Eliminating scourge of healthcare debt – by Dr. Nicholas Okumu

Picture Amina, a mother clutching her feverish child in a rural Kenyan clinic. We had diagnosed septic arthritis in the child’s hip joint, requiring immediate surgery. Yet, the fear in her eyes was not from the illness, but the cost. As a small-scale farmer, the Sh100,000 surgery could force her to sell her land, plunging her family into poverty. This is the harsh reality of healthcare debt in Kenya, a burden I witness daily as a surgeon.

In an ideal world, Amina’s sole focus would be her child’s well-being. But for millions of Kenyans, healthcare costs become a crippling foe, often leading to delayed care, devastating debt, and even death. While policy shifts have aimed to bridge this gap, their successes have been marred by unintended consequences.

My journey began as an intern in Embu, during the era of cost-sharing’s introduction in public hospitals. This policy aimed to generate resources for healthcare facilities, enabling them to offer services like emergency surgeries immediately.

I vividly recall the case of Sarah, a woman with a uterine rupture during labour, whose life was saved due to the availability of emergency surgery services at our facility. This was in stark contrast to the earlier practice of referring such cases to distant, better-equipped hospitals. The average cost of Sh50,000 was still quite a significant sum, but through the sharing of costs, the surgery was made possible.

However, the flip side of cost-sharing revealed its limitations and unintended consequences. The policy inadvertently placed a heavy financial burden on patients, leading to heart-wrenching decisions for many families, including one that sold their small farm to afford a hip replacement, which at the time cost about Sh250,000.

The disparities in healthcare access and the financial burden on patients highlighted the urgent need for more sustainable solutions. The system was also abused for profit with individuals starving public institutions of resources to benefit their private facilities such as labs and pharmacies.

The introduction of National Health Insurance Fund benefit packages marked a significant shift towards improving access to healthcare services, including surgeries. These packages made complex surgical procedures, previously out of reach for many Kenyans, accessible. The ability to perform surgeries such as spinal decompressions (average cost: Sh300,000) and joint replacements was a testament to the positive impact of expanded health insurance coverage.

Yet, the system faced challenges, including fraud and mismanagement, leading to a scaling back of benefits. This reduction forced Kenyans back into out-of-pocket expenditures, undermining the progress made towards reducing healthcare debt.

The new Social Health Insurance Fund, taxing 2.75 per cent of gross income, aims to broaden healthcare financing. While this model seeks to finance healthcare provision for all, concerns about its financial sustainability and impact on the disposable income of the employed are significant.

The effectiveness of this approach hinges on broad-based participation and addressing the endemic corruption in public finance management. My personal opinion is that this new scheme places undue burden on formally employed persons who are a very small percentage of the population and only serves to reduce their disposable income while not attaining the financial stability of the healthcare system that it seeks to achieve.

The journey towards eliminating healthcare debt in Kenya requires a multifaceted approach. Addressing corruption and inefficiencies in public finance management is crucial. Furthermore, there’s a need for a more progressive and equitable financing model that does not disproportionately affect the financially vulnerable.

Engaging stakeholders, including the working population, healthcare providers and policymakers, is essential in refining and implementing solutions that address the root causes of healthcare debt. Additionally, exploring alternative funding sources and enhancing the governance and accountability of health insurance schemes can contribute to more sustainable and equitable healthcare financing.

The struggle against the scourge of healthcare debt in Kenya is far from over. I know that the future still has families struggling with debt to be able to afford healthcare-related costs. However, by learning from past experiences and continuously adapting policies and initiatives, we can strive towards a healthcare system that is accessible, affordable and equitable.

The goal is to ensure that no Kenyan is left facing financial ruin due to healthcare expenses, moving closer to a future where healthcare debt is no longer a barrier to health and well-being. The day when as a surgeon I only need to focus on the patient and the surgery is coming, but more creative and collaborative solutions are required to achieve this goal.

Adapted from The Star Newspaper: https://www.the-star.co.ke/opinion/columnists/2024-03-07-okumu-eliminating-scourge-of-healthcare-debt/

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