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Friday, 13 June 2014

THE KENYAN HEALTH SYSTEM A PATCHWORK OF THEORIES, OBSERVATIONS AND CORRUPT PRACTICES.


 A few weeks ago I took my wife and my newborn daughter to a private health center. As we patiently waited to be attended a nagging question began to froth in my mind. Why am I here? Unfortunately it was not one of those self-discovery questions that cause you to understand the meaning of life. But rather I started asking why heath care was so expensive and inaccessible in Kenya, and not just here but across Africa. I wanted to know what has been our undoing, what missteps did we take and is the situation solvable.

This article seeks to ask and answer questions around this quagmire

Van-Leeuwenhoek father of microbiology 
Health care as we know it is not a recent invention, as far back as 437 BC the King of Sri Lanka had hospitals around his kingdom to care for the sick. Health care had a strong allegiance to religion and in most archeological findings it is common to unearth medical artifacts lying side by side with religious totems. What this symbolizes is the great mystery that was healing and health care for many centuries. Humanity has fumbled for many eons in the search for health. As far back as 300 years ago amputations were a norm because microbiology had not become acceptable. Medical practice then was steeped in shamanism and the occult.

In fact the exponential rise of population around the world lies squarely at the doors of a renaissance of human knowledge. A quick succession of industrial, information and knowledge eras have brought about astronomical medical advances. The only problem with these advances it seems is that the wave of change in medical practices has not rippled across the world. While access to health care is universal in some developed countries, in others 16th century shamanism and sorcery serve as health care solutions. The disparity could never be greater. 

Why is this the case?

Western imperialism became an export with the advent of the industrial revolution. Part of that brand was the health care system of the “races of highest social efficiency”. This was propagated across Africa with the same vain as the building of infrastructure e.g. roads, railroads and other innovations. What was lacking in these advances was a manual for the natives on how to sustain or surpass these innovations over time. This is why despite the freedom cry that rose over the mid 20th century across the colonized world, rot and rust is what remained after the Western powers had left. Systems that were maintained with German efficiency or English policing failed soon after.

Many developing countries have aped the western world health care systems, as ascribed after independence. What this has meant is that health care for the populace of developing countries has faired in the same vain as the economic fortunes of these countries.

It takes a concerted effort by the leadership of a country to decide on whether despite the economic situation of the country health care is a priority. And in most instances the proof is not in the money the country puts into the health care system, but rather the efficiency, quality and effectiveness.

While Bloomberg ranking of the most efficient health care by country for 2013, placed Hong Kong, Singapore and Japan at the top of the list. There is need to look at a third world country to find answers to what can be done to use less to achieve more in health care in Africa.  Ecuador ranked 20th and Cuba ranked 28th would be ideal for this article. 

Ecuador a “third-world country” adopted a new constitution in 2008 that mandated universal health care to all its citizens. With this came a four-fold increase in their budget for social security health care, construction of hospitals and clinics across the country, and doubling of doctors under the system. The icing on the cake for the citizenry was all would access this for $70 a month. Given the state of the economy and low levels of unemployment, Ecuadorians have a high confidence in their health system.

To understand Cuba on the other hand, you have to go back to 1950s and grasp how Fidel Castro came into power. And progressively how vilified Cuba became to its super power neighbor. Fidel Castro took charge of a country that was the playground of American capitalists who holidayed in its plush hotels. There were adverse inequalities between the White and Black. Between city and countryside. Corruption was rife. Fidel turned the capitalist state into a socialist state and emphasized social projects to improve Cuba’s standards of living, often to the detriment of economic development. Health care was nationalized and expanded.
Castro’s innovative investment in education and health care has since allowed the country to offer one of the best health care systems in the world to its citizenry cheaply. Over time it has exported its medical staff as a foreign exchange earner to other countries extensively, and also recently has become a haven for medical tourists from across the globe. Simply stated Cuba has been able to achieve a lot despite insurmountable odds.

So what can we borrow from this as Africa?

The first element we have to propose is how do you reduce waste, and one only have to look at the American system, to identify that a lot is wasted on “over-treatment, creation of illnesses, exposure to contagion through over-hospitalization, disease-focused instead of prevention-focused research, and making the poor sicker by refusing them treatment”[i].
Cuba's health care system
Photo by Sarah van Gelder
The Cuba preposition is to have a doctor-nurse team living in the neighborhood they serve. This This produces not just a professional adequate for providing healthcare but also a well-rounded, valuable member of the local community[ii].
allows the doctor to know their patients well. To cap this Cuba has the highest doctor to patient ratios in the world. This community integration approach has allowed a holistic training for medical students who learn about local cultures, indigenous medicines and effective community relations in practical conditions.



There is need to also have a concerted effort in improving infrastructure it is noted in the first 6 months of office Fidel Castro had build 600 miles of roads, $ 300 million was spent on water and sanitation schemes, 800 houses were constructed every month and more classrooms were opened in 30 months than the previous 30 years.

There is simply no way African countries can move ahead without a targeted and concerted effort devoid of corruption and greed. The sooner we realize this the sooner millions will begin to benefit from the little that is on the table.

African countries have to borrow a leaf from Cuba, and fully focus on health care, infrastructure and education in their budgets and not give pedestrian focus on these matters. Leaders like Fidel Castro, Lee Kuan Yew and Park Chung-hee may not necessarily have been democratic to their citizenry, but they brought change that was lauded across the world.

In conclusion, while I would like to visit a local hospital or clinic and get the best healthcare comparable to Cuba or Malaysia or Singapore, I realize that I need to gravitate towards leaders that are visionary who desire that my country takes leaps forward in development. That is not an easy pill to swallow, given the great leap forward geared projects ascribed by these countries were autocratic. But then again there is no greatness that was not achieved without pain.




[i] Why Is Cuba's Health Care System the Best Model for Poor Countries?
by Don Fitz

[ii] http://www.global-politics.co.uk/issue9/hanna/

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