Health Bill 2014: Prospects and challenges

The Health Bill 2014, which is awaiting crucial parliamentary stages before it can become law, is one of the most comprehensive and inclusive documents on health in Kenya.

Reading through the entire bill, one is left with a fairly good feeling that the health sector is headed for brighter days.

However, our experience shows there is a world of a difference between the letter of the law, its implementation and its enforcement.

Still, the Health Bill seeks to consolidate and update the various fragmented health-related laws that are in existence. The amendments to existing laws are expected to include changes that will entrench governance and values required by the Constitution.

Although the bill is beneficial in many respects, there are areas that need to be fine-tuned by the parliamentary committee on Health prior to their presenting a final report to Parliament for adoption.

For instance, Article 19(4), which talks of the requirements for appointment to the position of county director for health, needs to be broadened to include nurses, radiologists and laboratory technicians who have various competencies in the medical field. The idea that only a medical doctor is competent to handle the position is far-fetched. Experience shows that there are very able, non-doctor hospital personnel with enviable professional, leadership and managerial abilities.

Perhaps one of the most disappointing sections of the legislation is on mental health in Part VII. Considering that Mathare has a mere 600 beds, that provincial general hospitals have 20 beds set aside for psychiatric patients, and that only six out of 47 counties have psychiatric wards, there is need to adequately address the challenges facing mental health in Kenya.

The unprecedented growth in urbanisation has dealt a death blow to the traditional close-knit family units that ensured certain mental conditions like depression and anxiety were addressed within this social matrix.

Overall neglect

Further, various studies have shown that childhood disorders, substance and alcohol disorders are on the rise. Their effect on the economy is yet to be quantified. However, the overall neglect is bound to have a disastrous effect on the socio-economic fabric of society.

There is need to legislate on funding, infrastructure development, capacity and training of personnel considering that the country has very few mental health professionals compared to the population. It is unfortunate that, if passed as it is, the law will continue to marginalise mental health.

The legislation on traditional and alternative medicine in Part VIII comes across as escapist. There is reason to believe that practitioners were not involved in the deliberations on the Health Bill or if they were, then their views were not taken seriously.

Today, probably because our world has opened itself to the wonders of Asia, including its herbal cures, we are realising the extent to which we have been brainwashed by our westernised education that has tended to sneer at traditional medicines. Thankfully, our medical colleges have started to seriously incorporate herbal medicine in their curricula.

Revenue generation

Finally, Part X talks of health financing, which is central to achieving universal health coverage.

It has three related aspects: revenue collection, pooling and purchasing. To ensure equitable and efficient revenue generation and that payment mechanisms do not influence provider behaviour, the health financing provisions will have to be aligned to institutions. These include the much-awaited National Social Health Insurance Fund and Kenya Health Benefits Regulatory Authority, which will be responsible for setting health service fee levels and payment methods.

The writer is a researcher on mental health issues.