Survey findings released by Infotrak on the state of health care in Kenya paint a grim picture of the country’s public health system, which serves up to 70 percent of its population.
The survey findings indicate that Kenya’s public health system is in deep crisis and unable to provide health care services to a great majority of Kenyans who depend on it. The survey notes that this crisis, which has morphed over the years, is deeply embedded in policy decisions that Kenya has made over the years regarding the provision of health care services, and further compounded by a failure to prioritize and adequately resource the public health care system to meet the growing health care needs of Kenyans.
In Kenya’s Vision 2030, the government’s goal is to reduce its role in the provision of health care and hand most of the functions of health care providers to the private sector. And this is where the problems of Kenya’s health Kenya system are anchored. Health is a public good and the government has the primary responsibility for its provision to enable access by the majority poor.
The privatisation of health care over the years has led to under-investment in the public health system that provides the bulk of health care services and is used by 70 percent of Kenyans. This systematic underinvestment in public health care and neglect has led to the near-collapse of Kenya’s public health care system, leading to a health crisis that has now been laid bare by the COVID-19 pandemic.
The influence of private actors in health has been seen largely in health policies and programs, leading to prioritisation of the role of the private sector in health care at the expense of public health care. Most of these policies have in fact disincentivized investment in the public health sector, with arguments that they are inefficient and incapable of providing quality health care. The evidence of this has been seen in the focus of Universal Health Coverage (UHC) that has essentially prioritized universal “cost coverage” by emphasizing the monetary aspect of access at the exclusion of primary health care.
As a result, the focus has been on the provision of health insurance for Kenyans to access health care under the universal health coverage agenda. But evidence has demonstrated over and over again that the private health care system is not able to provide affordable and quality health care to a greater majority of Kenyans. This has been demonstrated by the number of people that sought health care services in public health facilities during the COVID-19 pandemic, with over 70 percent of Kenyan’s preferring to seek health care in public facilities citing affordability, according to the survey findings.
Even though the bulk of Kenyan’s can only seek health care in public health facilities, the demand is seldom met because of the challenge of inadequate staff to meet the needs of the many seeking health services, coupled with lack of essential health care commodities and supplies, and diagnostics and technologies necessary to diagnose and treat disease. The consequence of this has been that people are then forced to seek services in the often expensive private health care facilities, leading them into deep financial crisis and hence creating a challenge for the poor who bear the brunt of the high cost due to the lack of any form of social protection, with NHIF not enabling them to access health care in private health facilities.
In essence, Kenya’s health system is a system that is furthering inequality where the rich can access quality health care in private health facilities while the poor don’t have access due to the collapsed public health care system and exorbitant costs charged in private health facilities.
Because the government, national and county, haven’t prioritized the health workforce in the public sector, we continue to see the very frequent withdrawal of services, disrupting the provision of the much-needed public health care services by the majority of Kenyans. This has often led to the paralysis of the public health care system, even during the COVID-19 pandemic when the demand for health care services in public health care facilities increased significantly. The implication of this has been needless deaths, poor and uninsured people sinking into poverty because they have to sell their property to seek health care in private health facilities that are often costly and beyond their reach.
The frequency of health workforce strikes increased significantly with the devolution of health care services, where we have seen an unending battle between the health workforce and county governments over the need to resource the public health system, provide protective gear to the health workforce especially during the COVID-19 pandemic and generally improve the working conditions of health workers in terms of timely payment, listening to their issues and solving their grievances, employing adequate numbers of health staff—with Kenya among the 59 countries with a health workforce crisis, and better management of county health care system to avert the frequent strikes.
Besides, there is the long-standing issue of transfer of money meant for health by the national government to the counties, adversely impacting the delivery of health care services at the county level. The delay in the transfer of finances for health care provision means that county governments do not have money to pay health care workers, purchase health commodities among others. But even more worrying is the diversion of resources meant for health to political activities at the expense of health care.
In essence, the failure of the public health system has plunged Kenya’s health system into a deep crisis, adversely impacting everybody. The majority of Kenyans are not able to access quality health care services due to the inability of the public health care system to meet their health needs. At the same time, over 70 percent of Kenyans who depend on public health care services cannot afford health care in private health care facilities due to exorbitant costs.
The middle class that has often been aloof when it comes to championing for accountability in the delivery of public services despite being the taxpayers have often been forced to come to the aid of their relatives and friends who cannot afford health care in private health facilities. And this manifests in the numerous “Harambee” that are held through WhatsApp groups to raise billions of shillings to support payment of medical bills or funeral expenses, amounting to double taxation.
Our failure to act collectively to push governments for accountability for health care has often led us to act collectively to finance funeral expenses when these deaths could have been avoided.
