Challenge and Change

Faith Lelei is a senior resident of family medicine (GP) at Kabarak University, Nairobi. She shares about the challenges facing the Kenyan health system.

We have a significant shortage of healthcare providers, as 51% of doctors born and trained in Kenya work abroad. 40 of the 47 counties have less than 1 doctor to 10,000 compared to the recommended ratio of 1:1000. The few healthcare providers we have are unevenly spread around the country.

A few years ago, healthcare services were devolved from the national government to be run by our 47 counties. Very few counties have seen improvement. I know of hospitals where, when a mother needs an emergency caesarean section, she is given a list of things to purchase. That can include an IV cannula, sterile gloves, IV fluids and her IV antibiotics. If she is unaccompanied, she has to walk a few metres to purchase them. I shudder to think of what happens when she doesn’t have money.

A vicious cycle

We live in a country with glaring wealth disparities, where some people can afford to travel to South Africa and the UK for routine check ups or treatment. But this is the minority. One in three Kenyans live on less than a dollar a day. Only 40% of Kenyans live on 1.5 dollars or more per day and even those are just one disease away from poverty. This is exacerbated by the fact that about 80% of Kenyans do not have access to any form of health insurance. Typically people come to hospital with very advanced disease, when it’s also more expensive to treat than if they had come earlier, worsening the poverty cycle.

But change is on the horizon. Healthcare workers want to form a health service commission to oversee issues affecting providers and re-look at their distribution around the country. Our government is also in the process of introducing universal healthcare. While I have reservations about their approach, I am glad that we are beginning to have these crucial conversations.

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