MY HEALTH, MY RESPONSIBILITY

In my years of practice as a doctor, both as a general practitioner and as a specialist, the one thing I have never quite gotten over, is just how much we take our health for granted. This happens uniformly across all Kenyans, irrespective of their walks of life.

I am taken aback by a woman who suffers from post-menopausal bleeding for two years without going to the doctor because she had no money. Yet she is an employed civil servant whose modest salary permits her to visit a public facility at least for a consultation.

I have had my heart totally broken when a mother brings in a baby with severe pneumonia to the emergency department at midnight because she thought the paracetamol would control the fever overnight and she plans to visit the hospital in the morning.

I have held my tongue when a young man comes to the hospital with a perforated duodenal ulcer because he could handle the pain and didn't think it was that serious, yet he is now hovering on the brink of death after a drinking spree leads to the point of no return.

While our people wait to save enough money to see the doctor, or wait to observe this cough or ignore the painless symptoms, the cancer in their body continues to progress to stage four, the blood clot in their leg continues its upward journey to the heart and lungs, the diabetic foot progresses to an incurable ulcer and the uncontrolled hypertension continues to destroy the kidneys into end stage kidney failure.

Health care is utterly, totally expensive, whichever way one wishes to look at it. Someone somewhere pays for it even when the recipient of health services may not pay directly. Let us analyze some of these costs:

1. The Healthcare Professionals

This is perhaps the most expensive aspect of healthcare. The cost of training a health professional is out of reach for majority of people. It is estimated that the cost if training a single doctor in the basic MBChB or BPharm degree for instance, is almost one million shillings per year. This totals about six million shillings per doctor. Now, in keeping with WHO requirements, we need one doctor for every 1,000 people. This loosely translates to 47, 000 doctors for Kenya. These doctors must further specialize in various areas for improved service delivery. Training a degree nurse isn't any less expensive. Yet these two professionals don't even make up half of the hospital workforce. The perennially less appreciated clinical officers, physiotherapists, occupational therapists, nutritionists, laboratory technologists and technicians, radiographers and sonographers, medical records officers, morticians, sanitation officers, chefs and security officers form the bulk of the hospital team

2. Infrastructure

In the same spirit that we define required number of health professionals, the number of health facilities required per population is also stipulated. Level three facilities should serve a population of 10, 000, level four facilities, 100, 000, level five facilities 1, 000, 000. These facilities are classified based on size, staff complement and services available. It therefore calls to reason that Kenya should have at least 400 level four facilities!

3. Medical Equipment

If our recent Ministry of Health medical equipment scheme is anything to go by, equipping 94 facilities in Kenya costs something in the realm of Ksh. 38 billion for a period of seven years. This means some diagnostic and some interventional equipment put in facilities that are already up and running. Did you know that aside from purchasing an MRI machine, it costs an extra Ksh. 20 million just to safely install it for use? What of the cost of servicing these equipment and maintaining their functionality?

4. Consumable pharmaceutical and non-pharmaceutical supplies

This is the bone of contention in hospital tenders. The sheer volumes of supplies consumed in hospitals is mind-boggling. Yet this is unavoidable. Drugs must be safe, appropriate and adequate. Medical consumables such as gloves, needles, syringes and all manner of medical paraphernalia are all single use items that must be discarded for safety and proper infection prevention and control. And we haven't even accounted for the utilities like electricity and water.
 

No one chooses to get sick. But once we do, we are all equal in the eyes of the constitution. We all deserve medical care to the highest possible standards.

What we have all failed to appreciate, is that this care costs a pretty penny. And this is not limited to the private facilities only. The requirements are the same across board; the difference is only in the accommodation status! Part of the cost includes health worker remuneration. Remuneration that is commensurate to work done and skill set applied. Now, when this comes up in the public sector domain, the society gets jittery. They forget that the same skill set required in the public hospital is the same as the private hospital. The only limitation is when the public sector is constrained by lack of resources.

The gazetted doctors’ fees rules to chapter 253 of the constitution, lists remuneration for medical procedures done by doctors, taking into account the skill and time required to do this procedure correctly. If this yardstick was applied across to the public sector, the lowest paid doctor would still take home a minimum of two million shillings every month! Yet, by comparison to countries within Africa, these figures are lower than Egypt, South Africa and Nigeria. Taking a salaried position is the doctor's way of making care affordable to the employer, who is the government. Otherwise, if doctors opted to provide their services at consultancy level, the government would be in trouble.

As a society, we must change our mindset. We must accept that health care is not cheap. We must purpose to fund it at all levels. The government of Kenya must budget for health appropriately along the four main areas discussed above. The ministry of health must account for every penny to demonstrate appropriate use of these funds in achieving the objective of quality health care provision.  

The consumer, who is the patient, must budget in his own home, for health care provision. This is not a matter to take for granted. Having a medical insurance policy, irrespective of the type, is not negotiable. Once everyone is contributing to health care provision, then and only then, can we all appreciate the true cost of health care and realize why we must invest in it.

It is the twenty first century. As a country, we should no longer be holding fund raisers to treat common ailments. It is abominable!