In Kenya, the three leading killers are malaria, AIDS and tuberculosis (TB). Malaria remains a nuisance, coming during specific periods when there is a spike in the breakout. Much effort has been made in dealing with the environmental vagaries that increase incidences of infection by malaria with some emerging resistance to treatment by the protozoa. As of now a vaccine is not yet with us, but bold efforts have been made towards evolving one and it may be that before long the trials will be with us. The economic implications of malarial infections are enormous. This is because when one is bed-ridden, the economic productivity is put to rest. In some cases the unfortunate happens and the victim is severely anaemic and dies leading to loses in productive human resource and family labour bases. The economic implications cannot, therefore, be underestimated.
HIV-AIDS remains the most scary and dreadful killer in Kenya today. According to UNAIDS in their 2005 report, this nation of 34 million people had an infection rate of 1.3 million people with 140,000 deaths so far recorded from the opportunistic diseases associated with depreciated immunity brought about by HIV-AIDS. Kenya has recorded tremendous awareness in HIV-AIDS because of availability of information. However, little is still done to address the problem of stigma. Indeed, the war on AIDS lacks a warrior. Society has always resorted to eulogising HIV-AIDS victims with niceties like '(s)he died after a long illness bravely borne'. Bravery to live through AIDS infection is necessary, however, denial remains the greatest enemy. Surely, we are all not infected but we are all affected!
Because of stigma, for example, I was told that although Mosoriot Health Centre in Nandi North District offers anti-retrovirals (ARVs) for free to the victims, some people are too scared to go for them. In dealing with social stigma and suspicion, the 'clever' victims have devised an underground mechanism to obtain the drugs. Through 'brokers' who are paid a 'fee' for taking the drugs on their behalf during the designated days, the victims live faceless lives. Should the social stigma be allowed to stand in the way of the victims acquiring the drugs? While this is happening, Kenya's most productive demographic bracket of 15-49 year-olds register an infection rate of 6.1%. One live is as important as 140,000 and every effort need to be invested to ensure a healthy nation in our lifetime.
The third nuisance is tuberculosis (TB). Worldwide, 2.5 million people die of TB annually, three-quarters of these are drawn from poverty stricken sub-Saharan Africa. Kenya has its substantial contribution to this statistic. There has been an upward growth in the infection rates of TB which is controversially linked to the HIV-AIDS infection. Apparently, due to weakened immunity, TB finds the victim whose defences weakened as good as trapped. Together with these three, Kenya has other minor problems like leprosy and other skin infections, diarrhoea and worms. Thank God, some of the 'rich man's' diseases like diabetes, obesity and others are not uncommon but they remain of little consequence compared to the aforesaid maladies.
On health, Mrs. Charity Ngilu has made several efforts to make the Ministry of Health personable and consumer friendly. With the pay-as-you-take-the-jab policy, the government strengthened cost-sharing in its health institutions. Hospitals are cleaner, the doctors and nurses, though overworked and underpaid (compared to the greedy politicians), they work as hard as ever. Probably this is because of the Hippocratic Oath that the doctors took. Without the need to stoke controversy, the health sector in Kenya has improved. But it remains a far cry from the perfect picture promulgated in the Narc manifesto that cheated Kenyans into voting for that house of Babel.
Last year, quite some heat was generated when the erratic Mama Narc launched the populist but poorly planned 'free health for all'. Mr Kibaki took over power with the now famously forgotten quip 'there is no free lunch'. However, a lot of free goodies and promises of more have been flying from the hallowed house on the hill. Who is funding these 'roadside gifts'? The Kenyan tax-payer! Don't worry that your MP does not pay a dime for the perks (s)he takes home, and they hunger for much more. Universal free health is not offered in Germany, certainly not in another socialist economy, China. I have lived in these two lands in the last five years. Their health systems are as different as the ideologies of the leaders are. The health consumers themselves fund their health through a contributory insurance scheme.
First let me refresh our minds. Life for the Kenyan school girl is not easy with respect to the adolescent revolution and the attendant blessings of womanhood. Much less among our conservative Kalenjin families where these things are not mentioned to parents. They are as taboo as taking home your boy-friend to the parents. Apparently, parents silently applaud when the boys bring home the girl. What mean parenting this is! Some parents only get to know their daughter's love during 'kaboorunetabgei' which precedes 'kooito'. In fact some girls prefer to ask their elder sisters or cousins for the sanitary towels than ask their own mother. How long this stereotype will be sustained is not my current concern.
However, I remember when one day I went shopping at Uchumi in Eldoret and dared to buy some for a relative. You can't believe the shyness that greeted my honest effort. The relative vanished every time I arrived, as if she thought that I had an idea that she was wearing it everyday. Even if she did, what joy is there for a woman than to know that she has the 'normal' visitor every month. Lack of it could be worse! From henceforth, I'd rather give the relative money; never mind the convenience of me buying them cheaply wherever I had found them. Aside from that hiccup, one of the problems that was identified last year as a hindrance to good school performance by the Kenyan girl-child is the lack of sanitary towels. Beth Mugo said as much in 2005. Not even the zero-rating of taxes on sanitary towels guarantees availability of the same to all our school girls. Matters are not helped by the casual nature with which parents approach the girl-child's hygiene and the apparent laxity by school administrations who are ready to jump on punishing the girls any time they notice a change in behaviour. These issues may be worse in mixed schools, where boys take it as a cheeky issue. The onset of menstrual periods was even implicated in school absenteeism and pragmatism on the side of the administration is required not to make matters worse for the young victims of a natural phenomenon.
