Better oversight and vigilance key to success of UHC rollout
With the Government winning an African Union award and being recognised as a successful case-study at the United Nations General Assembly this week, it seems to be a good time to revisit the progress of Universal Health Coverage programme.
The Government launched the Universal Health Coverage programme pilot in the four counties of Kisumu, Isiolo, Nyeri and Machakos nine months ago. The programme seeks to progressively fulfil Kenyans constitutional rights to the highest attainable standard of health care. Access to safe, effective and consistently high-quality health services is the goal.
Under the programme, Kenyans can expect access to free immunisation, maternal health care and prevention of non-communicable and communicable diseases services. This expectation will be met by abolishing user fees, 100 new clinics, enforcing quality standards and enabling public oversight and accountability in line with the Patients Charter.
The initiative has already provoked continental and international interest. This week, State House announced that the President had won the African Union Political Leadership Award for Universal Health Coverage (UHC). The programme was also in the spotlight in a side meeting at the United Nations Global Assembly in New York.
The moment is not without historical significance. Less than two decades ago, the concept of universal health coverage was derided as socialist thinking. The idea of free health services was a financial impossibility. Any African Government who dared to declare like Cuba, its intention to implement free health-care, would face the wrath of the World Bank and the International Monetary Fund.
This week’s announcements left more than a few netizens expressing their disbelief. Citing numerous incidents of recent patient service denials, neglect and detentions for non-payment of fees, most challenged the assertion that the pilot is reversing the medical health care challenges. Among the many cases, is the tragic experience of young Mercyline Ongachi. Mercyline, a first-time mother, gave birth and then watched her twins die on the floor of Mama Lucy Kibaki hospital.
Public disbelief is informed by the history of medical neglect and misery. It may also be informed by the failure to track UHC in the pilot counties. Inadequate financing, weak public understanding of their rights, health workers ignoring clinical guidelines and poor application of disciplinary sanctions have contributed to health rights violations across the country.
Less than 10 per cent of our rural health facilities can effectively provide emergency maternal health care. The average health worker sees an average of 13 patients a day. This is an increase up from nine in 2012. With less than 30 per cent of health workers consistently following clinical guidelines, there were 115 cases of misconduct reported last year.
Health justice is elusive. Of the 985 cases lodged with the Kenya Medical Practitioners and Dentists Board over the last decade, only one doctor has been deregistered, four licences cancelled and six suspended. Families complaints to the media suggest that the incidents of medical mal-practise may have increased eight times since last year. This experience is precisely what the UHC programme seeks to transform.
According to the opinion poll released this week by the Health Peoples Movement, 82 per cent of the country think the programme is important for Kenya. Four of ten of the users sampled have been satisfied with the services they had received. Three quarters of users have not had to pay anything to access services. Given the high levels of poverty in the country, this is significant. According to the public survey, the challenges seem to lie in the inadequate supplies of medicine, long queues and for 64 per cent of those polled, having to travel distances of over three kilometres.
The County Governments and the Health Ministry can be encouraged for the progress so far in the four counties. The very real challenges must be addressed before expanding the programme to the rest of the country. For the programme to be truly universal, it needs to roll out to all hospitals and clinics and be adequately stocked with medicine and served by Kenyan doctors and health-workers. Public awareness and registration is also critical for the success of the programme. So too, is civic oversight.
This week, President Kenyatta challenged Kenyans to speak up and act up if the quality of services drops. The price of safety in our health facilities is oversight and vigilance. Every citizen must understand the promises of the Patients Charter. We must hold our doctors, facilities and policy-makers publicly and legally accountable for safe and high-quality effective services.
First published Saturday Standard, September 28, 2019. Kindly reproduced here with permission from the Standard Group