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County budget cuts bad for health.

Had Ben known he had thirty minutes to live, he would not have attempted to drive home that evening. Normally fastidious to a fault, he had indulged at the wedding of a favourite niece. Leaving the posh Naivasha resort, against the protestations of his hosts who wanted him to spend the night, he had taken the winding Mai Mahiu route towards Nairobi. A careering trailer would soon slam into his sophisticated German car, relegating him to the afterlife.

A hundred kilometres away in Nairobi, Anyango knew she had less than a year left to live. Having seen her husband waste away from HIV-Aids, she could relate with every one of the symptoms ravaging her frail body. Despite the anti-retroviral medication provided freely by the government, she could not afford to buy the nutritional sustenance needed to increase the efficacy of her medication. Not a priority when there were six kids to feed. Least of all, not from the meagre income she derived from washing people's clothes and houses. Eight months later, Anyango gave up the ghost.

Ben and Anyango (names changed) are representative of the victims of broken-down health systems in Kenya. The Bens of this world die because the first responders at accident sites have no basic first-aid training. Unlike developed countries, there are seldom any paramedics responding to accident victims within the first hour. At Ben's funeral, it emerged that he did not die from his immediate injuries. Rather, those who rescued him broke one of his ribs in the process. Thrusting him atop a pick-up truck caused the rib to puncture a lung. The bumpy ride to the nearest hospital did the rest.

President Uhuru Kenyatta has made affordable healthcare one of the four pillars of his legacy. In this, he is well aligned with the Sustainable Development Goals espoused by the UN. No less than the third SDG intends to 'ensure lives and promote well-being at all ages.' Part of the preamble of a joint World Health Organisation and World Bank report entitled Tracking Universal Health Coverage 2017, lends gravitas to President Uhuru's quest. The report says of Universal Health coverage, 'it is an investment in human capital and a fundamental driver of inclusive and sustainable economic growth and development.'

Even as the President embarks on his noble quest, he must bear in mind that health is a devolved function and that he must work with the county governments to ensure affordable healthcare. The wisdom of this is in the fact that all counties do not have homogeneous health challenges. For instance, while malaria may reach epidemic proportions in parts of the Rift Valley and Nyanza, it does not pose much of a problem to Nairobi and Eastern counties.

Similarly, tuberculosis may be a challenge in Nairobi and other urban centres where there is a proliferation of large informal settlements. Which is why there is reason for concern over CS Henry Rotich's proposal to have the Senate reduce disbursements to county governments by Sh18 billion.

Last year, the Commission for Revenue allocation proposed to raise the counties' budgets for 2017-18 by Sh63 billion. The bulk of this raise was intended for public hospitals to purchase drugs, equipment and other supplies. These gaps in funding of hospitals were also part of the reason public doctors went on a prolonged strike in the early days of the Jubilee administration. Rotich's intentions therefore do not portend well for a sector that is already grossly underfunded.

It would be worthwhile to bring to the President's attention that poverty is the biggest cause of poor health. There is more than ample empirical evidence to support this assertion. Children in slums die from malnutrition-related complications. Adults who partake of illicit brews because they cannot afford better, often suffer debilitating loss of sight.

Whilst there has been significant progress in programmes to address infant mortality, maternal healthcare, malaria and the fight against HIV-Aids and other illnesses, the battle is not over yet. Not by a long shot. Nor should specious arguments that relegate affordable healthcare to a preserve of the poor.

A good public healthcare system works to the advantage of everyone in society. Ben from Karen, would have been alive had he received prompt and expert care at a public hospital. But had he even made it there, it is probable that he would have found operation theatres without basic equipment or the requisite personnel to save his life.

As it were, his expensive Bupa insurance that would have guaranteed him treatment in the best hospitals overseas counted for nothing! The other side of Uhuru Highway, that mental construct that separates the rich from the indigent, is rendered moot where there is a damning indictment of our state of health services. We need affordable healthcare urgently.
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Publication:The Star (Nairobi, Kenya)
Geographic Code:6KENY
Date:Mar 14, 2018
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