Entries from January 22nd, 2020

No Health Without Mental Health

Posted by on 22nd January 2020

Categories: Uncategorized

The conversation on mental health has slowly but surely been gaining momentum in Kenya. In November 2019, President Uhuru Kenyatta directed the Ministry of Health to establish a task force that would investigate the current mental health status in the country and report back within 90 days. After which, the task force is expected to provide recommendations, in the form of new or revised policies, to address what seems to be a dire situation.

The timing of this directive by the President couldn’t have been better seeing that the media is awash with reports of suicide, violence and substance abuse. To this effect, the task force has set out to receive views from the public across the country. This public participation process is seeking submissions that will touch on; mental health priority issues in Kenyans’ respective areas, proposals on practical solutions to the priority mental health issues and the level of preparedness to address these mental health issues.

Through an SMS question, we sought to get a pulse of the nation on mental health. Some of the major concerns that emerged from the responses were; lack of awareness, stigma, inadequate mental health facilities and staff, accessibility and affordability of mental health services, availability of mental health facilities in counties and the current economic state and corruption as catalysts to mental illnesses.

These responses mirror some of the issues highlighted in the 2015 Kenya Mental Health Policy that was drafted by the James Macharia-led team. The 32-page document set out to achieve these four objectives; strengthen effective leadership and governance for mental health; ensure access to comprehensive, integrated and high quality, promotive, preventive, curative and rehabilitative mental health care services at all levels of healthcare; implement strategies for promotion of mental health, prevention of mental disorders and substance use disorders; and strengthen mental health systems.

Unfortunately, the rising cases of suicide countrywide paint a grim picture of the ineffectiveness of this policy. Access to comprehensive mental health care services remains a luxury yet health is a devolved function. Even with the expansion of referral hospitals and setting up of clinics, mental health is still neglected and overlooked. Perhaps this taskforce would fuel the much-needed enactment of the 2015 policy and beef it up with new recommendations to give the mental health status of Kenya the attention it deserves.

Health is among the pillars of the President’s Big 4 Agenda under Universal Healthcare. It comes as no surprise that the Ministry of Health has been put to task to find a lasting solution to what is now being termed as a “national disaster”. For a government that has anchored a good part of its legacy on youth empowerment, it would be a great loss if said youth are lost to more and more cases of depression, suicide and substance abuse.

As it has been said before, Kenya ails not from a lack of legislation or policy but from the reluctance to implement them to the letter. The fire that the task force has ignited should not die down along the way. Many Kenyans who have been suffering in silence are hoping that the task force brings practical outcomes that will save them from the shame and pain that has for long been associated with mental illnesses.

By putting measures in place both at the Ministry and County levels, the government will go a long way in attaining the preventive healthcare approach that has proven to be most effective.

Just as the Executive, the 12th Parliament has the task to leave a legacy. To consider and pass the Mental Health (Amendment) Bill, 2018 into law would be a significant way to cement this House as champions for a healthy Kenya.

The Irony of Universal Healthcare in Kenya

Posted by on 13th January 2020

Categories: Uncategorized

The recently released guidelines by the National Hospital Insurance Fund (NHIF) on 7th January 2020 provide a bleak picture into the future that envisioned Universal Healthcare Coverage (UHC) in Kenya. One of the changes is the reduction of the waiting period for new members from the current 60 day period to 90 days. There is also a mandatory 1 year upfront payment. For those defaulting on the payments, the changes provide for a penalty of 50% of each monthly contribution paid late for up to 11 months. Where the contributor has defaulted for 12 months, they will be required to start payments afresh and will only be eligible to benefits after 90 days from the date of resumption of payment. They will also pay a 1 year upfront payment. The rationale behind these changes is to marshal the efforts of NHIF towards the achievement of sustainable UHC and to enhance member retention. But is this really so?

Article 43(1) of the Constitution of Kenya 2010 provides that every person has the right to the highest attainable standard of health that includes the right to healthcare services. This is reiterated in the African Charter for Human and People’s Rights under Article 16.

The right to health is crucial to the realization of other fundamental rights and freedoms envisaged by the Constitution. Without it, one cannot be able to fully to enjoy their right to live fully. This right has four key elements that determine whether it can be enjoyed to the fullest. These are availability, accessibility, acceptability and quality. Availability connotes the present functioning public health and healthcare facilities for the use by the public. Accessibility takes different forms; the main ones being non-discrimination, physical accessibility and economic accessibility. Acceptability is with regard to being respectful of culture, minorities, peoples and communities. Quality relates to the scientific and medical appropriateness of the labour, equipment and drugs in the facility.

However, this is not the case as we know it. Almost daily, there are cries and complaints regarding the shortage of drugs in hospitals, shortage of beds in wards leading to even more deadlier cross-infections, lack of proper equipment to either detect or control certain diseases, long lines and wanting customer service to patients seeking assistance in healthcare facilities.

We acknowledge that indeed the realization of economic and social rights is contingent upon the availability of resources at the State’s disposal. Some might argue that limited financial resources at NHIF have necessitated these changes. However, what the Ministry of Health and its parastatal have shown Kenyans in the past 3 years is that there is little regard for taxpayers’ money. The much that has been given before has been mismanaged, misused and plundered massively leading to the current sad state of healthcare. A healthcare for the select few.

