What have we achieved in the health sector since independence?

By Anyang’ Nyong’o

In general, are Kenyans living longer on this Earth than they did 50 years ago? The answer is probably not. Are we eating better, having access to fresh drinking water and living in cleaner environments than we did 50 years ago? The answer is that some are eating better, a good number drink water that is dangerous to their health and the problem of environmental degradation is a danger to health all around us, whether we are in Mandera, Mathare Valley in Nairobi or travelling on the highway to Mombasa as big lorries belch dark smoke from their exhaust pipes onto our faces.

In other words, the increase in the incidences of diabetes, heart disease, cancers of all types and other diseases since independence is no accident: it is the result of our systematic abuse of our environment over the last 50 years; our rising population with a decreasing ability to provide proper nutrition to this population across the board; and our inadequate awareness regarding the basic things we need to do to prevent diseases.

Yet when we were born as a new nation we were quite clear in our minds that we could only develop as a healthy and prosperous nation if we tackled problems of poverty, ignorance and diseases together and with the same intensity. Our 1965 “bible” for development, Sessional Paper No. 10 on “African Socialism and Its Application to Planning in Kenya” was quite clear on this: it envisaged a nation where the people and the government would work together for prosperity, each citizen bearing the responsibility for the development of the nation as well as the self.

This was the philosophy of “mutual social responsibility”.

In the area of education we did quite well. What of the airlift programme to the USA organised by Tom Mboya that availed higher education to many Kenyans who might have missed the boat altogether. What of a similar arrangement by Jaramogi Oginga Odinga for those who went to the then Eastern Bloc countries? Then came the Harambee schools and the government takeover of the same, making upward mobility possible for thousands of children born to poor peasant families.

Then the Narc government came with its free primary school education where even 75-year-olds went to school for the first time. Although as important — and even more important — than education, health has not received as much-hyped attention either by the government or by wananchi.

We are acutely aware of our health needs and challenges, but we seem to leave it to be the affair of the individual or the family until a friend or a relative gravely falls sick or dies, then the spirit of Harambee (or mutual social responsibility) is momentarily summoned, and we gather in droves to equally momentarily alleviate the burden or tragic consequences of ill health on one of us.

Granted that we have paid attention to the immunisation of children, improvements in maternal care, access to health care by the under fives and the creation of facilities for the same.

But the truth is: too many mothers are still dependent on traditional birth attendants who cannot always effectively handle the health problems of mothers and babies after delivery.

Health is a social issue not an individual issue. Sickness and disease are not individual problems: they are social problems. In the 1960s our nationalists were aware of this.

And that is why Kenya was the first country in Africa in 1963 to initiate a planned parenthood programme, led by the then minister for Planning, T.J. Mboya, to ensure a quality population.

Kenya was also the first country in Africa to establish a National Hospital Insurance Fund to ensure that access to treatment was guaranteed to those who were contributors to the subsidised health insurance scheme. Treatment in government health facilities was free then, making it possible for the poor to receive treatment when in need. With the growing population as well as rapid urbanisation, the burden of financing free health care became unbearable for the government.

With the advice and pressure from the Bretton-Woods institutions, a cost-sharing programme was started in 1989. Health sector reforms initiated in 1994, and expanded upon since then by successive administrations, have not dealt with the basic problem: universal access to affordable and quality health care for all.

Countries which have confronted this issue headlong, have used only one method: universal health insurance coverage, wholly funded by the government or financed by social health insurance package that marries direct government funding with contributors’ funds. Transforming the NHIF into a National Social Health Insurance Fund (or scheme), as was proposed by the Narc government, or Grand Coalition Government, is the only sane option.

What is holding Kenya back from fulfilling our constitutional obligation of providing affordable and quality health care for all are two things: vested interests in the insurance fraternity and among some Health Management Organisations and political myopia among those who are always ready to crucify a good message because they don’t like the face of the messenger. It is time to wake up and live by the dictum “a working and prosperous nation must also be a healthy nation”. Otherwise Vision 2030 will remain a pipe dream in our lives except the glittering and winding highways close to urban centres.

The writer is Kisumu County Senator