Kenyans are not receiving the medical services that they clearly need. There are many reasons for this, some which stand to reason, others that clearly don’t.

A quick glance at our vital health indicators and statistics would show:

1. We spend about 4.1% of our Gross Domestic Product on Health (WHO 2004), this for a country with a life expectancy of 51 years and falling. A cross-sectoral comparison with our expenditure on, say defence would indicate where our priorities lie.
2. The HIV/Aids epidemic has significantly made an already bad situation worse; this has led to a stiff increase in disease burden with accompanying increase in demand for more health shillings/dollars. While the international community and local NGOs have made their mark in fighting this scourge, it took the government time to wake up to the reality and challenge of this disease, the results of this are most obvious now.
3. The government's successes in childhood immunization, antenatal care, vector borne disease control and nutritional deficiency diseases have a long track record, but have been found wanting in recent years.
4. The rapid growth of private hospitals and clinics, chemists and pharmaceutical manufacturing has been out of control allowing for little, if any, government regulation and leaving wananchi to bear the brunt of malpractice among other ills.
5. The mental health system (if one exists outside Mathare Hospital and the odd district hospital bed) is and has always been in shambles. Due to the economic situation of the mentally ill, this is not a field that lends itself to a private insurance funding. The government therefore needs to be the main driver of health care in this sector. It does not help that this is not an issue that features in the politicians' agenda.

The thrust of this article is not to point fingers at anyone, but to stimulate debate on current issues on health in Kenya, problems and possible remedies. We have already on in these pages discussed at length and in depth matters related to the economy and social issues. Health is also an important topic, especially as without a healthy workforce it will be difficult for economic and social prosperity to be achieved.

The problems that have crippled our health system are innumerable: nepotism, inefficiency, poor maintenance of facilities and equipment, poor financial planning and corruption being only the foremost among them. A highly centralized health system administration, taking after Kenya's politically centralized government, does not allow for efficiency as a wrong decision at Afya House is replicated all the way to the lowest level. This type of administration stifles initiative and is laden with unending bureaucracy - therefore administrators spend months waiting for decisions, signatures and documents from ‘headquarters', to the detriment of their patients' health.

Another of the problems that beset our national health system is the serial appointment of incompetent senior administrators. While a doctor's bedside manners might be commendable, it is not a guarantee that they will in turn be professional administrators. Such appointments at Afya House have created a culture where senior clinicians and doctors feel entitled to senior management positions, even with little or no formal qualifications in the specific area. This was clear in the past when anyone with the Dr. prefix to their name could find themselves in a management position at the Health Ministry, even if his qualifications were merely academic.

Successes at Afya House
It's not all groom though, while the dream of ‘Health for all by the Year 2000' envisaged at the advent of Global Primary Health Care launch at Alma Ata has not eventuated in Kenya (or anywhere else), it has been followed by the endorsement of the Millennium Development Goals (MDGs) endorsed by the Kenya Government in 2000. This is a vision of the UN for its member states set to dramatically improve human conditions by 2015. Some might say this is a shifting of goal posts but there have been recent successes that deserve mention here including the following;

While Kenya's dream of having a universal health care system by 2000 was not attained, the Kenyan government endorsed the UN's Millennium Development Goals (MDG ) in 2000. The health infrastructure of some key services has come of age in Kenya, despite little in the way of government funding. Programmes such as the Maternal Child Health (MCH) and Family Planning (FP) have continued to do well leading to a notable decline in Kenya's total fertility rate and consequently birth-rate (from 4.1% to the current 3.5%, WHO 2005). Similarly, childhood immunization has reached 60% of the population (WHO) and diseases like measles, polio and whooping cough which were once commonplace during childhood are now much less common.

Another successful initiative has been the development of Nairobi Hospice whose objective is to help patients suffering form cancer and for whom curative treatment is no longer appropriate. In addition the hospice provides counseling and support to the families and close associates of such patients both before and after the death of the patient. Patients suffering from other terminal illnesses are also helped, subject to the hospice having the necessary resources and skills. This is no doubt a much needed service and other districts in Kenya would benefit by having a similar facility.

Nairobi is home to major international health agencies such as the International Committee of the Red Cross- ICRC, the African Medical & Research Fund-AMREF, and Medicins Sans Frontieres (MSF ) among others, which serve not just Kenya but the larger Horn of Africa. These agencies continue to strengthen and compliment our health system especially in times of crises such as diseases outbreaks.

The future

The enterprising spirit of Kenyans will count especially in developing private health care. However, the government needs to regulate the industry. As things stand now, it is very unlikely that smaller clinics, chemists and hospitals remit taxes to the Exchequer or sell medication and services at the recommended prices. It is also difficult to determine whether private health sector professionals are duly qualified. At the same time though, Kenya continues to produce doctors, nurses and other allied medical personnel. Some of these professionals rate well, not only locally, but also by internationally accepted standards. It is a result of renowned medical expertise in Kenya that has led to some forms of health tourism (including at the public-funded Kenyatta National Hospital).

To continue the progress that has so far been achieved, it is recommended that the following steps are taken.

Unlike the US, where the insurance industry is the main driver for healthcare delivery, the Kenyan government should continue to oversee and cover most healthcare expenditure and delivery. This underscores the need for both health promotion and disease prevention. Success in these areas will warrant an effective healthcare system.

Given Kenya's struggle with infectious diseases and conditions brought on by nutritional deficiencies, reform opportunities abound both in design of facilities and the procurement of drugs and where we get them from and the targeted training for both existing and a new healthcare workforce. There is need to accelerate the current technology in our hospitals to ensure prompt diagnosis and treatment, a break from the past medical equipment procurement practices would go a long way in remedying this. A focus on countries in Asia, such as China and India, as possible sources is long overdue.

We should also advance the level of computerization in our health facilities. We have enough expertise to drive this exercise and when achieved, information technology will integrate patient safety and quality, programmatic initiatives, business and research. There is a need to strive to maximize efficiency and effectiveness in health service expenditure and delivery to ensure Kenyan taxpayers get value for their shillings while reducing reliance on foreign donors for this most important government service.