Costing healthcare for greater efficiency
By Vincent Ogaya
| December 19th 2016
Incessant crippling of the health sector is becoming the norm in Kenya. Strike after strike, inadequate drugs, shortage of staff, low staff morale and high maternal and child mortality rates n are the order of the day.
Yet when we look back to the time devolved functions were being transferred to counties, we see the picture of a very clueless process.
The Transition Authority, weighed by huge public expectations and inadequate technical support from the national government, transferred these functions without proper mechanisms for their implementation.
Health as a function of the county governments was never costed. For instance, do the counties know the cost of immunization of a single child?
However, we see other areas that can be easily costed like administration and compensation to employees still gobbling a huge chunk of the health budget.
In fact, if the health workers were to be paid what they are demanding, whole health budgets would be utilized and still that won’t be enough. There would be nothing left for medical supplies or any other health function.
Constitutionally, any function transferred to the counties must be accompanied by enough funds and resources for the performance of such functions.
Right now if one gets treatment at any public health facility, the norm is that you are told to go buy drugs from pharmacies outside the hospital.
I was recently surprised to see a patient in a County Hospital being told to buy gloves and bandages from outside the hospital before commencement of treatment. Never mind she was bleeding from a fracture caused by a motorbike accident.
Emergency healthcare is also at its deathbed. The constitution gives everyone in Kenya the right to emergency healthcare.
Quite often, an expectant mother here or an accident victim there would be required to pay for the cost of ambulance services which also includes fuel and “something for the driver” before they are rushed for emergency treatment.
This often is out of the reach of many Kenyans.Suffice it to say that when there is little funding for health, much of the attention will shift to salaries and to a lesser extent curative and rehabilitative healthcare; thereby leaving very little for preventive and promotive health.
However, investing in healthcare must also mean putting in enough resources to check the social determinants of health with the aim of reducing the risk of developing diseases.
Reproductive healthcare, especially family planning and adolescent health, takes the backseat when heath is underfunded. Quite often, finance and economic planners do not see the meaning of investing in these areas.
Right now, some counties have put in resources to cost certain aspects of health. Homabay, Kakamega, Tharaka Nithi, Kitui and Siaya have all developed Costed Family Strategies. Other counties like Migori are in the process of developing theirs.
An overall costing of the health function must also be done so that other areas of health are not left to suffer. Programmes that have traditionally been left to donors must now be taken up and owned by the county governments.
These include the promotion of reproductive healthcare especially family planning and adolescent-friendly services aimed at curbing teenage pregnancies, HIV and AIDS, unsafe abortions, early marriages.
The construction of dispensaries and other hospital facilities need to be properly planned to ensure full utilization.
There are a number of buildings around the country which are supposed to be hospitals but are just lying idle due to lack of staff and commodities.
When every aspect of health is costed per county depending on their needs and disease burdens, the national government will then have to avail adequate resources and in good time to meet these needs.
Counties will also be able to mobilise resources from different sources in light of their financial needs in order to fund the health budgets.
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