The recent spate of criticism by the media on the failure of our public health institutions service delivery is in order and timely. Indeed, there is a lot to be done to improve health systems and services. However, the critique does not dig deeper into the myriads of policy failures that has brought the public hospitals onto its knees.
The World Health Organisation (WHO) has listed essential pillars for an effective and efficiently working health services.
These pillars or building blocks are Human resource for health (HRH), Finances, Infrastructure, Health Information (HMIS), Governance and Medical Products. I will only concentrate on three pillars i.e. HRH, Infrastructure and Financing for Health.
The other three pillars are well defined by perennial shortage of medical supplies, the weak leadership and governance structures coupled with the rudimentary health information systems, and is known by all and sundry.
On HRH, the WHO recommends a doctor population ratio of 1:1000. However, the human workforce in the country falls far below the recommended population ratio. Of the recommended 50,000 doctors, only 11,000 are available in Kenya.
Of these, only 3,400 are in public hospitals across the country.
The aforementioned is the same for nurses. Notwithstanding, the few available are well skilled. These skills have been acquired through individual self-development of doctors and paramedics as opposed to a strategic government human resource development policy at work.
On infrastructure, we all know the near complete absence of radiotherapy services in public hospitals. The number of intensive care units (ICU) beds in Kenya, both private and public, is less than 300 in comparison to recommend 2500 bare minimum.
That is why ambulance services are practically a makeshift ICU for patients. Recall the unfortunate case of Alex Madaga.
Financing is a fundamental pillar for an effective and efficient health system and is key if we are to achieve a functional health system.
Health financing allows for procurement of other pillars. The best skills and equipment can be availed with adequate financing.
Kenya’s health budget (3-6 percent) falls far below the Abuja declaration. Governments are expected to allocate 15 percent of their annual budget to health. In addition to Exchequer funds, other multilateral grants and charities contributes to the health financing through sector wide approach. Insurances and out of pocket (cash payments) is the other mode of health financing.
Research shows nearly 50 percent of Kenyans live on less than one-dollar daily.
This sector of the population does not contribute financially except through government and other safety net programs. Eighty percent of Kenyans access health services through cash payments. A plight where half the population are poor.
It hinders access to basic services and impoverishes families. Consequently, fundraisers are the norm to offset hospital bills for detained patients and bodies.
Insurances play a major role in financing healthcare. Around 20percent or 10million Kenyans are insured under a medical cover scheme with 90 percent of these falling under National Hospital Insurance Fund (NHIF). The unfortunate reality is nearly all payments done by insurances end in private hospitals. The contribution of private insurances to the public hospitals is negligible.
Nearly 90 percent of NHIF claims are by private hospitals. A Caesarean section (CS) at a public hospital is Sh20,000 to Sh30,000 while in top private hospitals an average payment is Sh300,000 to Sh600,000.
Additionally, all monies paid by government entities; Parastatals, Judiciary, Legislature, Independent Commissions and others, the stake of public hospitals is minimal. In short, public institutions shares of more than the Sh100 billion annual medical insurance is less than Sh2 billion.
With Universal Health Coverage (UHC) beckoning, the public hospitals will be expected to be the focus of service delivery.
For UHC to be a reality, Government resources should primarily be channeled to public hospitals. As it endeavours to compete for other available resources in the market by providing competitive services.
Admittedly, if public hospitals are expected to offer quality health services, it has to be adequately financed.
The gap in service delivery between public and private hospital has to be reduced. This can only be done by an aggressive biased approach. Government allocation for health has to aim for the 15 percent target.
Policy change has to take place at NHIF and Government owned entities. At least 80 percent of NHIF funds must go to public hospitals.
In the short term, NHIF has to give grants to government hospitals to put up adequate infrastructure including ICU services and radiotherapy machines.
Finally, do wananchi and cooperate have a role ?
Why is there no support for public hospitals by individuals and cooperates as in private hospitals ?