The Ideal Health system for Kenya (Essay Sample)

Assignment 2
The Ideal Health system for Kenya
Student Name
Registration No
Module Name: Health Systems and Evaluation of Health Systems, Services and Public Health Programmes
Module Code: UU-MHM-520
Tutor’s name: Daphne Kleopa
Date: 13th November 2020
Different countries have different health systems that suits their needs to the best level. However, when compared to health systems of other countries can elicit many differences between them. This means there is no perfect health system in the whole world since each country grapples with its own health system challenges.
Kenya is an East African Community state that is a low and middle income country (LMIC) with a Gross Domestic Product of $99.246 billion (IMF, 2019) and a population of 52.57 million in 2019. The country uses both the Beveridge and Bismark models healthcare delivery systems whereby funding is based on taxation and controlled by the national government allocations to public health facilities. Private insurance model complements the small percentage of healthcare.
The country’s population is changing rapidly necessitating a health care system that can sufficiently address the health challenges. Kenya’s health is affected by extreme poverty, lack of access to clean drinking water, hunger, drought, poor physical infrastructure, poor housing, high illiteracy levels, corruption, accidents and injuries, environmental pollution, high infant, maternal and child morbidity and mortality, high burden of communicable diseases and many other factors.
There has been increasing need to strengthen healthcare delivery systems in developing countries that has been necessitated by challenges in health conditions. International health objectives are all being focused on primary healthcare where community health workers fall directly. This paper highlights the strengths and weaknesses of the current Kenyan health system and attempts to recommend a system that can work better.
Current challenges facing healthcare in Kenya
Population coverage with both healthcare services and financial risk protection has been improving in Kenya. The government efforts to expand access to essential healthcare services and reduce financial barriers are fruitful. The efforts include policies such as the user fee removal and free maternity policies introduced since the year 2013. Despite these efforts, population coverage is still low due to inequalities where the rich have better coverage than the poor (KEMRI, 2019).
According to the 2019 national census, Kenya’s population is 47.6million people up from 38.6million in 2009. On average the country’s population grows by 10million annually. This rate of growth is high attracting diverse health needs.
The Kenyan healthcare system has achieved some healthcare milestones especially after 2010 constitution that brought in devolution of the healthcare management to county level.
Kenya’s Infant mortality is 39 deaths per 1,000 live births and under 5 mortality is 52 deaths per 1,000 live births according to the 2014 Kenya Demographic Health Survey. The maternal mortality ratio for Kenya is 362 maternal deaths per 100,000 livebirths while for US it is 23.8 maternal deaths per 100,000 live births (KDHS, 2014).
Kenya’s healthcare system depends on government revenue allocation from taxation, the country only invests only 6% of its GDP towards healthcare system. This low allocation of revenue has serious consequences for the country's urgent health care problems since it cannot meet the most of the needs (Netherlands Enterprise Agency, 2016).
According to Child Fund International (2016), Kenya has a high burden of communicable diseases. Malaria kills close to 4000 people annually with a 6.7 million new cases each year, high HIV/AIDS prevalence of 4.9%. Other problems are poor sanitation that exacerbates spread of diseases as well as high burden of non-communicable conditions such as cancer and injuries.
The health system is stratified from the community level to national referral hospitals. The latter are located in major cities far from reach of people in the rural areas. For example, Kenya has 4 national referral facilities (Kenyatta National Hospital, Moi Teaching and Referral Hospital, National Spinal Injury Hospital and Mathari Mental Hospital) all situated in Nairobi and Eldoret. The location of these facilities limits people from farthest rural areas from accessing the facilities that are well equipped. This is worsened by poor road infrastructure.
The government has not invest in adequate healthcare personnel. There is a longstanding shortage of healthcare professionals. There is only one nurse for every 1,000 people and are poorly distributed in the country. This has resulted in to low-quality treatment in remote regions. According to Kenya Healthcare Federation, low pay, leads to demoralization and fatigue among healthcare workers.
High poverty index in Kenya (majority of Kenyans live below poverty line) compounds on the major problem affecting access to healthcare. In the facilities where Kenyans can find the medical attention required, lack of affordability obstructs many from accessing health care. There are many partners that come in to fill this gap of access by direct funding to the marginalized communities in Kenya mainly in the northern parts. Organizations such as UNICEF, USAID and Medicins San Francisco have been helping Kenyans through their various initiatives access healthcare.
Kenya’s Healthcare system has been worst hit by corruption by government officials. This has happened over years whereby donor funds meant to improve healthcare have been embezzled by greedy government officials. Some donors have raised red flag on the rampant corruption in Kenya. US based organizations have reduced on funding and even withdrawn some essential services that touch directly on the health of the poor Kenyans (Daily Nation, 12th June 2019).
There is poor governance in the healthcare system of Kenya. Decision making around healthcare is not informed. There are several equipment that have been supplied to government hospitals that do not have either space to use them or the electricity to run them. Much money has been incurred in the purchase, yet the machines have been stored due to lack of personnel to operate them electricity to run them. Such machines include CT Scans and MRI that are stagnating in some hospitals yet patients have to travel long distances to access healthcare.
In Kenya, there is only 25% of population who are insured. The rest 75% fund themselves. The government has not done much to create demand for health insurance. The government run National Hospital Insurance Fund (NHIF) is undersubscribed and overstretched. The cover is mainly funded by the government and private entities as part of mandatory scheme contributions. There are a few self-paying Kenyans. However, there is a major disparity on the access to the NHIF fund. Civil servants enjoy more benefits during hospitalization.
In terms of healthcare quality, the system is characterized by long queues in hospitals, lack of essential medicines, lack of adequate sanitary facilities and poor patient care due to inadequate staffing. There also absolute lack of follow up of patients and almost lack of rehabilitative healthcare services in all public facilities in the country.
For sure there have been insufficient efforts towards addressing the social determinants that culminate to poor health outcomes like unsafe water and sanitation, rapid urbanization with poor conditions of living, gender inequality and low formal education. As a result, if a patient is able to access care in a health facility, they end up going back to the environment that might have resulted in their ill health (Mwoka, 2017).
Funding for medical research in Kenya is very poor. As such, no major innovations have been gained that touches the healthcare system. Most of the healthcare products are imported from developed countries.
Some studies have shown that there are legal and ethical malpractices by the doctors and healthcare professionals. This is also the case for Kenya. Whenever there are research grants for clinical trials, most physicians enroll patients in the clinical trials to earn a lot of money provided by the grants without the patient’s knowledge. In this case, patients end being used as products or commodities for personal gains (Shreibati & Baker, 2011).
Evidence is available on the disparities of healthcare provision based on social class, gender, race and ethnicity. These factors have affected many people and have resulted in mental and psychological issues. The poor end up avoiding to seek healthcare including primary screening for conditions. Hence due to late diagnosis, mortality increases among this population (Read & Gorman, 2010).
Free-market private insurance Health system: The way to go for Kenya
Many scholars in healthcare have compared healthcare systems across the world. The US systems is the only one of its kind, the free market insurance healthcare system that has very little government control compared to other developed and developing countries that have both the Beveridge and Bismark systems that work with some challenges as well.
From the above analysis, Kenya’s health system does not seem to be adequately solving health problems for its citizens. Despite having existed since independence, the system has remained the same with little or no innovations to address the ever changing healthcare needs of its population.