WHY WE MUST SUPPORT UNIVERSAL MEDICARE PLANS

Oduor Ong’wen

Disease ranks alongside poverty and ignorance among the three most dreaded enemies that our founding fathers vowed to fight and vanquish. Fifty-five years down the line, the war is far from won. Indeed, these enemies appear to have gained the upper hand in the recent years.   

State-funded funded healthcare programme was one of the first bold moves by the newly independent government in the early 1960s. However, gradually but steadily – almost unnoticed by the Kenyan public – there has been a major shift in healthcare strategy in the recent years. This culminated in the now infamous cost-sharing system in public hospitals and health units.

Thanks to the Washington Consensus, the shift has placed the responsibility of healthcare provision from the state to the “market forces.” The defining feature of this shift is many deaths from otherwise preventable and treatable diseases, resurgence of diseases that humanity thought were already conquered like tuberculosis and detention of decomposing corpses in village bandas christened “private clinics.” Not to mention quacks defiling patients in the so-called clinics.

David Werner, the author of the best selling book, Where There Is No Doctor, is very clear on why the public should be worried about the shift in global and national health strategies. Werner, a guru in community health practice and a consultant for the World Health Organisation (WHO), recalls how the celebrated concept of universal primary healthcare had been adopted by virtually all governments at the landmark 1978 WHO-UNICEF global health conference that endorsed the Alma Alta Declaration.

To advance toward ‘Health for All by the year 2000’, the Declaration promoted the principles that all people are entitled to basic health rights and that society ( and thus the government) has a responsibility to ensure that the people’s health needs are met, regardless of gender, race, class, relative ability or disability. 

The centerpiece of the Declaration was primary health care, a comprehensive strategy that included an equitable, consumer-centred approach to health services and also addressed underlying social factors that influence health. It called on ministries of health and health workers to be accountable to the common people, and social guarantees to ensure that basic needs (including food) of all people are met.

Any examination of the impact of the relationship between macro-economic change, including SAPs, and health should be informed by a historical and contemporary understanding of the economic, social and technical factors influencing health outcomes. 

The disease burden and pattern experienced by the people of Kenya today are strikingly similar to those of 19^thcentury Europe, i.e., they are primarily diseases of under-development and poverty, not a feature of warm climates in the tropics. Urban areas experience disease patterns more akin to those dominant in the industrialised countries.

Historical and contemporary experiences have shown that there is a definite but complex relationship between economic growth on the one hand and health status on the other. In general, sustained economic growth over the long run does lead to improved health and nutritional status: in the now-industralised countries the large and sustained decline in mortality has been accomplished by reductions in morbidity (disease) and malnutrition, and largely preceded any effective medical interventions. 

Factors influencing health outcomes include economic and environmental influences as well as direct health sector interventions. Thus, it is useful to categorise these factors into two broad groups - those originating inside the health sector and those that do not. 

Most observers now accept that adjustment has had a negative impact on infant and child mortality. There is evidence that non-adjusting countries with low levels of debt in Sub-Saharan Africa have succeeded in accelerating the rate of improvement of their infant mortality rates during the 1980’s; that the rate of progress in severely indebted, non-adjusting countries has remained broadly unchanged; and that progress in severely indebted, intensively-adjusting countries has slowed markedly. UNICEF cites evidence of increases in infant and young child mortality in several SSA countries over the past few years.

The likely causes of these reversals derives from declines in incomes; increases in food prices; and reductions in health sector spending, which have led to the imposition of user charges for health care, cutbacks in preventive programmes’ budgets and interruptions in supply of pharmaceuticals to public health care facilities. These have in turn resulted in deterioration in both the quantity and quality of diets, and reductions in immunisation coverage and in utilisation of health services for acute conditions, as well as weakening of disease control programmes. 

Consequently, the incidence (and possibly the severity) of the vaccine-preventable diseases has probably increased together with mortality from diarrheal disease, respiratory infections and malaria. There has also been a resurgence of certain communicable diseases which were previously substantially under control, particularly malaria, tuberculosis and cholera. All of these have contributed to increased morbidity and Presumed Mechanisms

In addition to the negative impact on women’s health associated with the general decline in communicable disease control and health care provision, there is evidence that morbidity and mortality associated with pregnancy has also been aggravated. 

The introduction of user charges for antenatal and maternity care has been associated with an increase in deliveries conducted at home, as well as those occurring in hospital without previous antenatal care or assessment. The rising costs of transport together with the lack of money on the part of poor women have been other contributory factors. 

Finally, there is evidence, mainly of qualitative nature, that deteriorating economic circumstances, which have forced an increasing number of women into commercial sex activity have influenced risk behaviour in relation to HIV transmission. The above factors have undoubtedly resulted in a sharp rise in already high maternal mortality rates, especially in poor countries and amongst lower socio-economic groups.

To ensure that the quest for universal and affordable healthcare succeeds, the government must rethink the Washington Consensus policies.

November 10, 2018