Health does not begin with disease but is dependent on the way of living, clean environment and good nutrition knowledge
In Africa, where we have a rural population, we need to provide primary healthcare and use a public health approach. Credit: Getty Images IN KENYA, the out-of-pocket expenditure on health is around 30 per cent of household income. We are trying to reduce this. A committee has been working since June to develop a proposal for minimum healthcare package that would be made available to people under universal health coverage (UHC). This is an identification of services that would be provided throughout the country to ensure a minimum health status. However, there is a big gap between the funds that are needed and what the government can provide. The country allocates around 3 per cent of its GDP to health, which is around 6 per cent of the total public budget. The package may have to be reorganised depending on how much funding the government will make available at implementation.
It is hoped that there will be sufficient funds because there is political will to provide UHC. The deadline for UHC in Kenya is 2022 and we are about to pilot the package in four counties. We have the option to pay for health services through insurance or through budgetary allocations or by a combination of the two. We are looking at a combination. We plan to have an independent body to monitor private health service providers. This body would ensure that the private sector does not take advantage of the consumer. We are focusing on social health insurance based on many lessons from the National Hospital Insurance Fund which already covers 30 per cent of the population.
We cannot say we will have 100 per cent success as there are likely to be hiccups. There are areas of the country like East Pokot where the population is scattered. These places need a different model. The local governments will have to devise their own plans. There is probably going to be 75 per cent success depending on the resources provided.
Basing healthcare delivery on doctors and their ability is likely to fail because nobody has enough doctors and nobody will ever have. The solution for Africa’s health problem can be found by basing health outside of disease. Health does not begin with disease but is dependent on the way of living, clean environment and good nutrition knowledge within the community. Unfortunately, we say that prevention is better than cure but then we turn it the other way in our programmes and concentrate on cure. This is because the practise of medicine is very dramatic. When you are sick, you get the medicine and within two days you are better. While only 2-3 per cent of the people in Africa go through this drama, majority of the resources are directed in treatment.
We cannot approach health like they do in the UK as we are at a different developmental stage. Diseases, not primary healthcare, are the biggest problem there. They do not need to worry about purity of water or insects and malaria. In Africa, where we have a rural population, we need to provide primary healthcare and use a public health approach.
(This article was first published in the 1-15th December issue of Down To Earth under the headline 'A different approach'. It is part of a series on healthcare in Africa. See links below).
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