Unveiling the mask of our ailing healthcare system in Kenya

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The right to health is guaranteed in our Constitution which came into effect in 2010. Health is one of the functions that was devolved under the new dispensation. Since then, a lot has happened in this critical sector. The shift from national to devolved units has presented opportunities for Kenyans by way of taking resources closer to the people. However, challenges continue to plague this all-important sector.
The UN SDGs put into perspective the need for Universal Healthcare Coverage which envisions an organised healthcare system that can provide healthcare benefits are accessible to all persons. This entails access to quality essential healthcare services and safe, effective and affordable medicines and vaccines for all. This in itself provides a paradigm shift towards looking at healthcare in its totality rather than the silo analysis that leads to inappropriate healthcare decisions. It is important to note that achievement of Universal Health Coverage can have far reaching effects on the wellbeing of a nation.

Low coverage of insurance complicates issues at hand considering that only 4% of Kenyans can access medical insurance unlike other countries with higher medical coverage. When looking at the cost of healthcare, it is often easy to focus on the cost of commodities, rather than look at the total cost, which include aspects like nursing, laboratory costs, hospitalisation and bed costs, consultation fees, which are varied but quite significant. There are a host of ‘invisible’ costs, such as transport to the hospital, that are borne by patients and which can prevent or delay access to healthcare.

Debate about the use of generics products as opposed to the branded products elicits a one-sided argument that often mixes issues but misses key concerns. Going by treatment volumes the world over, the cost and coverage of generic drugs far exceeds that of original products. In Kenya, patented drugs account for a paltry 9% of the total drugs sales and only 13% of consolidated prescription drug sales, the rest being generic products. As such, disproportionate attention and efforts focusing at only the cost of innovator products will yield to very small savings to the healthcare system in general.

The rationale for use of innovator products is misunderstood not only by patients but unfortunately by some healthcare providers too. While generic products are a true copy of the innovator products by virtue of sharing the same active ingredient, the two are never 100% the same. There are differences in the composition and manufacturing which leads to variability in patient experiences and outcomes that may be of significant proportion and implication in certain instances.

While generic products are not fake as is irresponsibly connoted there exist substandard medicines which present the greatest challenge and safety to patients. Where the reach and effectiveness of the regulatory agency is sub-optimal or inconsistent, healthcare providers and patients resort to branded products to guarantee quality. A blind scrutiny and cost containment through curtailing of prescription of branded products therefore fails to recognize effective regulation or lack thereof as the single most important factor in the quest to lower cost of treatment. Sadly, there’s a consistent misconception that cost of treatment and cost of medicine mean one and the same thing.

Looking at health insurance coverage, it is important to note that the current insured pool of approximately 4% is too small to make any insurance business case by way of pooled risk. This often leaves the insurers exposed to undue payment pressures. Perhaps the way out would be not only be to expand the coverage base, but also increase the services covered. This way, we can build towards a critical mass for pooled risk that makes an attractive business case for insurers. As such, the solution lies in better pooling of risk rather than isolating cost line items from insurance providers for elimination. This in itself would actually work against the whole idea of expanding the coverage base.

By these examples alone, it is possible to see how misleading it can be to make an analysis of healthcare costs by just looking at one aspect of healthcare system. Therefore, more efforts need to be put in place by all involved stakeholders, including the patients; to

  1. fully understand and own the healthcare system,
  2. advocate more funding towards healthcare
  3. advocate and safeguard the proper apportionment and use of available healthcare resources
  4. attain and sustain effective and responsive drugs regulation
  5. increase insurance coverage to cater for more people on the population.
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