A couple of days ago Mrs. Ngilu announced that the government had waived maternity fees payment. One must welcome this as it is bound to bring with it other multiplier effects. Babies will be born in hospitals thus guaranteeing access to ante-natal healthcare, birth registration will be promoted and consequently child mortality will be reduced. But with this announcement comes another edge of the double-edged sword. It increases the pressure on the government to increase freebies in an election year. One wonders, has there been clear policy formulation on the part of government and were these things discussed soberly and budgeted for or are we seeing a government acting with too much heart and less grey matter? Isn't it possible that somebody is soon coming up with a proposal to offer mothers small goody bags as 'successful birth' gift packs or even free recuperation meals during the maternity/paternity break? Let me hasten to say that I support any effort that guarantees good and sustainable health-care provision to Kenyans. But, are free things the way forward for a government which promised that 'kila mtu kula jasho yako'? Already, the Ministry of Health in the current financial year requires 76.9 billion shillings (>US$1 billion) out of which the government provided less than half. Additionally, salaries alone guzzle more money than is available for infrastructure and expansion. How is the new 'maternity freedom' going to be funded?
Quickly to my point, to guarantee a reasonable provision for Kenyans, my country needs a comprehensive medical insurance scheme to which every Kenyan in employment contributes. This is what we do in Europe, America and any other country that cares to guarantee good health to its people. Free sanitary towels, yes: free maternity services, yes. But these should be funded from a sustainable kitty, not one which can be dropped whimsically at the behest of a politically driven decision-making. Certainly not in an election year. One only needs to look at ideas like the Nyayo (free primary school children's) milk and ask why it ended when a lot of children were benefiting. Forget that the teachers were making ndubia, tapal and tigin (was it actually 'thick'?) tea. The Nyayo milk project, a brain-child of the octogenarian Moi, helped bridge the gap between the children who had access to milk at home and those without. Don't forget that it also provided a marketing avenue for the struggling KCC, if ever the right hand paid the left hand. The project was wrapped up because it was not economically sustainable; it was driven by politics and it was ended by politics. I will not be shocked if somebody will come up with a 'free lunch for every primary school' kid sooner than later as a campaign gimmick. Trust these politicians to somersault and dive onto impossible ground!
I have decided to rebuff Ngilu's proposal because although it is important to have a hassle-free birth, other sectors of health and the economy should not be jeopardised. I remember that the choleric Ngilu had an acrimonious tug-of-war over a maligned 'free' national healthcare insurance scheme sometime ago. She even went on a shouting match with Daudi Mwiraria, if my memory serves me right. Why has the minister reneged on a personal 'pet' to bring 'free' healthcare to everybody. This scheme has the potential to make life safer for the Kenyan, reduce patronage and pressure on politicians and it will lead to another plus. Let me explain. Anybody who listens to the radio announcements does not fail to hear of somebody somewhere who died. Upon death, the deceased family members summon fund-raising committees, one in Nairobi, another in Eldoret and yet another at the village sometimes the climax being the day of the funeral/burial itself. This is 'to meet the costs of an accumulated medical bill', which was left behind by somebody who has left. That the family will not raise enough money is not a secret. Politicians make pledges, issue bouncing cheques and then there is the other strategy in the village harambees. Whenever a harambee is held in the village, the organising committee 'borrow' money from a local businessman which will be used 'to attract donations'. After the harambee, the 'borrowed money' is returned to the businessman, no penny less. The remainder is paltry and the hole is dug in the family resources. How long shall we have families being left with debts by the departed souls, that they cannot repay?
Here in Germany, for example, we have contributions to a health insurance scheme deducted from one's salary. At a premium of anything up to 130 Euros/head/month (apart from the church tax!), one is guaranteed good health care. It is not free, but you are sure of your bills not following you to the grave. In fact, some of these schemes are so comprehensive and comfortable that if, for example, I went back to Nairobi and were (God forbid) indisposed, I'd get treatment in the dream institution like Nairobi Hospital. All I need is my Insurance card/number and other paperworks. This scheme takes care of in-patient as well as out-patient services. The only exclusions are fitting of teeth-fillers and glasses/spectacles. Where one is too poor to afford, the government may pay for them an amount which takes the burden from the family and government to the able hands of the risk management system-health insurance scheme providers. Is such a scheme not feasible for the Kenyan people? Can't a tea farmer contribute his Shs. between 50 and 500 or even more/month and the family in a well-paying job contribute money to cater for treatment even abroad? Should it be only MPs who can be flown to South Africa, Israel, UK, USA and Germany while our poor relatives die in poorly equipped bug-infested Nyayo wards? I think the Kenyan healthcare consumer needs no more freebies, what is needed is a comprehensive mandatory health insurance scheme. What do you think?
Kenyans need better life. This does not come in the form of free things, the government has already provided a lot of 'free stuff'. Free things are not good for a working nation. Some people who could earn by providing what the government dolls around as the 'free services' are rendered jobless and unproductive. Free sanitary towels and maternity services are not the panacea for the Kenyan woman, it is the evolution of a well-structured and managed universal health care insurance scheme to cater for the whole family that is needed. Get down to business and don't play games with our health, Charity. We need an insurance scheme for health in Kenya to remove the barriers of access to quality healthcare. A health insurance will ensure the mental health and peace of mind for the Kenyan families. Certainly with the spiralling burden wrought by HIV-AIDS, the burden for the cost of the health care should not be left to chance, we need bold policies for Kenya that will guarantee sustainability and reliability.
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