Friday, April 11, 2014

Jubilee one year on: Analysis of health pledges in Jubilee Manifesto

Free maternity keeps Uhuru and Ruto health pledge (I didn't do the headline!)
By Lukoye Atwoli
Daily Nation, Wednesday 09 April 2014

Soon after his inauguration, President Kenyatta declared that all maternity care would be offered free of charge in public facilities. Many commentators equated this pronouncement to President Kibaki’s free primary education pledge that was made so early in his term that many thought it would fail. One may suppose that President Kenyatta made his “free maternity care” pledge in this same spirit, and hoped that things would come together somehow and make it work.

To some extent, this has happened in many parts of the country, and the government says that hospital deliveries have registered a significant rise from 40 per cent to 66 per cent. However, there have been hiccups in some parts of the country where, due to limited financing, some counties have decided to start charging for some of the services.

To some extent, the fortunes of the health sector under the Jubilee government may be encapsulated in the success or failure of the free maternity care initiative. In the Jubilee manifesto, party leader Charity Ngilu, now a Cabinet Secretary, indicated that she joined the Jubilee coalition on the basis that it would “ensure that all Kenyans get quality and affordable healthcare.” This then became a key plank in the new government’s agenda, perhaps explaining the President’s haste in providing solutions for the sector.

The coalition identified bureaucracy and corruption as major impediments to improving health services, and further argued that the National Hospital Insurance Fund (NHIF) is “bloated and corrupt”. Brain-drain involving health practitioners, especially doctors, was mentioned as well. The coalition indicated that their first focus would be on preventive health, and universal healthcare was to be rolled out through local primary healthcare centres. Finally, the coalition’s stated intention was to make Kenya an international medical hub with an increase in medical tourism by adopting the “successful Indian model”.

Several specific pledges were made in the manifesto as the method by which the coalition would reach their healthcare goals. The coalition pledged to increase health financing from 6 per cent to 15 per cent of the budgeted expenditure, perhaps to bring the country into compliance with the Abuja Declaration target.

The number of physical facilities were to be increased, bringing a health facility to within five miles of every home, and many previous provincial hospitals were to be upgraded and equipped to the status of referral hospitals. Diagnostic centres for all conceivable illnesses were to be set up, and free mosquito nets would be distributed to all families in need.

Better nutrition was to be encouraged, and medical research, including on indigenous medicine was to be promoted under the Jubilee coalition government. E-health and private sector participation was also to be encouraged and promoted, and pay packages for doctors and other health workers were to be improved.

One year down the line, an evaluation of the Jubilee pledges comes up with perhaps one major success story.

Free maternity care is now government policy, and many facilities across the country are not charging mothers to deliver or get other services related to childbirth. This is a huge plus especially in rural and poor settings where mothers preferred to deliver at home, assisted by local midwives or other women, than go to hospital and have to pay what they considered to be exorbitant rates.

On the whole, however, it is difficult to find much to write home about what this government has done with regards to healthcare. Healthcare financing continues to be meagre, and in the last budget, the national government allocated 2.1 per cent of expenditure to health. It is not known what the counties collectively allocated to health, but the few that were analysed had allocated less than 3 per cent of their budgets to health as well.

The government started out on a bad footing when they appointed both a Cabinet Secretary and a Principal Secretary who were not healthcare professionals, going against the pledge made by Deputy President William Ruto in the Manifesto. This had the effect of delaying any serious initiatives in the sector, given that the two senior officials required a crash course in the sector and how it works.

One of the key handicaps faced by this government is that the manifesto did not take into consideration the changed healthcare environment, with the constitutional shift of primary healthcare and some curative services to the counties. Without a mechanism of ensuring cooperation of the county governments, it is therefore difficult to operationalise many of the pledges concerning healthcare at the county level.

Today, strikes in the sector are an everyday occurrence, and recent reports indicate that many doctors are leaving the civil service to go abroad or into private practice as a result of problems with their terms and conditions of service in the counties. The legislative and policy framework has not done any better. Four years since the coming of a new Constitution, health is the only sector that has not been re-formatted legislatively to conform to the law. The Health Bill has remained in draft form for a long time, and stakeholder involvement in its drafting and progress has been reluctant and limited.

As far as the health sector is concerned, the Jubilee coalition rates a very modest score. 

Dr Atwoli is a senior lecturer, Moi University School of Medicine and national secretary-elect, Kenya Medical Association.

1 comment:

  1. "Free" maternity services - there is nothing for free. It is paid for by the taxes of Kenyans. With the connotation of free, government and citizens do not interrogate these expenses much and an audit would likely reveal huge wastages. A discussion of how to provide quality and affordable healthcare would be more useful. In addition, we need to discuss more about healthcare financing.


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