KENYA’S HEALTH INEQUITIES: HOW DO WE CLOSE THE GAP?

Eleven days ago, amid pomp and flair, the Aga Khan University Hospital (AKUH) in Nairobi, launched its new Positron Emission Tomography (PET) CT scan machine together with its cyclotron particle accelerator. The event, graced by Her Excellency, the First Lady of Kenya, Mrs. Margaret Kenyatta, marked a massive leap in advancement of healthcare in Kenya. It marks an important milestone in investment for health in Kenya. A 600 million-worth of investment is no mean feat.

The acquisition of this important diagnostic tool is not only a sign of how much it is needed, but also a sign of the level of affluence that exists in the country. AKUH, being a private hospital, can only consider such an investment, with the assurance that this expensive equipment, which happens to be very costly to install and run too, will be put to good use and in the long, recover its cost and maintain its operational costs.

The tide of patients heading out to India to access this service is fairly high. Therefore, AKUH was not off the mark when targeting this market. These patients are not only from Kenya but also include our neighbouring countries and the region at large. They will certainly save a lot, even if it is just the air fare to India.

A week ago, the First Lady graced another important continental event. The second African Union Conference on Maternal, Neonatal and Child Health was hosted by Kenya at the Safari Park event. The three-day event focused on the state of maternal, neonatal and child health in Africa, mapping out where we are as a continent, steps needed to achieve the critical sustainable development goals and what we are currently doing in our various small spaces.

Innovations for health featured very strongly in the conference, with different key players showcasing their work, especially in the demonstration stands outside the conferencing halls. The most fascinating innovation I came across, that certainly caught my attention, was the Digisomo talking books by Centre for Behaviour Change and Communication (CBCC).

This simple little gadget scored 10/10 for me, not only in its simplicity and impact but also in the massive transformation in behavior change that it has had in the rural communities of Turkana, Pokot and Samburu. A simple digital audio-computer that is battery-operated, serves as a talking book to the populations in the arid North that have little or no formal education. The talking book provides health information and messaging through dramatization, disseminating powerful health messages to the people in a language they can understand and relate to.

What was even more commendable, is the impact this little gadget has had when it comes to behavior change. It is obvious that CBCC has seriously invested in psychologists and in anthropological research, to be able to understand their target populations, their customs, practices and behaviours and then plan on how best to influence positive behavior change.

In communities where men consider pregnancy, childbirth and raising children a preserve of women, it is no mean feat to get young morans to accompany their wives to the ante-natal clinics or carry their little ones miles away to the nearest clinic for vaccination. CRCC has demonstrated the highest level of innovation when it comes to influencing behavior change.

In a country where we have a population that can afford to seek PET-CT scans at a premium fee in another continent, it is amazing that the same country is home to people with such little education that we need basic audio gadgets to pass on basic health messages such as the importance of antenatal care, breastfeeding, child nutrition and vaccination. These are things majority of us take for granted as technology has put everything on our palms though smart phones.

Despite our constitution guaranteeing all of us the right to health, our socio-economic divide determines how we define that right. For the affluent, the “highest attainable standard of health” means access to modern technology in diagnostics, modern treatment options and the very best specialists across the globe. To the mother in Baragoi in Samburu, being able to deliver in a health centre with a trained midwife to avoid complications sums it up.

The divide is too large. We cannot speak of meaningful access to health for all if we are not able to close this divide. A client cannot demand for goods or services they know nothing about. A vegetarian cannot demand for grilled duck when they have no idea how meat tastes like. The lack of formal education and economic empowerment means that our underserved populations continue to lag behind in health.

This then means that the governments, whether at county level or national level, will not feel the pressure to step up the healthcare services provided to this population. In the beautiful wild North, health care services are still very basic to the majority of the population. For them, not much will have changed over the last five decades.

Fortifying nutrition through ensuring food security and adequate knowledge on nutrition goes a long way in setting the building blocks for enhancing healthcare. Strengthening preventive medicine through vaccination, elimination of harmful practices, health education and screening services is a major pillar in developing healthy populations.

In addition, there has to be a concerted effort to progressively grow and enhance curative services in this part of the country to achieve health equity. The rate of growth of health facilities seen in the rest of Kenya needs to be replicated in Northern Kenya. Unique solutions are needed for this population and their migratory way of life should no longer be the excuse for poor health services. Maybe it is time to consider upgrading the functionality of Lodwar County and Referral Hospital to level six status!