Actualise UHC dream to save poor people dying from treatable diseases

The point of divergence between ordinary Kenyans and President William Ruto on Social Health Authority (SHA) is that while they are concerned about dysfunctionality in SHA, Ruto is fixated on fighting ghosts that haunted the National Hospital Insurance Fund (NHIF).

NHIF had inherent weaknesses that turned it into a cash cow, especially for private hospitals. A little political goodwill would have made things better, but there was none. In the end, NHIF failed to respond to the needs of its members and to promote the ideals of Universal Health Care (UHC), which are access to affordable, sustainable, equitable and quality social healthcare.

At some point, Kenyans expected that NHIF would be fashioned after the Patient Protection and Affordable Care Act famously known as Obamacare. It gave more Americans access to quality healthcare, their statuses in society notwithstanding. 

The Obamacare Act of 2010 made it difficult for health insurers to make unjustified rate hikes while the public was given the right to appeal insurance company's decisions. With Obamacare, top earners were taxed more to finance healthcare while those in low-income brackets got tax credits and tax breaks.

The Social Health Insurance Fund (SHIF) and SHA, which replaced NHIF, have not made any positive impacts. In the six months since their operationalisation, they have attracted more complaints than NHIF in its entire life, but the government refuses to acknowledge there is a problem. SHA is an impediment to the actualisation of UHC goals. 

First, there is the cost factor, right from disproportionate monthly contributions that are higher than what NHIF used to charge. Secondly, the requirement that all treatment should start in dispensaries is burdensome and discriminatory. While the rationale behind this requirement was to ease congestion at levels 2 to 5 hospitals, it disregarded the fact that it would end up creating an even bigger problem in dispensaries that are not only understaffed, but lack basic facilities and drugs. 

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Most dispensaries are run by either a single nurse, or by a clinical officer assisted by a nurse or two. One wonders where patients in, say Baringo County should seek referrals when dispensaries like Chewera in Tiaty, which was built in 2013 neither have staff nor a single paracetamol tab, or Ngaina dispensary built in 2018, still in Baringo County, that now serves as a maize store. 

Despite talk about UHC becoming a reality, people are dying of treatable diseases like malaria because there is no comprehensive government policy, or medical coverage to ease the burden of costly medical care even in government hospitals. A week ago, I assisted an old patient suffering from hypertension to find a sonar centre and lab services in Kakamega town after being referred by the Kakamega County General Teaching and Referral Hospital. 

She had been asked to conduct a ‘bilateral blood limb oedema’ test, ‘urinalysis’, ‘RFT’, creatinine (kidney test) and electrolyte (nerve and muscle function), including HBA 1c (Protein test). To conduct the tests, she needed Sh8,250, yet she had only Sh1,000. Dejected, she left and forlornly said she would await her fate. She is just one of many who stare at preventable death in the face because they are poor, and UHC is a mirage.

Why refer patients to private clinics for such expensive tests yet, in 2014, the government rolled out a Sh38 billion Managed Equipment Services scheme through which two hospitals in each of the 47 counties were to get state-of-the-art diagnostic machines to ease the burden on patients?

What stops referral hospitals from having necessary machines for these tests? Of course, there is the element of corruption in which equipment in public hospitals is deliberately sabotaged to allow medical staff to make money on the side in their private clinics.

Even as it grapples with streamling SHA, the government should actualise UHC so that every Kenyan gets access to quality healthcare services that whenever and wherever they need them without financial hardship and meaningless red tape that transfers, rather than solves problems in the health sector.