PUBLIC HEALTH
How do we fix Kenya ’ s ailing public health sector ?
By Walter Nyabundi
The right to health is a fundamental human right enshrined in the Constitution of Kenya . Article 43 ( 1 ) ( a ) of the Constitution provides that every person has the right to the highest attainable standard of health , which includes the right to health care services , including reproductive health care . Truthfully , we are a long way from attaining this Constitutional imperative .
Kenya ’ s healthcare system faces a number of challenges : many citizens have limited access to health care facilities ; there is a lack of adequate personnel and expertise to address patients ’ medical needs ; We have poor infrastructure where most facilities do not have the proper equipment to handle different medical situations ; there are difficulties in accessing medical records ; and of course limited healthcare financing just to point out a few . The Covid-19 pandemic has only served to exacerbate these challenges .
An assessment of Kenya ’ s health sector indicates that 48 percent of health facilities are run by the government , 41 percent are run privately , 8 percent are run by Faith Based Organisations and 3 percent are run by Non- Governmental Organisations .
Part of Kenya ’ s Vision 2030 plan is to improve healthcare by systematically reducing the government ’ s role in service provision while encouraging private sector investments . The main problem with that is that provision of health care services by the private sector is largely profit driven and it is arguable that there have not been commensurate changes in the country ’ s healthcare systems and laws to match the extensive investment in private facilities .
A recent study by Infotrak Research and Consulting Limited indicates that 71 percent use public health facilities ( 70 percent of these are low-income earners ), whilst just 28 percent use private healthcare facilities . Clearly , Kenyans are still heavily reliant on public health infrastructure for the provision of health care services .
Despite the Covid-19 pandemic , the country continues to reel under the weight of HIV / AIDS and STIs , Cardiovascular Diseases , Respiratory Infections and TB , and Malaria . In 2019 , before Covid , Kenya recorded 104 deaths per 100,000 people as result of HIV / AIDS and other Sexually Transmitted Infections . Cardiovascular diseases resulted in 81 deaths per 100,000 people , while respiratory infections and Tuberculosis resulted in 76 deaths per 100,000 people . In the same year Kenya recorded 10.7 million cases of Malaria .
“ Kenya ’ s health system is not meant to prevent illness , rather it is meant primarily to treat the sick ; simply put , there is little emphasis placed on preventive healthcare and this only adds to the country ’ s disease burden .”
The aforementioned study by Infotrak noted that 26 percent of Kenyans who visited a public health facility between the end of 2020 and mid-2021 sought treatment for a pre-existing condition , 19 percent for Malaria and 17 percent for a respiratory illness . The fight against Covid-19 , while necessary , must not take away our attention from dealing with other threats to our collective health and wellness .
Since the late 1980s , the government has encouraged private investment in the provision of health care services and there is now a large and diverse private healthcare delivery sector comprising for-profit and non-profit facilities . The growth of private healthcare has in turn created demand for private health insurance of most of the population .
In a country plagued by poverty and income inequality , where access to affordable health care depends not just on the availability of funds but also on the availability of health workers and facilities , private health insurance is beyond the financial reach of most citizens .
The National Hospital Insurance Fund ( NHIF ) currently has about 16 million registered members . The Association of Kenya Insurers ( AKI ) estimates that the current coverage for private health insurance is a paltry 2-4 percent of the insurable population ( policy holders and beneficiaries ). Policy holders are mostly formally employed and covered by sponsored / group medical schemes .
Infotrak ’ s findings reveal about 2 in 5 Kenyans spend under Ksh . 10,000 on
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