Empower communities for better healthcare

There have been multiple reports of cholera outbreaks across many counties in this country.

It started with Homa Bay, then Migori, before spreading to Kisii and Bomet counties, and now Nairobi, Kiambu, Nakuru and Embu.

Cholera is a hygiene disease. It is better controlled by astute public and primary health measures.

Health services were devolved to the counties, and a few have done remarkably well by equipping their hospitals and employing health care workers.

Some counties, however, have performed worse. Not only have they demotivated the existing health workforce, they have also intimidated and even sent away their doctors and specialists. As we speak, these health workers have joined private or tertiary institutions.

The only good thing so far achieved by the counties is the branding of once Level 4 and 5 hospitals as ‘county referral hospitals.’ But health service delivery is more than just buildings and signboards. We must identify counties that have registered mediocre performance and shame them.

Many Kenyan patients suffering from preventable communicable and non-communicable diseases such as diabetes and high blood pressure depend on public health facilities. And high blood pressure is now termed a silent killer, causing several deaths and complications.

The question is; where did we go wrong? In my opinion, it is our approach. All along, we approached healthcare from top to bottom.

Healthcare needs of the population are discussed in hotels and boardrooms in Nairobi and the decisions are expected to be absorbed and implemented by those at the bottom. The county health managers too have adopted the same approach, one that is expensive and very ineffective.

It’s time we approached health issues from the bottom to the top. We need to empower communities with information to manage their health problems. Communities need to take responsibility for their health needs.

This will help them seek help at the earliest opportunity and adhere to treatment plans. Issues to do with hygiene, including proper human and other wastes disposal, use of latrines, proper diet and other lifestyle measures, can better be addressed when we put communities into perspective. One way to do this is by training and deploying more primary health clinicians under the leadership of family physicians.

This group of health professionals are trained to approach a patient as a member of a family who belongs to the community. They can work as a link between the patient and lower cadre clinicians and specialists in tertiary centres.

This country does not need more national hospitals. It needs better equipped county hospitals with motivated doctors, nurses and other healthcare workers. Then, we will turn Kenyatta National Hospital and Moi Teaching and Referral Hospital into the referral and research centres that they ought to be.

Dr Ronald Kibet Towett is the family medicine doctor for Bomet County and lecturere at the Moi University School of Medicine.

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