By It’s becoming harder to ignore the obvious: our healthcare system is failing. While political distractions grab headlines, the real crisis is quietly escalating. The government asks its citizens to contribute 2.75% of their earnings to healthcare, and then expects employers to cover private insurance. It’s double-speak, plain and simple. Meanwhile, the system continues to crumble.
What Does a Functional Health System Look Like?
According to the World Health Organization (WHO), a health system isn’t just hospitals and doctors. It’s the entire network of organizations, resources, and individuals that aim to improve health outcomes. From preventive care to rehabilitative services, these efforts span public health actions and healthcare facilities.
A functional health system delivers more than just services; it treats people with respect, is financially fair, and is responsive to the needs of the population. This kind of system rests on solid foundations, which include:
- A reliable service delivery mechanism
- A skilled and competent health workforce
- Access to critical health information systems
- Availability of essential medicines and technologies
- Adequate financing
- Strong leadership and governance
If these elements are in place, a health system can thrive. It improves health outcomes, ensures financial risk protection, and provides access to quality care. But that’s the ideal. Where are we as a country?
Service Delivery: A Broken Pillar
The service delivery in our healthcare system is shockingly uneven. The difference in care quality between health facilities is too vast to guarantee consistent, decent care across the board. The Ministry of Health (MoH) provides guidelines, but often at the lowest possible standards—standards that are affordable but not necessarily the best.
This creates a healthcare system with two tiers: one for those who can afford better care, and one for those who cannot. Private health facilities routinely ignore MoH guidelines because they don’t suit their operating conditions. Take, for example, the care of women who experience miscarriages. In public hospitals, manual vacuum aspiration under local anesthesia is the standard, while in private hospitals, sedation is the norm for more comfortable, less traumatic care. The disparity is glaring, and it all comes down to how these guidelines are written.
Moreover, critical aspects of patient care—like comfort, privacy, and hygiene—are often neglected. Public health facilities have overcrowded wards, patients sharing beds, and poor sanitation. The message seems to be that the poor don’t deserve to complain, an absolute failure in upholding patient rights.
Workforce: Quantity Over Quality
The government’s approach to building a skilled workforce is another weak link. It seems the goal is to churn out as many health workers as possible, with little thought given to their quality or future employment. There is a policy on staffing norms, yet no concrete plan to implement it.
The Kenya Human Resource Advisory Council (KHRAC) exists to address staffing issues, but it has been largely ineffective. We need a better strategy for producing health workers of unmatched quality, starting with stronger pre-service training. Internship training programs, which are vital for ensuring a skilled workforce, are at risk. If we don’t safeguard these programs, we’ll lose what little quality assurance we have left in our healthcare system.
Health Information Systems: A Data Crisis
In any industry, quality data drives decision-making, and healthcare is no exception. However, our health information system is in disarray. Decision-makers across both the public and private sectors struggle to access the data they need to make informed choices.
Routine reviews and updates to our data collection methods are sorely needed. Without accurate data, how can we expect to manage health challenges effectively? The lack of reliable health information is a stumbling block we must address urgently.
Access to Medicines: A Shrinking Supply Chain
In the past year, multinational pharmaceutical companies have been fleeing the country, citing an inhospitable business environment. At the same time, local production of essential medicines has stagnated. We continue to import these vital drugs at exorbitant prices, leaving us with little control over supply costs.
The failure to expand local manufacturing of medicines and medical supplies has made a bad situation worse. As it stands, we’re vulnerable to external market forces, further weakening our already fragile healthcare system.
Financing: The Government’s Singular Focus
Health financing seems to be the one area where the government has concentrated its efforts. Yet, even here, the approach is flawed. The health financing pillar cannot function in isolation. It needs to be integrated into a well-rounded, functional system, but that’s not happening.
The government must support all the pillars—service delivery, workforce, health information, access to medicines—if the financing model is to succeed. Otherwise, it’s like building a house on a foundation of sand.