On December 9 and 10, the Senate and Parliamentary Standing Committee on Health invited the Cabinet secretaries of Health, Treasury and Education and the Council of Governors chairperson and several governors and other institutions to appraise it on their dealings with the Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU).
KMPDU Secretary-General Chibanzi Mwachonda described the intensive care infrastructure outside Nairobi as non-existent and accused the government is doing nothing to support healthcare workers.
What he did not say is that our health infrastructure is a pyramid, where the smallest number of patients at the apex get the largest share of the healthcare budget and the base, with the most patients, the least attention and lowest budget.
As we respond to the demands of Covid-19 on our health system, it would be wise to face the universal health coverage (UHC) programme, part of the Big Four Agenda, head-on.
Countries that have achieved UHC invested significantly in community health systems and the level 2 and 3 facilities. Kenya is not doing so. And Parliament is asleep at the switch.
Health services are a devolved function. But many counties are plagued with human resource management and information asymmetry issues, characteristic of the sector.
Doctors’ pay is much higher than the average county employee’s, with terms of service as the main problem. Some doctors are their own masters, working when and where they choose.
Question authority
We have a culture that does not question authority, especially of a health professional. If a doctor tells a patient to see them at their private clinic, the former has no agency to object or seek reasons, hence cases of misdirection and unnecessary expenditure occasioned by unscrupulous professionals.
The problem with UHC is the low uptake of National Hospital Insurance Fund (NHIF). Counties such as Laikipia have invested in addressing these gaps through engaging in evidence-informed solutions such as enrolling households into NHIF through community health workers.
This cadre of healthcare providers are able to customise messaging for households based on in-depth knowledge of the areas they serve. This has helped to increase in NHIF subscription and where needed, the county participation to cover the most vulnerable.
This approach has moved the NHIF registration in one region of Laikipia from 6,000 to 48,000. It is also informing other innovative health solutions like data collection and management that have seen access to health services significantly improve.
Such gains could, however, be eroded if we avoid discussing pertinent issues that affect the system, such as the mismatch in allocation of funds.
The questioning by the members of the National Assembly in both Houses left a lot to be desired.
There were blame games and empty bravado against both the national and county governments for “failing” to protect healthcare workers.
These all seemed to be grandstanding gestures to be on the bandwagon of a growing perception that our healthcare system is broken because doctors have contacted Covid-19. But nobody bothered to know where the real challenges to the health system lie.
In these times of political velvet gloves, however, we can expect our politicians to continue giving these matters a wide berth.
Dr Karua is a healthcare management specialist; kari-karua@icloud.com.
Mr Njoroge is a development communication specialist; njorokaranja@gmail.com.