La lucha del sistema de salud keniano

Kenya’s Struggling Health System

26.10.2017
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Public healthcare workers in Kenya often work in conditions where they are overloaded and under resourced

Six months ago the 100-day Kenyan doctors’ strike came to an end after the doctors’ union and government agreed to sign a new collective bargaining agreement (CBA) geared to improve their working conditions and pay. Currently, a nurses’ strike is entering its third month as a result of a lack of follow up and commitment by the government to implement a previously negotiated CBA, also aimed at improving their working conditions and pay.

Photo: USAID U.S. Agency for International Development, via Wikimedia Commons

There is one doctor for every 10,000 people

Both strikes have led to the crippling of the public health system, to an extent that no patients are being admitted in most of Kenya’s public health facilities, in addition to reports of increases in maternal mortality cases in some parts of the country. Public healthcare workers in Kenya often work in conditions where they are overloaded and under resourced, with inadequate remuneration and opportunities for growth. These latest disruptions by healthcare workers signal the frustrations that have been building up over the years. Additionally, they highlight the poor governance and leadership in the health system, a critical building block for efficient and inclusive health systems.

Every year about 40% of doctors that graduate go to other countries due to lack of growth opportunities

Kenya is one of the countries listed by WHO as having a critical shortage of health care workers. Nationally, there is one doctor for every 10,000 people, with the majority within the private sector. Every year about 40% of doctors that graduate go to other countries due to lack of growth opportunities and poor working conditions among other reasons.

Primary health care has been shown to be one of the key ways to reduce mortality and morbidity (...), yet it receives the least funding

Late last year the Ministry of Health was involved in a corruption scandal involving misappropriation of more than US$ 5 million from the health budget. In the background of this, health financing remains at about 6% of the country’s gross domestic product; in comparison to the agreed target of 15% in the Abuja Declaration. According to the 2009/10 Kenya National Health Accounts, of the Total Health expenditure in the country; 29% is contributed by the government, 34% donor funded and 37 % from the private sector. Of this funding, 60%  is spent on hospitals,  20% on health centres, dispensaries, clinics and pharmacies and 14% on public health programming. This is an indication of a reactive rather than a preventive health care system. Primary health care has been shown to be one of the key ways to reduce mortality and morbidity in addition to reducing costs for the patients and the providers, yet it receives the least funding.

Photo: DFID - UK Department for International Development via Wikimedia Commons

Furthermore, there have been inadequate efforts towards addressing the social determinants leading to poor health outcomes, such as unsafe water and sanitation, unhealthy urbanization, gender inequality and low education. This means that even if a patient is able to access care in a health facility, he/she ends up returning to the same environment which is likely to have led to his/her poor health.

Even if a patient is able to access care in a health facility, he/she ends up returning to the same environment which is likely to have led to his/her poor health

In light of this, there is a clear and urgent need for improved leadership and governance to push for wholesome health reforms that cut across all aspects of curative, preventive and promotive health while taking into account the social determinants of health.This will need a strong multi-stakeholder approach to effectively implement integrated interventions with the government taking charge.

It’s therefore my hope that the Government of Kenya will step up and take charge of the situation to avoid more suffering, deaths and inequitie

Rwanda is a good example, with significant efforts towards universal health care system led by government efforts, which has resulted in the reduction of maternal mortality, increased coverage of health insurance and a strong primary health care system. Health is a human right which requires the stewardship of the state to ensure that whichever actors affect health directly and indirectly, the health and well-being of the people is always a priority. Additionally, a healthy population is a crucial instrument towards achieving economic growth. It’s therefore my hope that the Government of Kenya will step up and take charge of the situation to avoid more suffering, deaths and inequities.