generation Alpha governors must strip out the ineffectiveness of past Generation Z governors, they must not throw out what was working. As county governments reinvent their health systems, they can build on the emerging thinking within County 47.

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