• In pre-Covid-19 times, effective county public health policy required a focus on mothers and children, and an operating theatre for caesarean sections was the biggest investment that many counties made.
• Now the governors are having to consider the costs of ICUs and HDUs, and how much money to dedicate to new ventilators, not to mention the cost of hiring specialists who know how to use them to save lives.
We are entering a new phase in the fight against the rampant coronavirus, in which the burden of public health management will increasingly fall on the county governments.
As such, I believe an initial assessment of how the central government has performed thus far in addressing this same challenge may be in order.
And on this front, if we look at the visible aspects of the performance of the Ministry of Health, then there is much to be depressed about. Most of the time, the much-publicised daily reports — when contrasted with “reports from the ground” — only served to reveal that the left hand did not know what the right hand was doing.
But, surprisingly, if you consider the overall results, then no doubt congratulations are in order. For countries such as Brazil and India, which have equally large slum-dwelling populations — slums being potential “infection hotspots” where social distancing policies are impossible to implement — seem to have done much worse at keeping their people alive.
Well, now the battlefield shifts to the countryside. And here, I think it is only fair to point out that this is a challenge that will likely prove to be beyond any county government to effectively handle.
Let us start by considering what the key public health challenges in Kenya were, in what we must now consider to be “the pre-Covid era”.
Two of the top leading causes of death were “diarrhoeal diseases” which mostly affected children under five years of age, and which could best be tackled by improving the supply of clean drinking water; and neonatal diseases that were the cause of so many new-born babies not surviving to celebrate their first birthday.
Then there was also malaria, HIV-Aids and Tuberculosis.
This is in no way a comprehensive list, but it does serve to illustrate the fact that effective public health policy in the pre-Covid era focused on maternal and child health; and then on malaria, TB and HIV-Aids.
In all these, what was required was a proactive approach aimed at preventing the various bacterial, viral, and parasitic infections from taking hold in the first place.
Hence the focus on providing insecticide treated bed nets for families with small children; encouraging pregnant women to visit the local clinic from the earliest months of pregnancy; and providing clean drinking water to every village, usually via the drilling of boreholes and subsequently setting up hand-operated water pumps.
Above all, there was a need for health education: Any village woman who was made to understand what the biggest threats were to the health of her children, could easily take the right steps to ensure they did not get infected with any deadly microbes. And they could also do their best — within their limited means — to ensure their children had a balanced diet since “nutritional deficiencies” also features in the “Kenya top 10 causes of death” list.
Given these specific challenges, it can be argued that there has never been any great need for very advanced medical facilities in the rural areas, where most of our people live.
Most lives could be saved purely by taking the appropriate preventative measures; and for those suffering from various non-communicable diseases such as cancer or cardiovascular diseases, there were the regional referral hospitals.
But we are now faced with something quite different. When it comes to the coronavirus, according to multiple sources, “Most people who fall sick with Covid-19 will experience mild to moderate symptoms and recover without special treatment.”
So, the question is one of what is to be done for that minority who will be severely affected, and this is where the schemes for setting up high-dependency units and even intensive care units in the counties, come in.
In pre-Covid-19 times, effective county public health policy required a focus on mothers and children, and an operating theatre for caesarean sections was the biggest investment that many counties made.
Now the governors are having to consider the costs of ICUs and HDUs, and how much money to dedicate to new ventilators, not to mention the cost of hiring specialists who know how to use them to save lives.