Ideas & Debate

Kenya health system needs urgent reforms

It has become difficult for the government to meet the medical needs of a galloping population with its scarce resources. Photo/LIZ MUTHONI
It has become difficult for the government to meet the medical needs of a galloping population with its scarce resources. Photo/LIZ MUTHONI 

Many times we have responded to numerous fund raisers to contribute money to send relatives and friends out to India to receive medical treatment for ailments such as cardiac, renal and cancer, among other diseases.

South Africa has also been another destination, but most of the traffic is to India.

The feedback we get about India is that treatments are generally affordable and widely available.

Professional expertise and equipment are of the highest calibre and success rate for treatment quite high.

We also understand that the Tanzania equivalent of our NHIF has permanent arrangements with key hospitals in India where Tanzanians are routinely referred to for ailments beyond local expert capacity.

India, we understand, has become the global medical care destination of choice.

Poor equipment

This then begs a number of questions about Kenya where public healthcare is perceived as mostly inadequate in quality and capacity, while private healthcare providers are mostly expensive for the average Kenyan.

Whether public or private, specialised professional expertise and equipment in Kenya are insufficient and where available, fairly expensive.

We must admit that as the population more than doubled over the last three decades, incremental healthcare capacity has neither matched this growth nor sufficiently matched technological sophistication in medical care.

Recent data indicates that Kenya requires 24,000 doctors but it only has 8,000, with only 3,000 of them working in public hospitals, 4,000 in private facilities and 1,000 outside Kenya.

Medical manpower attrition in public hospitals is said to be high and mainly due to low morale, poor pay, and absence of suitable amenities and working environment.

This shortage of doctors cannot be alleviated immediately or within the next few years.

A well coordinated and prioritised national medical manpower development plan is perhaps what is required, if we do not already have one.

It is a catch up game that has become quite urgent and requires collaboration of all players in healthcare provisions.

This includes private and church based health providers, and universities offering or with capacity to offer medical training.

Nairobi University has been producing doctors since 1972, with Moi University establishing a medical faculty in the 1990s.

Aga Khan University has recently established itself, and we understand that Kenyatta and Maseno universities are also planning to launch medical faculties.

If we do not have enough lecturers and professors to help expand our existing medical faculties or establish new ones, let us face the reality and hire expatriates, for in deed we may not have much choice initially.

In the medium to longer term Kenya should plan to have an excellent hospital in each county, equipped with enough doctors, beds, drugs, and sufficient equipment to treat most of the ailments.

This is why it is urgent to fast track professional and facilities capacity development.

For the private healthcare sector, the challenge is how and when to create in Kenya a healthcare hub modelled along the lines of India.

Private investors, assisted by an enabling regulatory framework, should emulate the ongoing efforts here in Kenya to create ICT and financial hubs.

We should not view healthcare as a burden, but see it as a glaring investment opportunity with both social and economic deliverables.

We have sufficient local and regional demand for reasonably priced quality and high tech healthcare as evidenced by the traffic flow to India and South Africa.

Local and foreign private capital can facilitate creation of a competitive critical mass of quality healthcare that meets most of the expectations, like medical specialists, advanced equipment, high rate of treatment success and reasonable charges.

The ideal is to create sufficient capacity and competition among healthcare providers so that they can deliver excellence at lower costs.

It is only with reasonably priced quality healthcare, both private and public, that we can start to debate the format and scope of a national healthcare insurance provision, not before.

There has to be effective healthcare that is worth insuring for.

Private medical insurance covers today are quite expensive and NHIF covers are barely sufficient to cover hospital bed costs, with patients left to meet high professional costs.

All said and done there are glaring gaps in healthcare provision here in Kenya.

For the lower income (or no income) groups of our society the gaps are evidently a national shame.

We have seen instances when dead bodies cannot be collected as they are used as collateral for unpaid hospital bills...

We have seen the media highlighting numerous desperate cases of serious but curable ailments, where patients have given up as they cannot afford treatment.

We have heard of patients sharing hospital beds.

Long term

Such cases as listed above cannot wait for long term planning, for they represent an emergency in the real definition of the word.

Healthcare provision safety nets for Kenyans of little or no income need to be established.

The new constitution now provides that "every person has the right to the highest standard of health, which includes the right to healthcare services...and a person shall not be denied emergency medical treatment”.

The Minister for Health recently returned from a successful treatment of cancer in USA, and we should all share in his happiness for his newly found vitality.

The Minister quite clearly articulated the gaps existing in our healthcare systems especially in respect of complicated medical cases which are mostly curable in this day and age of medical technological sophistication.

We can only hope that there will be ministerial follow up. Private healthcare providers and prospective investors should grab opportunities to create healthcare institutions that will match the Indian excellence.

The country can save foreign exchange flowing out to India and elsewhere, and at the same time set a stage for regional clientele that will bring in even more foreign exchange.

Mr Wachira is the director of Petroleum Focus Consultants and can be reached on: [email protected]