National regulator can help fast-track UHC initiative
By Hosea Kili
When the 2010 Constitution was promulgated, the health sector became the largest sector to be devolved under the new dispensation. All the 47 counties had power to design and implement interventions to meet unique health needs relevant to their contexts and more effectively include citizens in decision-making.
Hospitals and dispensaries in the counties were quickly upgraded and equipped like never before, and there was real hope that management at local level would improve the quality of healthcare services based on community priorities.
As the hardware improved, a crisis emerged that stagnated healthcare and reversed some of the gains already achieved. Initial symptoms included shortages of personnel, late payment of salaries that led to doctors, nurses and support staff to stage the longest strike that left millions of patients unattended and vulnerable. Hospitals lacked infrastructure to support multi-million-shilling equipment while drug shortages, mismanagement, corruption cases soared amid a vicious and now familiar blame game between National and County governments.
Healthcare was on its deathbed, literally, and various associations and stakeholders even called for a return of the sector to the National government. The Constitution provides that Kenyans are entitled to the highest attainable standards of healthcare and guarantees the right of every child to healthcare. But this is not the case.
Studies show only 62 per cent of Kenyan’s primarily rely on the public healthcare system within an hour of their homes and health indicators fall below average compared to various other African countries. The private sector is the dominant player in healthcare, occupying 65 out of the 4,929 health facilities in 2014. Half of the counties have fewer than two health facilities per 10,000 people and 4.2 facilities per 100 square-kilometers. Patients in counties such as Marsabit, Tana River and Isiolo which have the fewest health facilities, have to travel long distances, even for days to access health facilities.
Healthcare, therefore, is expensive business and while some gains have been made towards Universal Health Coverage (UHC), the situation is still alarming. At least 112 Kenyans are diagnosed with cancer daily. There country also suffers a shortage of medical technologists, kidney experts, gynecologists and others. Disparities in counties and regions point to a disjointed sector in dire need of radical reforms to ensure quality and timely healthcare uniformly.
The supreme law anticipated that counties will provide essential health services while the National government manages health policy and provides technical assistance through consultation and cooperation. The Health Care Act (2017) aims to create a unified health system that aligns with the Constitution by spearheading and coordinating the interrelationship between the two levels of government.
Aligned to money, manpower and management is the need to address the complexities to effect the quantity, quality, safety and distribution of services in the health system. This includes the costs and affordability, human power, access and awareness among others. The World Health Organisation advocates the use of regulation when developing options to effect national health planning processes.
A regulator for health services will implement the government policy on UHC by, for example, regulating the touchy issue of supplies and distribution of medicine; ensuring regional blocs that guarantee networks of functional facilities providing complementary essential services; incentives that enable service providers and partners support cost-effective financing of universal healthcare; ensuring a pool of qualified and motivated staff, and the timely transfer of funds while providing a higher standard of protection for citizen rights including insurance.