Monday 2 April 2018

Universal health coverage hurdles in Kenya AKA vizingiti vya Afya kwa wote nchini

President Uhuru Kenyatta has made affordable healthcare one of his Big Four Agenda for his final term. This wouldn’t have come at a better time since the world is heading towards universal healthcare. Universal healthcare focuses on access to quality services for citizens of all social classes. This requires bold discussions around the key pillars of an effective health system as defined by World Health Organisation. A well-functioning health system responds in a balanced way to a population’s needs and expectations by: Improving the health status of individuals, families and communities; defending the population against what threatens its health; protecting people against the financial consequences of ill-health; providing equitable access to people-centred care; making it possible for people to participate in decisions affecting their health and health system. The WHO has identified six key components of a well-functioning health system as: Leadership and governance, health financing, human resources for health, health information systems, essential medical products and technologies, service delivery. All this components must perform optimally for the realisation of Universal Health care access. In health financing Kenya ranks position 140 out of 190 in the WHO Ranking of the World's Health Systems. The difference between us and leading countries is health financing. This has greatly affected other components such as human resources, essential medical products and technologies and, ultimately, service delivery. The WHO provides for minimum staffing norms, which were customised in the August 2014 Human Resources for Health Staffing Norms and Standards by the Ministry of Health. This was to be achieved by employment of 12,000 health workers per year for four years, but the government has since employed only 15,000 in four years. As the period for the staffing guidelines expire at the end of year, we are nowhere near compliance with minimum staffing standards. According to the guidelines, we were supposed to have 16,278 clinical officers, 13,141 doctors and 38,315 nurses in public health sector employment against the current 6,000 clinical officers, 5000 doctors and 25,000 nurses. We are nowhere close the 50 per cent minimum staffing standards. This may be a contributor to the medical errors recently at Kenyatta National Hospital, where staff are overworked and fatigued. The ideal minimum health worker to population ratio should be 23 health workers to 10,000 Kenyans or 40 clinical officers per 100,000 Kenyans, 32 doctors per 100,000 Kenyans or 95 nurses per 100,000 Kenyans. The shortage of essential medical products in our public facilities is one that cannot be ignored. Kenyans fly to India for cancer treatment and many patients die waiting for the only radiation machine at KNH that sometimes breaks down for weeks. Most patients visiting county hospitals are forced to buy drugs from private chemists as medicines are out of stock most of the time, coupled with long queuing hours to see a clinician. Access to highest attainable standards of health is a constitutional right under Article 43 ( 1 )(a) and therefore Kenyans have a right to ask their elected leaders to account on facilitation. The government through parliament should increase health financing in the 2018-19 budget to at least 10 per cent to ensure the human resources for health staffing norms and standards are met and that essential medical products and technologies are optimised to ensure equitable access of health care services to all Kenyans. www.mugambipaul.com for more

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