Why health-for-all dream may be stillborn

On Thursday, the President launched a pilot Universal Health Coverage (UHC) project in four counties, with the intention of eventually rolling out the scheme for all Kenyans. While the scheme has many moving parts some of which are not yet clearly worked out, those of us interested in the health sector must acknowledge that the intentions behind it appear very good and beneficial to the majority of our people.

All of us want the scheme to succeed in order to remove the scourge that continues to impoverish Kenyans and prevent them from achieving their full potential.

Unfortunately, our history in implementing ‘mega-projects’ has not been very inspiring in the recent past. Massive theft and corruption have attended each and every one of the projects that have been launched with the intention of improving the quality of life of Kenyans.

CORRUPTION

From road construction to the Standard Gauge Railway; from the managed equipment scheme in the health sector to the basic education curriculum change and production of new textbooks; all sorts of public projects are riddled with corruption and massive theft of public funds.

It is therefore only natural that some of us maintain a healthy scepticism whenever a mega-project is launched.

In order to determine whether this UHC project is likely to succeed or fall into the clutches of our hyenas, it is necessary to keep asking the hard questions.

This is especially so in a sector that literally deals with life and death.

ESSENTIAL ELEMENTS

A key consideration, in my view, is an assessment to determine whether all elements in the plan are catered for, or if the roll-out is being rushed without considering essential elements. As presented by the government, UHC aims at providing a certain package of services to the largest proportion of the population possible.

The package must be of acceptable quality that accords to established standards of care.

Indications in the health sector at the moment are that the government has its mind set on creating a new system of healthcare delivery hitherto unknown even to most in the health sector. Under the guise of ‘task-shifting’ (which in reality is task-shirking by those that have the responsibility to deliver quality healthcare), the government has determined that it is better and perhaps cheaper to create new cadres of health workers to deliver highly specialised care for Kenyans at all levels.

SHORT-TERM TRAINING

Instead of allocating resources to train and deploy sufficient numbers of specialised and generalist doctors, nurses and other health professionals, the government has bought into the idea of giving short-term training to relatively lay providers and deploying them, presumably at lower cost, to provide specialised services to poor Kenyans.

We are even seeing proposed legislation that is aimed at allowing primary healthcare personnel to admit patients into hospitals and prepare life-altering medical reports for Kenyans in need.

These, and the sideshows involving attempts to determine professional fees charged by private doctors in private facilities leave us with doubts as to the seriousness of the government in implementing UHC.

A recent study published in the highly respected Lancet medical journal demonstrated that in the era of UHC, more people are dying due to poor quality care than due to poor access to care.

It would appear to me that in failing to heed the lessons of history, we are preparing ourselves to repeat it.

Atwoli Associate Professor of Psychiatry Dean, Moi University School of Medicine; [email protected]