Introduction
Health is a basic human right irrespective of race, social status, creed or sex. Consequently, governments are under obligation, through national laws and international treaties, to guarantee their citizens’ enjoyment of this right. For Kenya, the provision of quality health to the citizens has been a priority issue since independence some 43 years ago.

Good health constitutes the total well-being of an individual. With good health, individuals are able to perform productive tasks and contribute to national development. Quality health is essential for economic growth and general well being of a nation. Among others, it increases enrolments in school, ensures a high number of skilled workers, reduces medical costs and promotes savings.
Quality health includes access to good health delivery systems, good nutrition, food security and absence of morbidity and mortality.

The government’s goals on healthcare are contained in the Kenya’s Health Policy Framework Paper and include promoting and improving the health status of all citizens and making all health services more effective, accessible and affordable. The other goals are restructuring the health sector to respond to the proposed reforms and raising a population tuned to health seeking behaviour.
Several players are involved in healthcare provisions - the government, private investors, religious organisations and charitable institutions. The main player, though, is the government that runs most of the health facilities and services.

Despite its commitment to achieving quality medical for all, the government has not realised this goal because of high costs involved. Demographic surveys show that many people are not accessible to quality medical care because the costs are just too high. An average of 40 per cent of the population never seeks medical attention because they cannot afford it. They end suffering for treatable diseases and some even die prematurely for what could otherwise be prevented.
Expenditure to the health sector has generally been low, hardly more than 10 per cent of the GDP. The largest percentage of the budget, about 70 per cent, always go to curative health, 13 per cent to rural health and only 6 per cent to curative health. The rest goes to administration and planning, training and research, medical supplies and the National Hospital Insurance Fund (NHIF).

Besides inadequate funding, the health sector is reeling under serious staff shortage, lack of essential drugs and generally poor health facilities. Although efforts have been made in the past three years to rehabilitate and expand the health facilities, the progress is generally slow and the impact is yet to be felt, particularly in rural and urban slums, where public health facilities are critically needed.

Matters have been made worse by HIV/AIDS that has dealt a severe blow on the drive towards providing quality for all. More than half of the hospital beds are occupied by those suffering from ailments associated with HIV/AIDS. The high infections rates means that the bulk of resources earmarked for the health sector have to be directed towards fighting the scourge, thus leaving very little for other diseases.

In view of the high medical costs, the government has changed its approach from treatment to prevention. Campaigns are being focused on public education to sensitise the people on ways of preventing diseases so that they do not need to seek medication that is expensive.
It is also worth noting that a plan mooted in 2004 to transform the National Insurance Fund into a social medical insurance scheme to finance medical care for all citizens through low contributions, was shelved as it was found to be expensive for the economy. Little was said about it in 2005 and by the look of things, the idea would have to be re-examined and discussed afresh if it is to be brought back for public debate and eventual implementation.

Developments in the health sector in 2005
Healthcare consumes less than 10 per cent of the national budget. In the 2004/ 2005 financial years, the sector’s budget went up by 95 per cent while the health facilities and hospital bed capacity increased by 4.5 per cent. On aggregate, the number of health facilities went up from 4,557 in 2004 to 4,767 in 2005, representing about 5 per cent increase. Similarly, there was a modest increase in the number of hospital beds and cots, which went up by 4 per cent, from 63,407 to 65,971 during the period.

A common feature of the country’s health system is the disparity in terms of access to medical care by regions and gender. Rift Valley, the most expansive province, continued to record the highest number health institutions – 1374 – representing 28.8 per cent of the total while the North Eastern Province, despite an expansion of the medical facilities, still had 101, which is equivalent to 2.1 per cent of the total. The recurrent feature is that there are fewer health facilities in relation to the population, with a ratio of one facility for every 5000 people. The details of health institutions are presented in the table below.

