Columnists

Healthcare system needs deeper mends

DRUGS

Mis-prescribing drugs is very dangerous. FILE PHOTO | NMG

It’s hard to watch our healthcare system being driven from bad to worse in the cause of universal healthcare. But as we watch the comprehensive downgrading that is underway, is it arrogance or commerce that is driving this wagon? On the face of it extending the National Hospital Insurance Fund (NHIF) coverage to more patients and more clinics will increase healthcare access.

Before, the employed could get free healthcare at public clinics. Now, those outside the formal sector can pay their own NHIF contributions and access services at both public and private clinics. So our state-provided health insurance is being widened.

The sum is that the new people getting access do pay. But they and all the NHIF-covered before them get a wider range of clinics they can access, with the private clinics in play too.

Thus, we see the seemingly contagious rise of low-cost private clinics such as the Bliss GVS clinics. And the sense seems there. A narrow tax base, an overspent government, not enough health care – let the private sector add resources, and restructure the system so more people can access both public and private facilities.

But it is from there that the logic seems to have gone for a long vacation - with the first burning matter being that of doctors. For a long time, Kenya has been starkly short of doctors. The number we have seems to be debatable, but a general consensus suggests we have around 0.15 doctors per 1,000 Kenyans, or 7,500 doctors to serve our 50 million citizens.

That is about one-sixth of the level needed to achieve adequate healthcare, according to the World Health Organisation.

So, we needed more doctors, and we did things to create more. We added more schools to educate doctors and increased the pipeline of new qualified doctors, jumping from two to six schools, and now producing more than 2,000 new doctors a year - which actually is phenomenal from a base level of around 7,500.

It is enough to see a very rapid upgrade in the level of ‘doctor availability’ per Kenyan.

We also raised the bar on doctors’ training: it now takes six years plus a one-year internship. Now, there must have been a reason for this. We don’t just make courses longer for fun. In increasing the depth and breadth and scope of the doctors training, one has to presume there must have been a reason and that it must have been related to the quality of our doctors and thus to the quality of our healthcare.

Yet, having opened more medical schools, with longer and deeper training, we then stopped employing our doctors. The counties stopped employing them and switched to clinical officers. The new low-cost private clinics employ clinical officers too.

The result is that most Kenyans will now never actually see a doctor at all. Yet the clinical officers emerge from unregulated courses after three years. So does this mean that we were wrong to increase the doctors’ training to seven years because we don’t need that level of knowledge in our healthcare system at all?

Indeed, is it the case that we really don’t need so much training at all anywhere in our healthcare system? For these three-year trained, unregulated clinical officers can prescribe medication too. Yet our five-year trained pharmacists cannot. At this point, I disappear into confusion as to what the policy makers believe constitutes dangerous.

I know that misdiagnosis is very dangerous. It leaves real conditions untreated. I know that mis-prescribing drugs is very dangerous. It can leave conditions untreated, but it can also cause other and horrible health impacts from the wrong drugs themselves.

Yet, worry not. We no longer need seven years of training to correctly diagnose, and five years of training to understand medication. We can do it all in three years.

And even the pharmacists aren’t necessary for Kenyans, it turns out. We only need two-and-a-half-year training pharma technicians.

So you tell me: is it arrogance? Do Kenyans not need safe when it comes to healthcare? We can create a lesser system now even if it kills some of them (even a lot of them). Or is it commerce – and less trained is just simply cheaper.