The 2018 budget leaves much to be desired but we need honest conversations on health care

Posted by on 21st June 2018

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The ongoing war on corruption or lack thereof has drawn mixed reactions from all over Kenya. Strong supporters of the President believe he wants to mop up this mess and leave a legacy. Those who support his deputy think it’s a witch hunt to settle political scores. Other critical voices think we’re missing the point focusing on the President or his deputy, that corruption begins right from the budget making process.

And if these allegations are true then our MPs as the people charged with the duty to approve government spending are squarely at the center of corruption in this country, but I digress.

Whether the thieving done in the budget making process is purely out of errors of omission and commission is something that warrants a study to be ascertained. What we can ascertain however is that this year’s budget didn’t have the common man in mind and if it did, it was not well thought out.

For starters, the President’s big four agenda strikes the right code in the hearts of majority Kenyans. I mean, who wouldn’t want affordable housing, food security, and jobs through manufacturing and universal health care? These are indeed the things that Wanjiku craves.

So should we rest easy that the government has allocated over Sh400 billion to these big four agenda in this 2018/19 financial year? Absolutely not. If anything, past budgets with mega projects like this big four have only served to put billions of shillings in the hands of a few rich folks as the majority poor continue languishing in poverty and servicing bad loans resulting from the same projects. In short, mega projects are synonymous with corruption.

Take the universal healthcare for instance. The government introduced a community health programme dubbed Linda Mama with a clear goal of reducing the gap of pregnant women dying or losing their babies due to complications arising from giving birth at home. At the core of this problem was poverty and so the Linda Mama’s key objective was to bridge that gap by offering free maternity care.  Yet the statistics show we still have many women (in rural areas) preferring to give birth at home through the Traditional Birth Attendants (TBA).

In the 2018 budget the government is taking things a notch higher with the National Hospital Insurance Fund (NHIF). Only those women registered with NHIF will access the free service. They say, the registration is at no cost and a mother is not obliged to contribute the monthly Sh500. This is mischievous considering one of the KPIs for the fund is membership. If say one million women register and are not contributors, the fund can still use these numbers to boast of their progress which doesn’t translate in monetary terms.

Another thing is the fund has been dogged by too many allegations of financial impropriety that one wonders if there will be another scandal from this initiative. Already there’s a blame game between City Hall and NHIF over delayed payment in three key public hospitals that are threatening to discontinue the services over a Sh80 million debt.

The government appears to have little interest in finding out why the initiative is not sorting out the problem it was set out to do and this is not for lack of data. In fact majority women in rural areas are not taking advantage of Linda Mama because there are not enough hospitals and pregnant women would rather go to a trusted TBA and hope to deliver safely than travel many miles and queue at a public hospital where the experience is something you wouldn’t want to go through on your best day, let alone when pregnant. A joint research by JKUAT and KEMRI focusing on Kilifi County published in 2016 confirmed distance to the hospitals was the barrier and not so much economic challenges.

Consequently, these hospitals are so ill-equipped that patients share bed space among other things; coupled with drug shortage, TBAs appear more appealing than delivering at a public hospital. These are limitations the government is well aware of but chooses to engage in PR instead; taking up large chunks of print and TV airtime advertising the little success and refusing to deal with the real things that can edge us closer to universal health care.

The government already rolled out a Sh4 billion comprehensive medical insurance scheme under NHIF targeting secondary students. Health experts have questioned this logic saying it would’ve been easier to cover the parents instead. What’s the logic driving the government to focus on students?

Of the four legacy agendas, universal healthcare is the most important to the common man, yet most controversial in its implementation, notwithstanding the fact the health sector has been bedeviled with corruption. The government is ignoring all signs this key pillar is doomed to fail before it can even start. We need to have public debates on this before we sink billions into another pipe dream.