As a strategy to improve the health sector, the government increased its budget in 2005 by 1.3 per cent, from 8.6 per cent to 9.9 per cent. The amount is to be increased progressively for three years to by 74 per cent, which in actual terms would mean a rise from KSh24.7 billion in 2004/5 to KSh43 billion in 2007/8. When that is achieved, the health sector would then consume 11 per cent of the national budget.

To achieve its stated goals as outlined in the health sector plan, the government set out to achieve the following in 2005:
• Increase immunisation coverage to about 75 per cent of the target population.
• Reduce child and mother mortality rate.
• Reduce malaria in-patient mortality to 15 per cent as a share of total patient mortality.
• Put in place strategies to reduce HIV prevalence and improve access to affordable drugs.
• Improve health service delivery through decentralisation of health services.
• Increase expenditure to preventive and basic health services.

Health management
The Ministry of Health is charged with the responsibility of providing quality healthcare. This has been articulated in various Government policy documents and Development plans. The ministry’s responsibility are: developing health and sanitation policies; offering preventive and promotive health services and co-ordinating HIV/AIDS programmes and other sexually transmitted infections (STI) and management. It is also responsible for health education; family planning; providing guidelines on food and food handling; health inspection and other public health services.

Besides, the ministry is responsible for administering quarantine and sanitary services. It supervises clinics, dispensaries, health centres and hospitals; is responsible for registration of doctors and paramedics. The ministry as a number of organisations that perform specific tasks and these are the National Hospital Insurance Fund, Kenya Medical Research Institute, Kenya Medical Training College, Government Chemist, Kenya Medical Supplies Agency (KEMSA) and Kenya Radiation Protection Board. There are also regulatory body run by medical professionals that are responsible for standards and ethics.

Challenges
The provision of quality medical care is hampered by several factors, including inadequate funds to establish more health facilities and provide all the equipment required by a growing population. Shortage of medical personnel persists, especially doctors and nurses, and this means that the sick are not able to get good and timely medical attention. The other challenge is inadequate medical facilities and equipment especially in rural areas where the vast majority of the population lives. High cost of health services has made it difficult for many people to seek medical care. The high rate of the spread of HIV/AIDS has compounded the problems by eating into the resources available for medical services making it difficult to give attention to equally killer diseases like malaria.

Way forward
The success of the government’s campaign to realise quality healthcare for all hinges on availability of adequate funds. At the current rate, where the health sector only consumes 9.9 per cent of the national budget, it would be difficult to substantively expand the medical facilities, equip them with the requisite equipment and drugs to guarantee effective service delivery.

Despite express policy to diversify into preventive health, instead of focusing on curative health, in reality that has not been effective. A large chunk of the budget still goes to curative health, which is quite expensive as compared to the preventive health. Expanding preventive health would require more investment in public information, communication and education to enable citizens understand the causes of common diseases and consequently take precautions to avoid them.

In addition, the Government has to step up efforts to increase coverage of immunisation, reduce mortality rate among children under-five years, reduce HIV prevalence, and increase the access and availability of essential drugs. Improvement of health service delivery for the underprivileged rural and urban slums will be a priority. As the Government focuses more on promotive, preventive and basic health services it will also need to enlist additional capacity through partnerships with civil society, faith based, and private sector organisations.

Also, there is need to strengthen cross-sectoral co-operation to strengthen ties and collaboration with critical areas of water and sanitation, reproductive health, gender, HIV/AIDS, nutrition, and school health, among others. The Government will improve on co-ordination and collaboration to achieve synergy and reduce inefficiencies, of various stakeholders in of healthcare industry. This will involve developing and implementing a joint national health sector strategic plan; monitoring and evaluation framework and mechanisms for annual health sector programme reviews; a medium term expenditure framework and annual sectoral public expenditure reviews. All these efforts will help evaluate the effectiveness of actual expenditures against the predetermined objectives of this sector.

Lastly, the strong political so far shown in improving and expanding health services should be maintained and strengthened.

Kenyatta Hospital IV. © Camerapix