On February 19, the Ministry of Health held a consultative forum with the National Assembly committee, in which the ministry sought to embark on a Rapid Results Initiative in the next 100 days, promising to deliver key services to Kenyans.
These promises included:
To increase access to social health insurance, NHIF plans to register 500 households per county. This will see 117,500 poor people registered and 189,370 elderly and persons living with severe disabilities.
To increase critical care services in the country, the Kenyatta National Hospital will set up two critical care units; each with five beds. This will help reduce death among patients with critical ailments. We will also distribute 100 ICU beds across the country.
To increase student enrollment at the Kenya Medical Teaching College, to open four new colleges in the next 100 days in Iten, Rachuonyo, Molo and Othaya.
Kemsa Logistics Management Information System will be rolled out in 20 counties to enable them order health commodities online. This has already been done in 27 counties.
To enhance consumer protection, the Kenya Medical Practitioners Board and the Pharmacy and Poisons’ Board will come up with an SMS code that will enable the public to know whether their healthcare service providers are duly registered.
To further protect the gains in the reduction of HIV and reduce the current burden, the ministry will test 750,000 clients and put 25,000 people on anti-retrovirals (ARVs).
To enable people living with disabilities to access benefits such as tax exemptions, and NHIF cover, the ministry will register 30,000 people with disabilities in the next 100 days.
To improve access to health services in the slums, the ministry shall establish portable clinics in 100 identified sites in Nairobi, Nyeri, Thika, Kisumu, Mombasa, Kilifi, Eldoret, Nakuru, Nanyuki, Kitale, Nyahururu, Machakos and Kericho.
To reduce malaria morbidity and mortality, the ministry will distribute six million mosquito nets in malaria prone regions. In addition, the ministry shall distribute 11 million doses of antimalarial drugs and train 6,000 health workers on malaria case management.
To reduce the TB burden, the ministry shall put 20,000 patients on TB treatment in the next 100 days.
To deal with the current burden of cancer, the ministry shall set up five cancer centers in Nakuru, Kisumu, Nyeri, Mombasa and Kisii and expand the Cancer treatment Centre at the Moi Teaching and Referral hospital as well as Kenyatta National Hospital in the next 18 months.
To enhance coordination between the National and County governments the ministry shall hold quarterly intergovernmental forums
Many were skeptical to say the least, as this was an ambitious plan especially if one was to consider the 100 day period in which they were to be executed.
Were these actually practical? Were the targets realistic? What would be the impact? Others would have argued that it might have been better to pace this plans, not only for the sake of implementation but to ensure efficiency and sustainability. After all, what was the point of having of having portable clinics, if there was no supporting plan to fuel them? What was the use of putting TB patients on treatment if there was no follow up to ensure that they were actually taking their medication? Would it make sense to have critical care units or cancer centres, if there was recurrent shortage of drugs, broken down equipment and with the doctors striking for what appeared to be every other month and the nurses right in tow on alternate months?
All the same, the Ministry of Health, through the Kenya Health Policy 2014–2030 and the Kenya Health Sector Strategic and Investment Plan July 2014–June 2018, laid out elaborate plans towards the commitment to providing equitable, affordable and quality health care of the highest standard to all Kenyans through the Constitution 2010 under the Bill of Rights. And according to the Ministerial Strategic plan, it aims to support the achievement of the objectives of the Vision 2030 of transforming the country into a globally competitive and prosperous middle-income nation with a high quality of life by 2030.
It’s been over 200 days since the consultative forum, and one has to wonder how many of the above laid out plans have been achieved? And if not, what were the challenges or, as some might preferentially state, ‘stumbling blocks’?
One challenge and certainly, a thought that might have gone unstated amongst skeptics, would have been that of resources. More specifically, the cost of providing health care services with so many competing programs, all under one roof – health.
Taking a more general view of the Kenya Health Sector Strategic Plan (KHSSP) III which utilised the One Health Model tool for the medium term to long term ( 3-10 years) strategic planning in the health sector at national level. It estimates the costs of health service delivery and health systems as related to the public sector. The health sector is projected to cost US$13,142 million (Sh1,103 billion) over the period from fiscal year 2013/14 to 2017/18. During the years KHSSP III is to be implemented, the annual cost of the health sector is projected to increase by 33 per cent.
This year, Cabinet approved a Sh2 trillion, 2016- 2017 budget plan of which the health sector will receive Sh60.269 billion, compared to Sh59 billion in the 2015/2016 budget. This was certainly a welcome increase with Health Permanent Secretary Nicholas Muraguri saying that it would cater for “a number of strategic health interventions” that the ministry is implementing.
Why then would anyone argue that financial resources would be an issue? Simply because, despite it all, they continue to argue that there might not be enough left if one was to consider the breakdown.
Treasury Cabinet Secretary Henry Rotich said of the Sh60 billion this year that Sh29.09 billion would go to recurrent expenditure and Sh31.18billion to development expenditure.
Sh4.29 billion will go to the free maternity programme while Sh4.50 billion will cater for medical equipment for 98 hospitals. Sh8.8 billion will go to Kenyatta National Hospital, Sh4.8 billion to the Moi Teaching and Referral Hospital and Sh1.7 billion to the Kenya Medical Research Institute.
A further Sh2.74 billion will cater for the allowances of intern doctors, degree nurses and clinical officers. In addition, Sh1.39 billion was earmarked for the universal health care coverage in addition to Sh900 million for free primary health care; Sh500 million will go towards social health protection for the old and physically disabled and Sh500 million will go towards establishing clinics in low income and hard to reach areas.
The truth of the matter is that resource allocation is not as straightforward as many would like to think and as a reformed skeptic might argue that as we lay out plans, accountability is also a critical step.