2017: THE DEATH OF PUBLIC HEALTHCARE

If there was a time to write an obituary for the public health system in Kenya, the year 2017 would be it. The tombstone would read: Herein lies our public health system, born in 1963, died in 2007 after a lifetime of sickly struggle.

We have seen the public health system ailing for several years with moments ranging from sick but stable condition to moments of being in the intensive care unit. There has been moments when we had had rays of hope that this situation could be finally alleviated, to severe crashing moments when we are hanging by a thread.

The last four years have seen public health care in the state of palliative care, mostly attributed to devolution of healthcare, but the deep seated problem has been a failed policy implementation framework.

In 2013, with implementation of the new constitution, counties came alive, with a whole new governance structure, budgets and devolved functions. The transition to a devolved system has been anything but smooth. There has been turf wars between the county and national governments, much to the detriment of service provision. The level of mistrust and absence of positive intergovernmental relations is severely undermining service provision.

The Ministry of Health has been the hardest hit. From the outset, the health workers were up in arms against the hurried and unplanned devolution of health functions without appropriate structures. They went on a nationwide strike in 2013 that should have served as a wake-up call to all involved to rise up and take action. Unfortunately they were ignored and matters went from bad to worse.

Subsequent years saw multiple county-based strikes take place at the expense of the poor patient. Counties had ridiculous reactions to the industrial actions that were taking place while overall public health was rapidly being crippled.

The year 2017 was the final nail in the coffin. In December 2016, the doctors went on strike, an industrial action that lasted 100 days, closing down every public health facility in Kenya. For 100 days, the taxpayer, whose taxes are meant to cater for their health, was denied a basic right. As patients died, the health custodians played tag and ignored the silent genocide they had set up.

The strike eventually ended but the respite was short. A few weeks later, the nurses went on strike, paralyzing every health facility in Kenya. Despite Kenyatta National Hospital and Moi Teaching and referral hospital trying to hold together a semblance of service delivery, the truth is that they two institutions are so overwhelmed that they are crossing into the line of doing more harm than good.

The nurses’ strike has crossed the 100-day mark. For 200 out of 365 days in 2017, we have not had a public health system in place for the country. The sector finally drew its last breath and gave up the ghost. We are no longer in ICU hanging by a thread. The sector is dead and the obituary published. And all this, under the watchful eye of the well-paid custodians without a conscience.

The much touted free maternity care is in the bin as the maternity wards across the country are closed. Shifting the burden to private and faith-based health facilities is escapism. How many of these exist in Taita Taveta, Marsabit, Isiolo, West Pokot, Mandera and Tana River? As mothers and newborns die like flies and we refuse to acknowledge the statistics, it begs to question, are they children of a lesser God?

How much longer are young men going to die of trauma-related injuries? How many babies are missing life-saving vaccines and succumbing to pneumonia because there is no oxygen? How many of our patients living with HIV are missing their life-saving medications? How many diabetics are succumbing to diabetic coma? How many strokes and heart attacks are claiming out hypertensive patients as the clinics remain closed?

As supremacy wars rage on between the counties and the Ministry of Health, let me remind the custodians of public health care that they cannot escape blame. For those counties that refuse to invest in their facilities, human resource, and their operations and maintenance, some day that sleepy populace that voted for you shall be liberated from ignorance and the tables shall turn. It may take longer than necessary but as sure as the sun sets, it shall happen.

As for the national level custodians, let it be known that abdicating your responsibility is not acceptable. Policy implementation falls squarely in your docket. I would like to see just one policy that the Ministry of Health has bothered to implement in relation to healthcare that touches on devolved services. One that does not involve procurement. Let’s start simple, how about implementation of the staffing norms? Just this once, could the Ministry please rise up and give direction to counties on what the requisite numbers and complement staff are and call for the implementation in all counties?

How about the hoax that NHIF is about to turn into? How do we explain how a patient is allocated a facility that perennially does not have the drugs required by the NHIF beneficiary, forcing them to pay out of pocket anyway? Why won’t the facility have the drugs? Alternatively, why is a prescription not referred to another facility the way expensive radiological investigations are referred? Surely, a patient can be sent to a private facility for a CT scan costing Ksh. 6000 but won’t be sent to a private pharmacy for anti-hypertensive drugs for Ksh. 1000? Where is the policy custodian?

While the country is at a standstill because of politics, be thee warned that they cancers out there are progressing to incurable stages, the patients on dialysis are dying for lack of access to dialysis centers that are closed, cholera is doing a happy dance as it continues to cause havoc unchecked and our maternity ambulances are rusting away in hospital parking bays as the midwives are on strike!