By Mary Mwendwa
Nairobi, Kenya: In September this year, 2023, Fred Laparan and another employee at Mama Lucy Hospital in Nairobi were jailed for 35 years for child trafficking by a Kenyan court. This child trafficking syndicate was unearthed by BBC’s Africa eye investigation which filmed Leparan accepting 2500 USD to sell a baby under the hospital’s care.
This was not the first case of complaints from the public about services at the hospital.
In August cleaners at the facility went on strike claiming they had not been paid for over three months’ salaries in arrears.
In 2019 there was a public uproar after a secret Camera by KTN news recorded a woman giving birth in the corridors of the hospital with no doctors attending to her. She gave birth as people watched her.
All these cases have trended on social media pages like Twitter now X where Kenyans have called for better service delivery at the hospital.
Mama Lucy Kibaki Hospital is under the Metropolitan Health Services Sub-programme with other hospitals such as Mbafathi District Hospital, Pumwani Maternity Hospital, and Mutuni Hospitals.
Mama Rose, not her real name is one of the current victims of service delivery at the Mbagathi District hospital. She lives in Kibera Makina village with her three children. Her story is sad because she is living with pain after the disputed elections of 2007 where post-election violence erupted.
“ I was raped by four police officers who were dressed in combat and were speaking in Ugandan dialect. My brother was also killed. I got pregnant and infected with HIV. My child who was born as a result of rape is now a teenager and looking forward to taking her to form one in the new year.” A teary Rose narrates her story.
“ Mimi sijui tutasidiwa na nani, who will help me, we were raped and infected, we are many here in Kibera, and nobody bothers to hear our cry, it was not our fault.”
Rose now has another challenge that she believes if no one comes to her rescue she will be completely doomed. Her daughter injured her knee a few months ago, and the knee is swollen with some colorless liquid oozing from it. “ I have gone to Mbagathi Hospital with my National Hospital Insurance Fund(NHIF) card and turned away that they cannot cover the Magnetic Resonance Imaging (MRI) scan for the knee. We were referred to a private facility in Upper Hill, the German medical center that charges 18,000 for the MRI.”
Rose confides that she cannot afford the 18,000 KSH for the MRI, she desperately watches her daughter’s knee deteriorate day and night. “ A well-wisher pays for me and my family 500kSH for the NHIF cover, I have always been sure that in case of a health issue, I will not beg anyone, now see, I am helpless.” She sobs.
An NHIF member is expected to access the inpatient and outpatient benefits which include maternity, surgical, dialysis, radiology imaging services, mental, and oncology.
Asked if she has considered other options like Kenyatta National Hospital she replies.” I have made inquiries about Kenyatta, the queues are long, many people have booked and take long to be attended to, and at times the machines also are not working.”
Rose’s case is not unique to many Kenyans when it comes to access to public health care in Kenya.
The system
President William Ruto recently signed the four progressive health coverage bills, the Primary health care Act of 2023, the Digital Health Act, the Facility Improvement Financing Act, of 2023, and the Social Health Insurance Act, of 2023.
Governors have protested about the bill, arguing that they were sidelined. The matter is now on hold waiting for deliberations on both sides.
While all these challenges have been directed at service delivery, experts in health systems say it is a systems challenge that needs concerted efforts to fix the problem.
Dr. Ouma Oluga, former Director of Health Services at Nairobi MetropolitanServices ( NMS) who is now a consultant physician and health systems expert says that service delivery is just one block of the health system.
WHO has outlined the six building blocks of health systems as follows, leadership and governance, service delivery, health systems financing, health workforce, medical products, vaccines and technology, and health information systems.
Oluga notes that Kenya has added two other blocks; infrastructure and access to health care.
Challenges- health systems
“ All these blocks are interdependent, you cannot focus on one and leave the others, some of these challenges we have relate to capacity and they cut across the board.”
Oluga notes that coordination and regulation are where other setbacks in the healthcare sector are. “You see when it comes to capacity this is where resources come into play, not being able to have enough resources to build a health care that can respond to the needs of the people is also a problem.”
Oluga further says that coordination in the health sector is critical. This means that the relationship between the blocks and how they interplay to produce a service that is accessible, and affordable and how they they make the health system resilient and respond to the needs of the population.
” This coordination has been the biggest problem and has been worsened by devolution.”
He further points out that our healthcare system still does not have a practice that is uniform across all hospitals.
On the issue of doctors being blamed for not participating fully during the constitutional debate, Oluga confirms that doctors were involved. “ There is a way politics tend to lessen issues that they don’t think they want to talk about, the discussions around devolution as much as they were robust, they were driven by certain interests, health care is one of those issues that we can see was not handled well.”
“ The challenges that we found in the health sector in Nairobi when I was the director of health services for NMS are not over, we had plans for the system to be resilient and sustainable. We signed up with NHIF that out of the 128 hospitals in Nairobi, 124 are offering free treatment to patients, the foundation still exists and we hope it works.
Oluga concludes by saying that Kenya’s healthcare system is still among the best in the region. Morocco, Egypt, and Ghana are at the top of the list.
