In the era of a revolution in access to information, the
third world is a clear winner. Alternative media has given mainstream media a
run for their money and for them to survive, they must be able to adapt rapidly
to stay ahead of the game.
The Arab spring has been largely credited to access to
alternative media and we see this replicated everyday in our own country. Along
with Nigeria and South Africa, Kenya dominates social media in Africa in a
manner that is unprecedented.
The platforms have been used by every individual or group
that is marketing, advertising, advocating or protesting. Locally, the civil
society and labor unions are currently at the top of the charts in driving
their agenda on these platforms, mobilising the public and creating awareness.
This has been demonstrated in the past 78 days, where social
media platforms have been flooded with hash-tags highlighting the Kenya Medical
Practitioners, Pharmacists and Dentists Union’s grievances, enabling us to follow
the intrigues of the ongoing strike. #LipaKamaTender, #DoctorsStrike,
HealthOnTrial, #DoctorsOnTrial, #DoctorsInJail, #HealthCrisisKE #CBASeven,
#DoctorsReleased are some of the trending tags that have made headlines.
These tags have enabled the doctors to highlight their grievances
to the public and even use them to communicate to the higher levels of
leadership in the country. In the process, they have elicited strong responses
from both sides of the divide in equal measure. Pictures of the incarcerated
union leadership in the infamous prison garb forcefully raised a public outcry
from supporters of the union and equally scathing remarks from the opposing
camp.
One of the critical observations made from these interactions
is the glaring lack of knowledge in the public arena about the right to health.
Chapter four of the Constitution of Kenya 2012 conceptualizes the following relevant
provisions for health:
1. Section 21 (1): It is the fundamental
duty of the state and every state organ, to respect, protect, promote and
fulfil the rights and fundamental
freedoms of the bill of rights;
2. Section 43 (1) (a): Every person has
a right to the highest attainable standards of health, which includes the right
to healthcare services, including reproductive health care;
3. Section 43 (2): A person must not be
denied emergency medical treatment
4. Section 46 (1) (a): Consumers have
the right to goods and services of reasonable quality;
The drafters of these provisions intended to avert
preventable morbidity and mortality while maintaining a healthy population. Why
then, has ignorance about these rights persisted? Some of the following reasons
include:
1.
Lack of supportive acts of parliament
that will define implementation of these provisions.
Take for instance the case of the
patient who died in an ambulance for lack of access to intensive care. It is
critical that an emergency care act defines what is regarded as emergency
medical conditions; interventions categorized as emergency care; who pays for
this care and modalities of how this is done; who will provide this care from
point of contact with the patient to transfer into continued care. In the case
of the critical care, when does emergency intensive care end and continued
intensive care begin; what happens in case this care is not available and who
shoulders the economic burden of intensive care for instance.
2.
Poor public attitude
The biggest hindrance to access to
the highest attainable standards of care has been the client. The poor state of
health in Kenya has persisted for so long that it has been accepted as the
norm. This has resulted in the blunting of the need to demand for quality
health care provision. Take for instance the mother who has been granted free
maternity care. She is so grateful to access what she thinks is a free service,
failing to realize that she has already paid for it through her taxes. Instead,
she is afraid to question why she is sharing a bed with three other women in
labor. Or the breast cancer patient waiting for radiotherapy treatment for eighteen
months while the cancer progresses to stage four. In both cases, the patients don’t
recognize their consumer rights to reasonable standards. The most outrageous
attitude I come across is the notion that poor health standards are expected in
the rural or less developed areas in our country.
3.
Enforcement
Enforcement of these rights is a task
that must squarely lie with the state and its various organs. It is critical to
realize that enforcement of the highest standards of health must be separated
from who owns the service point. Whether the care is in a state-owned or
private facility, the quality must be standardized with respect to
infrastructure, human resource, skills and supplies. The state must accept to
mete out punitive measures to facilities that allow poor health outcomes
whether they are state-owned or not, including summary closure. Therefore, monitoring
and evaluation becomes a critical component of enforcement.
4.
Health financing and universal health
care
It is absolutely impossible to expect
enforcement of the right to health without commitment by the state to meet the
financial obligation. Each country must find a formula that works but the
ultimate goal is to ensure adequate fiscal commitment. Universal health care,
if adopted, must be well thought out and efficiently rolled out for it to be
successful.
To this end, it falls upon the state to take up its
responsibility in ensuring this constitutional right is upheld at all times as
mandated in Section 21 (1) of Chapter 4 of the constitution. This starts with
passing the requisite laws, starting with the stagnant health bill. Civic
education is critical, even to those who do not realize that affording health
care is not equivalent to knowing your health rights. This awareness then helps
in enforcement, as the populace can then demand of their government to maintain
standards across the health sector.
The Doctors’ strike has provided an opportunity to open this
discussion as a country and commit to taking the drastic measures required to
turn around the state of health. Good health care is not a privilege, it is a
right!
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