Did our public health system or criminal negligence kill Hannah Njoki?
First published Saturday Standard, September 1, 2018. Kindly reproduced here with permission from the Standard Group
I spent six hours on Wednesday night at Kenyatta National Hospital with a friend who had suffered a Transient Ischemic Attack or stroke.It had been a while since I had been in KNH and I saw several reforms. The emergency department was cleaner, friendlier and safer than I remembered it. Fourteen exhausting hours later, she was discharged after a range of six or so diagnostic tests and care. She was lucky. Road accident victim Hannah Njoki didn’t make it. Three days after being brought in on Saturday, KNH still hadn’t been able to find an ICU bed for her. Without the money to access private emergency health care, she passed away Tuesday. Her family grieves this weekend. We need to ask what fails Hannah and all patients denied health care and how can we fix this.
Kenya has made some of the most important declarations on the right to health on paper. Article 43 of our constitution and the Health Policy 2014-2030 obligates national and county Governments to provide the highest possible standards of health for all Kenyans. Healthy living, safety from violence and injuries, quality health care at the time we need it and better collaboration between our public, not for profit and private health providers is key to this. So is, guarding the preciously little investment that goes into public health care.
The right to health is personal for us all. At this moment, I have no less than seven members of my immediate family grappling with debilitating or life-threatening health conditions. Like most families, the experience is simply, frightening. It requires courage and curiosity at the same time. What health-care do we need, what does health insurance cover or not cover, what is going to cost and where do we find the money?
The denial of quality and affordable health care is still the number one killer and financial catastrophe risk for too many of us. This is why we must take note of the recently released Ethics and Anti-Corruption Commission systems review into the pricing of pharmaceutical and non-pharmaceutical medicines and equipment. Launched by Health Cabinet Secretary on August 17, the report found several systemic weaknesses and failures in the Ministry’s procurement policies and practices. The absence of a list of accredited suppliers, periodic reviews of essential medicines, involvement of health experts in developing the Market Prices Index and general procurement guidelines are among them.
While very welcome, the review findings are not a surprise to some of us. It validates the whistle-blowing policy brief released three years earlier by civic organisations, the Society for International Development, Kenya Ethical and Legal Issues Network and Transparency International. The EACC have acknowledged the “Sealing corruption loopholes in our health procurement system” 2015 report as the primary reason for the review last year.
The review has taken a year to be released after it was completed. The issues it touches on, relate to lapses in the Ministry in 2014 and 2015. At least three Cabinet and Principal Secretaries have come and gone. The scandal with GAVI and other donor funds remains unaddressed. Accounting officers entrusted with public duty have neither been absolved or implicated by this or any other investigations.
There are two questions we need to be asking. Does the current Government treat these lapses as matters of systemic failure, criminal negligence or both? What is the cost and impact of delayed reviews and institutional reform?
In his national call against corruption in November 2015, President Kenyatta seemed clear on the first matter. He called for major reforms at the Public Oversight Procurement Oversight Authority and announced that the Criminal Investigation Department and Assets Recovery Agency would investigate both companies and state officers who have colluded to illegally increase health care costs.
On the second question, we know that the percentage of citizens using Government health facilities dropped by 27% last year. Nearly half of these may have moved to private or NGO facilities. While these figures were driven by the protracted negotiations with striking doctors, they sound an alarm to those of us who believe in universal health care. Citizens have cited the lack of medical staff, cost, distance and quality of treatment in this order.
To borrow a phrase from our indefatigable Director of Public Prosecutions, the system of chaos has to be transformed from many ends. Tighter policy oversight, swifter interruption of corruption cartels and deeper patient awareness and vigilance will fix this. If we do this, our public clinics, dispensaries and hospitals will become equipped, empathetic and professional spaces of sanctuary and recovery for our ill and injured. Not just for Hannah and some of us, but even for the relatives and friends of those currently sabotaging our facilities.