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Kenya's public healthcare system is at a crossroads

By Dr Irene Mukui | January 11th 2017

“Another fund-raising ended, they will be departing for India next week.” Is this story familiar?

In the recent past, there has been sharp focus on our health system for multiple reasons; devolution of health service delivery, constant unrest among health workers and not least, misappropriation of resources!

Despite the improvement of health indicators over time, the performance on key indicators remains dismal in relation to global targets.

A child born in Kenya today will live an average of 61 years, 10 years below the global average.

Maternal, neonatal and child deaths remain unacceptably high. One in every 26 children dies before one year; one in every 19 before their fifth birthday and for every 100,000 live births, 362 mothers die due to conditions related to or worsened by pregnancy.

Like many African countries, we experience a disproportionate burden of infectious diseases and a rising burden of non-communicable diseases.

So what ails our healthcare system?

The World Health Organisation defines six health system building blocks - service delivery, human resources, information systems, essential medicines, health financing, leadership and governance.

Despite much progress, the system is plagued by multiple challenges, which include service delivery inefficiencies, an inadequate and highly disincentivised workforce, a shortage of medical supplies, fragmented and inadequate information systems, minimal investment in research, insufficient infrastructure and a governance crisis.

It is impossible to envision the state of health without conceptualising key underlying factors. Half the population is poor, 80 per cent lacks health insurance and significant socio-economic inequities exist.

Healthcare remains unaffordable for most. In addition, we suffer the consequences of structural adjustment policies that imposed embargoes on staff hiring and weakened the ability to provide quality universal healthcare.

However, there are two issues that stand out - health financing, and leadership and governance.

Health financing in Kenya has evolved, characterised by cycles of introduction, withdrawal, re-introduction and reductions of user fees.

The National Hospital Insurance Fund (NHIF) is yet to be reformed to the much-envisioned national social health insurance fund, and remains limited in coverage and scope.

Health remains underfunded, with the Government allocation lingering between 4 and 7 per cent of the national budget in contrast to the intended 15 per cent.

But perhaps more critical is governance and leadership. This requires a mix of appropriate policies, oversight, collaboration, coalition building, regulation, system structuring and accountability.

There remains debate on whether devolution will lead to significant improvements. This health system structure, an expansion of the post-colonial hierarchical pyramidal structure, has failed to ensure equitable access.

Co-ordination of multiple donor agencies remains a major challenge. Non-government organisations and donor-funded projects often set up parallel structures and undertake projects that collapse with their exit.

Allegations of corruption at multiple levels bring this to the fore. Corruption and lack of accountability deprive the sector of crucial resources for development.

We need a critical system review. The Government must mean what it says and do what it means! Who knows, those countless trips to India might just end!

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