Seal cracks in public health to address inequalities
Doctors are clear now that several factors or vectors are responsible for microbes turning into the pathogens that can cripple our bodies. It is not being cold that gives us the flu. It is the combination of our exposure to viruses and low levels of immunity usually does it. It is the same with governance, a fact our leaders should not ignore as they select their cabinet for the next five-year term.
This week, Oxfam released new and startling statistics on inequalities in Kenya. 8,300 individuals own more wealth than 44 million Kenyans. 19 million people are absolutely poor and 6 million are completely destitute. Yet, the number of millionaires are set to grow by 80%. Extreme inequality is now out of control.
Inequalities slice across gender, class and geography. It directly affects our access to health and other essential services. One in four Kenyans do not have regular access to healthcare. 66% of our population risks bankruptcy by surgery or hospitalization bills. Middle and upper-class women have three times more access to maternal health-care than those living in poverty. Tragically, arriving dead on arrival or being detained at child-birth is a familiar danger for too many now. How we manage our public health deeply matters.
Health is also big business. By 2014, it grew to become a Kshs 234 billion business across a range of private, public and not for profit services. The intensity of these competing interests pit international, national and county interests against each other.
Return on investment rather than development assistance is increasingly the lens by which North American, European and Asian governments and companies view Kenya’s health sector. DFID recently shifted its policy from “aid not for commercial interest” to “aid with spin off commercial results”. The new Dutch policy “A world to gain: A New Agenda for Aid, Trade and Investment” emphasizes market access by Dutch companies. Similar aid and trade policies exist in the US and China.
Bolstered by this, Philips, GE Healthcare and Toshiba lead new public private partnerships like Managed Equipment Services that fund a range of public private projects across the counties. Companies like Abraaj Health Group have recently acquired 50% ownership in the Avenue Group of hospitals among other investments including Brookside Dairy Group and the Java chain of restaurants.
Universal primary healthcare is correctly a priority for both national and county governments. To succeed, they will have to improve their capacity for direct policy control and regulation. We know from the 1980s that unregulated privatization led to health workers being laid off, increased health-care disparities and the collapse of the public health systems across Africa.
We must do more to seal the factors or vectors that weaken our public health system. The revolving door between policy-making and private business is simply too fluid. Corporate business advisory board positions, research funding and technical assistance crowd out the voice and interest of patients and the public. Over-invoicing, dubious investments, beneficiary inequities and arbitrary benefits changes challenge the impact of our National Health Insurance Fund.
Why did it take so long to bring the doctors’ strike to an end? We now know that the primary beneficiaries of the strikes were private facilities. As patient access dropped 33% in our public hospitals, twice as many patients accessed private facilities this year than in 2016.
Tenderpreneurs still stalk the corridors of our public hospitals and chase after our ambulances with too much confidence. 2015 and 2016 saw massive diversion of public funds in highly inflated procurement deals, non-essential purchases, double budgeting and last minute budgetary supplements. Not even fixed generators are safe as we learned in the case of Tharaka Nithi.
These risks conspire to produce low levels of immunity within our public health system. Left unchecked, they will overwhelm it. Private healthcare does not undermine our right to health. If regulated well, it compliments it. Citizens must press for robust conflict of interest policies and greater regulatory oversight in line with national standards. Our 47+1 Governments must transparently regulate the excessive influence of business and increase the influential role of citizens in decision-making. Health business associations must hold corporates liable for any illegal activity and actively challenge all forms of corruption.
By doing this, profits will not threaten patients and microbes can be stopped from becoming pathogens and overwhelming our nation’s health and prosperity.
First published Sunday Standard, December 10, 2017. Kindly reproduced here with permission from the Standard Group