Invisible enemy exposed the good and ugly of our healthcare

The Covid-19 pandemic has not only continued to exacerbate the inequities and inequalities from a health, gender and social perspective that Kenyans have faced, but has also exposed the feebleness of our health system and our inability to adequately ensure provision of socio-economic rights as guaranteed under the law.

Kenya has witnessed more Covid-19 related deaths among the poor, those with limited access to health services, social protection, food, water, adequate housing and reasonable standards of sanitation.

On April 7, 2021 the world marked World Health Day, which is meant to create awareness of a specific and urgent global health theme.

It is not a coincidence that the World Health Organisation (WHO) settled on building a fairer, healthier world for everyone.  This is urgent for Kenya.

Though the Constitution of Kenya at Article 43 (1) and the Health Act section 5 guarantees access to health care, it is still a mirage for many Kenyans. The Covid-19 pandemic has only compounded this problem with hefty hospital bills and purchasing medicines.

Those with medical insurance covers from either the National Hospital Insurance Fund (NHIF) or private insurance have not been spared the out-of-pocket spending with many insurance companies taking a step back from covering Covid-19 related ailments.

This has forced many Kenyans to either fundraise to pay hefty cash deposits at hospitals. Many have also faced threat of unlawful and illegal detention in health facilities for non-payment of bills when the economic strain is rife with many having lost jobs and sources of income due to effects of the pandemic on business and jobs.  

The growing concerns around access to Covid-19 tests,  ICU beds for those who are critically ill, medical oxygen for those with respiratory challenges and access to well trained and remunerated health personnel demonstrates the fragility of our health system.

Challenges have also been experienced with addressing Covid-19 non-related aliments, including the looming threat of a national stock out of ARVs and septrin medicines utilised by over 1.5 million people living with HIV in Kenya. 

The inequities and inequalities in health that are driving us further from having a fairer and healthier world for everyone have similarly come to play at the global level, particularly with regard to access to vaccines and other related Covid-19 technologies.

Some wealthy countries have been racing to hoard vaccines in advance, yet some of the poorest countries are yet to receive any vaccine doses, let alone vaccinate anyone. 

The same rich countries have also significantly blocked the transfer of technology and knowledge that would allow other local manufacturers to develop urgently needed vaccines. This is a great and unfortunate departure from the lesson learnt in the HIV response where the TRIPS (Trade-Related Aspects of Intellectual Property Rights) flexibilities were utilised to allow the local manufacturing and a parallel importation of ARVs that have saved lives of very many people living with HIV globally.

Ironically some of the rich countries are propositioning the introduction of vaccine passports - a concept that would amplify the inequity not only in health, but travel and education opportunities for people from poorer countries who have limited access to the vaccines. Yet we all know and agree that access to a Covid-19 vaccine is a human right that no one should be denied.

Kenya has been lucky to receive over one million doses of the Astra Zeneca-Oxford Covid-19 vaccine doses via the Covax facility. The challenge has remained the timely, accurate and reliable info about the availability, eligibility and vaccination sites.

More than 560,000 people had been vaccinated by April 14, which is unacceptable at a time when we desperately need to vaccinate more people quickly with a looming threat of the virus mutating.  

As health advocates and concerned citizens we need to continue to advocate, mobilise and or litigate to ensure that both the national and county governments strive to have people-centered health systems that are grounded in human rights. They equally must have plans in place that citizens can use to track their efforts to progressively realise the right to health against the globally accepted parameters that all health services, goods and facilities must be available, accessible, acceptable and of good quality while simultaneously ensuring that leakages, wastage and corruption is minimised to ensure the resources reach those who need them the most and no one is left behind.

Allan Maleche is Executive Director, Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN)

@MalecheAllan