Universal health care: Lessons Uhuru can learn from Nyayo Wards

Universal Health Care in Kenya can be dealt with if the issue of funding is taken care of. [Photo: Courtesy]

One of President Uhuru Kenyatta’s Big Four agenda is the provision of Universal Health Care. Of all of them, I consider this the greatest. After all, a healthy nation is a wealthy nation.

In the 1980’s then President Daniel Moi, attempted to address the issue of health care by spearheading the famous Nyayo Wards. Kenya had fallen out of favour with the donor countries and as result President Moi opted for fundraisers to cater for the shortfall in health care funding, including the construction of in-patient facilities. That somehow worked. Efforts by multilateral institutions such as the WHO and UNICEF complemented these efforts. But it was Mr Moi’s experimentation with African Socialism that had profound impact on healthcare provision in the country. 

It was a simple, yet innovative way of funding and with the benefit of hindsight, it worked. Nobody can disagree that the one obstacle standing in the way President Kenyatta’s objective is funding. To get most Kenyans covered under the UHC is one Big Hairy Ambitious Goal that will require a substantial amount of capital outlay which will largely depend on how innovative we go about it.

Funding challenge

Funding challenges is not unique to Kenya though. The USA, a country that spends trillions of dollars on health care still has not managed to get everyone covered. Millions of Americans are still vulnerable despite President Obama’s Obamacare policy that introduced in the sunset years of his presidency.

The 2010 Constitution provides a legal framework that guarantees an all-inclusive approach to health service delivery to Kenyans. It states Kenyans are entitled to the highest attainable standards of health, which includes the right to healthcare services including reproductive health care (Article 43). Article 53 provides for the right of every child to basic nutrition, shelter and healthcare.

In Article 56, the Constitution provides that the state shall put in place affirmative action designed to ensure that minorities and marginalised groups have reasonable access to water, health services and infrastructure.

Frankly speaking, health is at the top of the mind of any leader worth their salt. I have heard tales and met with families whose finances have been turned upside down by disease. The reality of the matter is, without money, you will die.

A lot of families have been bankrupted by the exorbitant cost of medical care for their loved once. I have interacted with families taking the last of their possession to the market to sell, just so that their sick relative can be healed. And many more.

My own experience after my wife was diagnosed with cancer two years ago humbled me. In the thick of it, we throw anything in our hands to save the precious life being squeezed out of a relative by a slow epidemic. Sadly, she passed away but not before we had spent a fortune on her medical care.

Partner with private sector

Like Mr Moi, President Kenyatta will have to think out of the box to get the project up and running soonest. Doing fundraising like in the Nyayo Era might be a long shot. Times have changed. Mr Kenyatta’s bet could be in partnerships with the private sector.

So I was overly excited last week when the United Nations in partnership with the Ministry of Health and the governors from the Northern Frontier announced their intention to find ways to get those excluded from healthcare covered. Together with the Frontier Counties Development Council (FCDC) they want to considerably drive up healthcare coverage in the region.

Such partnerships could be replicated across the country.

For example, large multinationals have jumped into the bandwagon and have offered to devise innovative ways to cater for those largely excluded from health care due to distance using technology. Despite challenges in funding, innovation offers great comfort that this might just work.

One of the least considered partners in the healthcare crusade is the private sector. Yet there is so much that the private sector brings to the table through initiatives such as CSR.

They bring valueless expertise, knowledge and good work ethic. It could just be that what the health facilities sprawled across the country need are good managers.

The private sector could partner with some of this and implement skills-transfer like in budget development, setting up controls to minimise theft and wastage and financial prudence.

Managed like a private entity, it is amazing how the many dysfunctional health facilities can be transformed overnight.

Mr Guleid is a Governance Consultant