Resetting our development discourse II

This is the second of my articles aimed at resetting our development discourse. Last week, I dwelt on education and value addition (manufacturing). This week, I focus my attention to health and social protection.

In a short period since the advent of Covid-19, we have learnt more about health than the past 50 years. We shall continue to learn, not just from our experiences, but from the mistakes of others. The lessons are an asset to define our future health initiatives.

Indeed, Eleanor Roosevelt once said, “Learn from the mistakes of others. You can't live long enough to make them all yourself.”

What have learnt from the pandemic is that that countries that did not have a functional universal health coverage suffered more than those who did. 

In an article, The imperative for universal healthcare to curtail the COVID-19 outbreak in the USA, Alison P. Galvani and others argued that:

The Covid-19 crisis is exposing frailties in our healthcare system. More than 78 million people in America do not have access to adequate health insurance. Given that health insurance in the US is typically provided by employers, millions more are at risk of losing their healthcare coverage as unemployment surges.

In contrast, Taiwan, having gone through the SARS experience 17 years ago, responded quickly through its National Health Insurance (NHI) by asking hospitals to trace and triage high-risk patients. Hospitals there set up an integrated hospital quarantine system and linked themselves to NHI Pharmacloud System to facilitate normal hospital operations. The country has had 543 cases with 495 recoveries and seven deaths.

Taiwan was able to achieve this phenomenal score against Covid-19 because of cooperation from the citizens (adherence to hygiene matters i.e., washing hands, masking, and social distancing), leadership and inclusive health policies. When systems are fair and inclusive, people become generally cooperative and listen to leadership demands.

Government spending

Our persistent squabbling, just like in most free market economies, emanates from the fact that such systems precipitate mass inequalities. Yet, in times of crisis the very same countries respond with stimulus programmes – although against their philosophies – to pacify the ordinary people.

In the US, for example, congress passed a $2.2 trillion guaranteeing at least $1,200 per household. The congress is proposing a further $3.4 trillion package once more. Some of the money will go to large enterprises that have suffered during the pandemic.

Experts say that government spending will increase to about $1.9 trillion if universal health care is implemented (that’s the government covering 80 percent of healthcare costs). That level of spending, however, will save the country $600 billion, in the long run, in terms of a healthy workforce, lower pricing of medicines in a socialised healthcare system and other benefits like more people with disposable incomes to spend and stimulate the economy.

We are in a similar paradox. Our 2020/21 Budget contains a Sh56.6 billion post Covid-19 economic stimulus package, ostensibly to cushion Kenyans from the effects of the pandemic. At the same time, we are in weekly Harambee meetings to raise money for the pandemic patients detained in hospitals. In essence, we are undermining the very essence of economic stimulation. We have no disposable income to stimulate the economy through consumption.

My agenda in health, , therefore, is twofold. The first relates to the creation of a fair and inclusive healthcare system. By this I don’t mean that we simply pour resources into the National Hospital Insurance Fund (NHIF) or sending diagnostic equipment to county hospitals. We can do more with the meager resources we have.

Covid-19 has thought us that to have a sustainable healthcare programme, public health must be prioritised to deal with costly opportunistic disease that are now virtually under control because of the pandemic.

In addition to the current pandemic mitigation measures, we must enhance hygiene measures to not just to limit infections but also create employment for many young people who are jobless.

We need to expand the hygiene measures to include provision of safe water, sanitation and waste management and hygienic conditions as “essential for preventing and for protecting human health during all infectious disease outbreaks, including of coronavirus disease 2019 (Covid-19),” which are part of World Health Organization (WHO) requirements.

Good leadership

I have gone to great lengths to analyse different propositions in health systems. What I have realised is that we need to create a healthy workforce and save billions of shillings that can be used in other national projects. As you recall, leadership is central to the success of these proposals. Good leadership is accompanied by good structure.

The shift from the national to county management structure of healthcare is not working. It may never work and there is no need to waste more years in something that will never work. The persistent strikes will continue.

The governance is wanting. It does not take a genius to know that health at county level has become a cash cow. The infrastructure we always see splashed in news papers is meant to justify the spend but the quality - a pile of concrete topped with tin roofs – says it all. No one has dared ask since “It is our turn to eat.” 

You can tell that I have not said anything about social protection. I will deal with it next week since I have run out of space. Much of the analysis here will build on to next week.

Let me once more restate the purpose of trying to precipitate meaningful debate in in this forum. Our politicians have failed on issues in favour of divisive ideas. They are not addressing the needs of the people.

Although technology can help inform about the sentiments of the people, politicians can’t even anticipate what urgent issues their audience wants to hear. In last week’s the Mashujaa Day celebrations in Kisii, politicians did not have a clue as to what was hurting the people most – the declining Tea revenues - that is threatening their livelihood.

It is our duty to re-establish responsive political discourse in our country.