As we enter the final lap in the first five years after devolution, there is heightened activity on the political end as incumbents and aspirants align themselves for the electorate’s votes.
Health care as an agenda will certainly take some time in the campaigns and run up to next year’s election.
Big strides have definitely been made across many counties in improving access and quality of healthcare: the number of health facilities built and health workers have also risen across all counties. In terms of budgetary allocations, most have surpassed the previous system’s health allocations too.
This however is not enough judging by the never ending strikes and labour unrest. In the last few weeks, Nakuru and Nairobi counties’ health services were thrown into disarray following their doctors’ strikes.
Reports suggesting that a large scale doctors’ strike may be in the offing are not reassuring.
An analysis of the problem indicates the root cause of all this unrest is lack of adequate financing on the counties sides. However poor health policies and politically motivated decisions have contributed too.
The one certitude with public healthcare unlike other departments is that it is an abyss that just consumes resources. Unlike roads which can attract cess and other financing models, or schools whose needs are easily budgeted and extrapolated for financing, this is not possible on our side.
Health budgets are just rough estimates that will always be revised upwards. In financing health systems, placing a high premium on the services locks out people, having none ensures you cannot adequately sustain or cater for their needs in a quality manner.
It is the typical catch-22 situation and is part of the reason we are in problems currently.
While counties complain of poor and delayed access to funds from the central government, some of the initiatives attempted by some reveal a lack of strategy and perhaps lack of clear cut knowledge on the problem. A few counties are trying novel approaches to promote health services.
Kakamega County’s well intended maternal health incentive project that offers cash incentives to women to encourage higher Antenatal Clinic, Post Natal Clinic and skilled hospital attendant deliveries is well-intentioned.
It, however, fails to underscore or indicate one key goal of such “subsidy” schemes: what is the exit?
As a recurrent expenditure for an assuredly increasing population sample, the county needs to allocate funds for this group annually.
Regardless of the source of funds, this scheme leaves out one point, the newborn and the mother are still left to look for healthcare funds financing elsewhere when they exit the programme.
In regards to Makueni County which recently launched “Free Universal Healthcare” for residents, several points for discussion arise. Can our counties really afford to offer free healthcare if they cannot afford to pay health workers?
Beyond political posturing it is time the professional medical bodies and healthcare financing planners offered input into some of the decisions county governments make.
For those working towards Universal Health Coverage initiatives, “free healthcare” without improving the number of citizens included in health insurance schemes will not work. Let us call the bluff on these initiatives.
The only way counties can improve healthcare is by ensuring as many as possible of their citizens have some basic form of health insurance.
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