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Kenya |
HEALTH
When Kenya attained independence in 1963,
one of the country’s goals in
line with the World Health Organisation’s aims,
was «health for all». We
are now in the year 2,000,
but that goal is far from being achieved
A number of issues have contributed to this sad situation. One of them is that health-care funding has proved to be a major concern. According to a research paper published by the Institute of Policy Analysis and Research (IPAR), the total Ministry of Health spending has only increased very gradually. «But 70% of this budget is still tied to staff emoluments, leaving only 30% for medical supplies», states the research paper.
Cost-sharing
The problem of lack of funding has been worsened by the implementation of Structural Adjustment Programmes (SAP)s in the early 1990s, with one of the results being the introduction of cost-sharing. In the health sector, this is known as the Facility Improvement Fund (FIF). (The FIF is a contribution made by the patient towards his/her medical treatment). The funds thus generated, help in the running of local health facilities.
The FIF revenue collection has had positive effects. The health facilities have been able to purchase necessary items directly, thereby ensuring the continuing supply of essential drugs. It has also facilitated the management of the various health institutions.
However, cost-sharing has hit the poorest section of the community as it scares away many people who can’t afford the charges. Then there’s the abuse of the system by those handling it.
Patients or would-be patients are the first to complain. John Oduo is a carpenter, and he makes this comment: «With the introduction of cost-sharing, getting the proper medication is proving a problem. Nowadays, without money in Kenya, you can easily die from a curable disease».
Then there’s the case of a woman who was diagnosed as having a problem in the uterus which required the removal of that particular organ. However, she did not go for the operation, saying: «We simply can’t afford the “contribution” we are supposed to pay». Another sad case concerned 45-year-old Ibrahim Nyambila who died after he was denied admittance to St. Mary’s Clinic in Mumias (Western Province), as his brothers could not come up with the necessary admittance fee. (It must be mentioned, however, that those in charge of the clinic said they had done everything possible for this particular patient after he had been transferred from another hospital. Patients will always be treated even without payment).
Poor staffing and drug-availability
In addition to the cost-sharing problem, health facilities are few and far between. In the government sector, a division must have at least one health centre and a dispensary depending on the need. A district must have at least a District Hospital and a Sub-District Hospital. These hospitals are generally understaffed. For example, a District Hospital might be serving a population of approximately 100,000 people within a radius of some 100 km, yet it could have only four or five qualified doctors, of which two are involved in administration. In the wards, one health worker (nurse) is in charge of 30-50 patients.
Many people resort to a number of risky practices such as self-treatment through the purchase of over-the-counter drugs. (without a doctor’s prescription). Indeed, these days you can come across certain people known as «mobile chemists» — i.e. a peddler or even a public service van (matutu) loaded with drugs.
For a population of 28.6 million people, Kenya has only 1,300 graduate pharmacists, and another 1,800 holding a diploma in pharmacy. Hence the existence of all these quacks one comes across, and the dangers inherent in their medical «prescriptions» with their wrong diagnosis and incorrectly prescribed drugs.
I once had the experience of nearly falling victim to such illegal practices. A matutu van drew up loaded with boxes of deworming drugs. The driver tried to persuade me to buy some. Each packet had four tablets and the driver said the dosage for an adult was four tablets «a go». However, clearly written on the packet was «not more than three tablets to be taken at each occasion».
A sad state of affairs, indeed, in Kenya’s health service!
 | Isaac Nyangeri, Kenya, August 2000 — © Reproduction authorised, with usual acknowledgment |
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PeaceLink 2000 - Reproduction authorised, with usual acknowledgement