In 2012 Kenya has one doctor to 7,142 people - since only 2,300 doctors work in the public sector, those unable to afford private care have to make do with one doctor to 17,390 patients. Compare this to the USA and UK where there is approximately one doctor to 450 people- whilst lucky old San Marino has a somewhat unrealistic one doctor for every 21 people. Kenya’s ratio now falls behind both Afghanistan and Yemen.
Consequently the maternal mortality rate in Kenya stands at a shocking 530 per 100,000 live births significantly worse than in the 1980s; compared to the USA which has 17 per 100,000. To reach one doctor per 1000 patients, another 40,000 doctors are needed. Insufficient numbers of doctors are trained and each year doctors depart for better pay and conditions to America, Europe and Asia.
The irony of the situation was heavy in the November 2011 doctor strike when the dispute took longer than necessary to reach arbitration because BOTH Health Ministers were abroad.......... seeking medical treatment.
The government spend on health as a percentage of the total budget is 5.4 %, lower than in the 1990s, compared to 15% in the UK. This transfers to an annual per capita spend on health of $23 whilst the UK spend is $2,843 and a massive $7,420 in the US. Even with an agreement to raise the healthcare budget significantly major change in the doctor patient ratio is a long way off.
So what are the short and medium term solutions to improved health care, particularly in the much neglected arid and semi arid rural areas?
The GOK plan to build new health centres is a welcome start, and it is good to see some of these going up. Equipping of these health centres and staffing with clinical officers and nursing staff is the next step. NGOs are increasingly active in training of Community Health Workers, but in most instances these CHWs are expected to work in a voluntary capacity, meaning little activity can be expected of them, moreover these schemes need a good deal of clinical support and organisation that is frequently lacking. Likewise NGOs are enormously active in many other areas of health care, yet a lack of coordination mean that often efforts are duplicated whilst some populations are missed out.
The recent rollout to target 10 of the 17 Neglected Tropical Diseases through Bill Gates’ encouragement to create an unlikely spirit of cooperation with the world’s 13 biggest drug companies, is an example of Public Private Partnership that will undoubtedly have a major affect on these diseases. As Bill gates states, soon they will just be ‘Tropical diseases’, no longer deserving of yet another Three Letter Acronym - NTDs.
The Health Ministries in Kenya appear very positive to embrace Public Private Partnerships in many areas and perhaps this should be seen as a major bright light for future health care development here.
Great blog! With a lack of governmental commitment and dwindling aid money from bilateral organisations in the current economic climate, particularly the EU, I think seeking financial and operational help from Big Pharma is actually a brilliant idea. It's time to put aside the Constant Gardener-style conspiracy theories and take financial help for marginalised people where we can get it. This partnership is in no way endorsing any 'bad' that Big Pharma may be involved in, but is exposing them to the 'good' they can be instrumental in. We need their help, they're willing to give it, whether they have an ulterior motive or not. Would the billion + people suffering worldwide at the hands of inefficient, under-resourced health services prefer you to struggle on with government funding? No, they want us to do what we can to provide a decent health service. So long as the programmes are implemented effectively and by experienced health service providers/development professionals, there is a huge chance to make a difference to Kenyan healthcare here. And healthcare means a stronger populace, which means more people accessing education, gaining knowledge of how their country is run and feeling capable of doing something about it. Yes, the collaboration with the 'evil' private sector shouldn't be taken lightly, and should be regulated, but with major development foundations at the helm and publicity meaning accountability to the global citizenry, it could work. From PPP to social mobilisation? Maybe.
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