A price tag on life: How Kenya’s health system is failing mothers

Rollins* did not know what hit him as he leaned on the wall behind him and slid slowly to the floor. His world had shattered into a million pieces right there and then the doctor pronounced his wife Rosa* dead.

Rosa and Rollins had been married barely two years when Rosa got pregnant. A secretary at a local high school, her husband ran a hardware store at their local market and together, they signed up to the Social Health Insurance Fund (SHIF) for their health needs.

 Rollins, being an only child, celebrated the news of the pregnancy with his mother with gusto. They took turns to take Rosa to antenatal clinics at their local mission hospital, the best choice of facility in their community. An ultrasound confirmed that they were having twins, a double celebration. Because the babies were in a breech position, a cesarean section was scheduled.

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On the scheduled day, Rosa was escorted to the mission hospital by her husband and her mother-in-law by 7am. She was prepared and wheeled off to surgery; with her family wishing her well as they waited outside the operating theatres. Two hours later, a sleepy Rosa was transferred to the postnatal ward with her beautiful babies.

Over the next two days, Rosa appeared stable but complained of pain. This was compounded by a poor pain management regimen, making it almost impossible to get out of bed, or even tend to her babies. The nurses would give her a shot only when the pain was unbearable; otherwise, she was pretty much on just paracetamol.

At discharge, she was instructed to come to the post-natal clinic after two weeks, to breastfeed the twins exclusively and to clean their umbilical cords daily. She never saw the doctor who operated on her ever again. Rollins later learnt the hospital had no doctor on permanent terms as they could not afford one. They only called in one for the surgeries.

Pass stool

Though Rosa was happy to be home, sleep in her own bed and get help with the babies, she deteriorated rapidly. The next day, she was sick, in pain, bloated, unable to pass stool; and by evening she was vomiting. Rollins opted to take her to the level five public hospital that was 30km away.

At the emergency department, the doctor took one look at her and activated the emergency protocol. Within four hours, Rosa was headed back to surgery while a nervous Rollins waited in prayer. Intraoperatively, the surgeons found a mess. Rosa’s gut had been injured during caesarian section and the young and inexperienced operating surgeon missed this. The intestines were perforated, leaking faecal matter into the abdominal cavity, causing life-threatening septic peritonitis.

The surgeons had to clean up the abdomen and leave behind a colostomy as her gut was in no state to be repaired immediately. Grace would wake up to her bowels emptying into a bag on the left side of her abdomen. The sepsis hit her hard and she went into shock. She had to be transferred to the critical care unit.

Rollins sat beside her, red rimmed eyes, praying for his children’s mother not to leave them at birth. All night, the doctors fought to save her, but by dawn, Rosa’s heart stopped. Rollins was sent out as the team resuscitated her. She managed to hang in there, but by noon, her kidneys were failing and she needed dialysis. She suffered a second cardiac arrest that took her.

Rosa’s story is not isolated. She represents hundreds of women in this country suffering the curse of a dysfunctional health system. It won’t matter how much we hark on about universal health coverage, at the end of the day, the single most important pillar in this equation is healthcare financing. The underfunding of health facilities is costing Rosa and many like her as health facilities take major shortcuts to provide care with the little they are paid.

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In a developing country with a high birth rate, the single highest consumer in health service provision is maternity care. This why all across the country, many private and faith-based institutions will purport to provide services but are just offering maternity services, a service in high demand irrespective of socio-economic standing.

As a result, it drives up cost due to sheer volumes, demanding a huge chunk of healthcare funding. The architects of a tax-funded maternity service have treated it like a joke as evidenced by the Tariffs to The Benefit Package Under the Social Health Insurance Act No. 16 of 2023.

Biologically, the burden of child-bearing unilaterally falls on one gender, even when the children are a product of both. You would imagine that everyone would be falling over themselves to ensure that the women are kept safe during this crucial process.

Politicians have long used free maternity services as a political weapon against women. Yet, the investment in free maternity services is insulting. The cost of neutering a dog in Kenya is higher than for delivering a baby. The tariff allocated for a vaginal birth is Sh11,200, all inclusive of the actual procedure of delivery; medications; bed charges; food; and in private sector, the midwives, clinical officers and doctors involved.

It is worse for caesarian delivery, at a measly Sh32,600 allocated to do mandatory preoperative tests, safely put a woman under anaesthesia, open her up, remove a baby, close her up, accommodate her in the ward, feed her, give medications, provide nursing care, and still include all the health care providers involved.

With these peanuts, we expect quality of care in the most delicate of processes in healthcare involving multiple lives, where a single turn of events quickly results in death or lifelong disability that is not even quantifiable. Yet, on the same list, we see tariffs up to a million where cardiac and urological procedures are involved. Removal of tonsils costs more than twice as much as a caesarian section, while removal of a prostate cost nine times more!

It is not hard to conclude that Kenya is a country where the lives of women and newborns do not matter. How does one explain how a pregnant woman who gets her baby safely to term is given care worth Sh11,200; yet, should this pregnancy turn out to be an ectopic pregnancy, suddenly, saving her single life is worth Sh134,000?

There is no justification for the tariffs set for childbirth, whether vaginally or by caesarian section. This is an abomination. Over the years, I have learnt to look at a company’s health insurance policy and quickly conclude on who was involved in the negotiation of the policy.

When led by elderly men, they will ensure the policy caters to their chronic age-related conditions such as hypertension and the complications it leads to like kidney failure. They have no recognition of the priorities of the younger members of staff who are in their childbearing years; whose needs are a comprehensive maternity cover and a good outpatient cover for the young under five children.

It looks like this is the same lot we contracted at government to decide the country’s priorities regarding health. That tariff’s list is a true demonstration of the patriarchy that ails this country. Yet our population pyramid denotes that 51 per cent of the population is under the age of 18; of which 20 per cent of the females are pregnant at any one time.

At this rate, our rallying call should be a boycott to child-bearing until our health needs are prioritised. Women and newborns have borne the brunt of poor medicine for poor people for far too long. It is time the so-called Tariffs and Benefits Committee rolled up their sleeves, got to work, and did right by all Kenyans!

The writer is a gynaecologist/obstetrician