At the 2019 Kenya Health Forum convened by the Ministry of Health between the 14th and 15th of August, Health Cabinet Secretary Sicily Kariuki stated that, “UHC means much more than healthcare. It means ensuring that all Kenyans can get quality health services; where and when they need them, without suffering financial hardship. This has also been a key objective of UHC under the Big 4 Agenda that the Government is currently driving: that there may be a realization of a society where no one is ‘left behind.’

These changes are discriminatory not just to those who are not able to afford these services under this punitive regime, but also to women. Most new members of NHIF during the financial year 2017/2018 were citizens from the informal sector with a 13% increase from the previous year. It is evident that people in informal sectors and those struggling financially will be the first casualties. Their inability to meet these high costs will certainly leave them behind and result in unnecessary deaths that can be prevented through proper treatment. On the other hand, for voluntary members, access to maternity will be restricted to 6 months post card maturity. What then happens to expectant mothers who cannot afford the exorbitant costs of private hospitals? They will be denied adequate health services or pay hefty prices and end up suffering financial hardship in their quest for better healthcare.

The question that therefore arises is, who then speaks for citizens’ welfare? There exists, in both the National Assembly and the Senate, a Departmental Committee on Health that deals with matters of national health. These Committees are mandated to cover the functions of the Ministry of Health alongside its semi-autonomous Government agencies including the National Hospital Insurance Fund. Besides that, the Committee has a duty to investigate, inquire into, and report on all matters relating to the Ministries and departments as they deem necessary and as may be referred to them by the House. It also has a duty to study the programme and policy objectives of the agency and the effectiveness of the implementation.

Once Parliament resumes from recess, Members of the Health Committee in the National Assembly should take up this matter and represent the interests of the people. Some of the recommendations the Committee can propose to NHIF include; reduction of the premiums and elimination of the 1-year upfront payment, reduction of the waiting period, promotion of prompt disbursements of payments to healthcare providers, regular monitoring on the quality of services offered in accredited healthcare facilities and stringent rules on the management of financial resources at the Fund.

According to the Kenya National Bureau of Statistics, the overall membership of NHIF in the year 2017/2018 increased from a total of around 6.8million to 7.7 million. There is a high probability that the number is much higher now following the 2019 population census. These new changes spell doom for healthcare in Kenya and are actually parallel to the efforts of attaining UHC. The State in itself has an obligation to take necessary measures to protect the health of its people and to ensure that they receive proper medical attention. More can be done if there is right leadership and proper public participation.

Let healthcare be affordable for all; not just a select few. That is the Universal Health Coverage that Kenyans deserve.

May 2020 Bring a Change of Leadership

Posted by on 7th January 2020

Categories: Uncategorized

The festive season has over time evolved from just being a period of celebration and fun to being a time of self-evaluation and reflection on the just concluded year. As Mzalendo wound up its calendar of activities in 2019 we engaged our audience through an SMS question.

“What do you think has been 2019’s Parliament success story as the year comes to a close?”

The feedback painted a citizenry that had lost faith in its representatives. Some Kenyans thought that Parliament was no longer an independent institution and had instead morphed into the Executive’s puppet. Others felt that MPs were self-serving people who prioritized their interests over Kenyans’ needs, while others simply thought that Parliament generally underperformed in its role of legislation, oversight and budgeting. These responses might just represent a few Kenyans but their thoughts mirror the general mood on the ground.

“There’s never been a Christmas that has felt this un-Christmas-sy,” read a post on Twitter. The replies under the tweet were from Kenyans who largely attributed the slow death of the ‘Kenyan Christmas’ to the tough economic times the country is currently struggling with.

There is indeed a general sense of hopelessness in the electorate that would form a good business of objective inward-looking by Parliamentarians. 2019 was quite an eventful year for Parliament that had more lows than highs. From the standoff between the Senate and National Assembly over the DORA Bill, to 2022 political formations, to unpleasant comments on and off social media between MPs and the touchy subject of money. Parliament sure did make headlines this past year.

With such an integral role in the attainment of the vision of Kenya, it’s only prudent that MPs undertake in a SWOT analysis for the just-concluded year. Highlighting what succeeded, the challenges that emerged in their work and what failed will make room for strategic planning even as the year begins. Not only does this present an opportunity to restore public faith through value and impact-driven work, but it also gives Kenyan governance an opportune moment for a much-needed facelift. This, however, cannot be attained without deliberate effort from MPs.

2019 was a year that really put to test leadership expectations as envisioned in Chapter 6 of the Constitution. Besides the political drama between MPs from opposing camps several state officers were embroiled in graft cases that are yet to be concluded. Countless headlines made their way to the front pages of local dailies over billions of taxpayers’ money lost in looting. Systems exposed failure in the management of state agencies and as a result, put Parliament on the spot over its oversight role.

This should be a wakeup call for Parliament to step up in 2020 as it has previously been accused of rubberstamping the Executive’s wishes. MPs should objectively vet all appointed officials, hold state agencies to account and ensure that laws passed are enacted to the letter. Without a doubt, there will be a significant improvement in governance and service delivery if Parliament unbiasedly plays its watchdog role.

In the spirit of making new year resolutions, Parliament needs to only commit to protecting the Constitution to achieve the legacy that they wish to leave behind as the 12th House.