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Two Kinds of Healthcare Systems: The Gross Anatomy of Corruption-The Kenyan Case Study

Two Kinds of Healthcare Systems: The Gross Anatomy of Corruption-The Kenyan Case Study

  • June 4, 2024
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Healthcare systems around the world can be broadly classified into two categories: those designed to make money by keeping people healthy and those that profit from people remaining sick. The former incentivizes preventive care, wellness, and efficient medical services, while the latter is driven by the treatment of chronic conditions and the filling of hospital beds. The Kenyan healthcare system, undergoing significant reforms and facing numerous challenges, serves as a pertinent case study to explore these dynamics.

Preventive and Wellness-Oriented Systems

A healthcare system that focuses on keeping people well emphasizes preventive care, early intervention, and chronic disease management. In such systems, healthcare providers are rewarded for maintaining the health of their patients, reducing hospital admissions, and promoting healthy lifestyles.

Kenya has been making strides in this direction through various initiatives. For example, the Managed Equipment Services (MES) partnership between the Kenyan government and GE Healthcare, launched in 2015, aimed to decentralize specialized healthcare services to county levels. This initiative improved access to diagnostic services, such as radiology, thereby enabling early diagnosis and treatment of diseases like cancer. The program has increased the number of digital exams and reduced patient referrals, illustrating the benefits of a preventive care model (World Bank).

Moreover, Kenya has secured substantial funding to bolster primary healthcare services and enhance institutional capacity. This funding, supported by international organizations like the World Bank, is aimed at improving healthcare infrastructure, training medical personnel, and ensuring equitable access to healthcare services across the country (World Bank).

Systems Profiting from Illness

Conversely, a healthcare system that profits from illness tends to emphasize treatment over prevention, often resulting in higher healthcare costs and less focus on patient outcomes. In these systems, hospitals and healthcare providers may be incentivized to keep beds filled and perform more procedures, regardless of their necessity.

Kenya’s healthcare financing structure has elements that reflect this model. The country heavily relies on out-of-pocket payments, which accounted for about 35.9% of total health expenditure as of the mid-2000s. Such a system can lead to inequities in healthcare access, as those who cannot afford to pay are often left without necessary medical care (International Journal for Equity in Health). Additionally, Kenya’s public healthcare spending has been relatively low, with significant portions of healthcare funding coming from donors and private sources, which can lead to a fragmented and inefficient healthcare system (BMC Health Services Research).

The Dual Reality of Kenyan Healthcare

The dual nature of Kenya’s healthcare system illustrates the tension between these two models. On one hand, the country is making efforts to improve preventive care and healthcare access through strategic partnerships and funding. On the other hand, systemic issues such as reliance on out-of-pocket payments and inconsistent public healthcare funding undermine these efforts.

For instance, the decentralization of healthcare services through initiatives like the MES program shows positive outcomes in terms of improved access and early diagnosis. However, the persistent issues of financing and resource allocation reveal the challenges of transitioning fully to a preventive care model (World Bank, WHO).

Kenya’s healthcare system exemplifies the complexities of balancing preventive care with the economic realities of healthcare financing. While initiatives to improve healthcare access and focus on wellness are underway, significant challenges remain due to systemic issues and financial constraints. Moving forward, Kenya’s experience underscores the need for sustained investment in preventive healthcare and equitable financing mechanisms to ensure a healthier population and a more efficient healthcare system.

The Gross Anatomy Corruption in Kenyan Healthcare System

Corruption in Kenya’s healthcare system has dire consequences, exacerbating poverty and healthcare inequality. The systemic corruption diverts essential resources away from public health needs, leading to inadequate services, substandard care, and higher costs for medical treatment.

Impact on Healthcare System

  • Diverted Resources: Corruption in Kenya’s healthcare system often manifests in procurement fraud, embezzlement of funds, and bribery. This diverts resources that should be used to improve healthcare infrastructure and services. As a result, hospitals and clinics are left without essential medical supplies and equipment, directly impacting the quality of care provided to patients​ (UNODC)​​ (Horn Observer)​.
  • Increased Healthcare Costs: Corrupt practices increase the cost of healthcare. Patients are often required to pay bribes for services that should be free or low-cost, leading to financial strain. This is particularly burdensome for low-income families, who may forego necessary medical care due to unaffordable costs​ (Health.go.ke)​​ (Kenyans)​.
  • Inefficiency and Poor Service Delivery: The inefficiency caused by corruption means that healthcare facilities are often understaffed and under-resourced. This leads to long wait times, inadequate patient care, and sometimes even medical malpractice. The lack of accountability and transparency further compounds these issues, making it difficult to rectify problems​ (Horn Observer)​.

Exacerbation of Poverty and Inequality

  • Pushing Households into Poverty: The high cost of healthcare driven by corruption pushes many households into poverty. Families are forced to spend a significant portion of their income on healthcare, often selling assets or borrowing money. This financial burden can be devastating, especially for those already living in poverty​ (Health.go.ke)​.
  • Widening Inequality: Corruption in the healthcare sector disproportionately affects the poor and marginalized communities. Wealthier individuals can afford to pay bribes and access better services, while the poor are left with substandard care. This creates a significant gap in health outcomes between different socio-economic groups​ (UNODC)​​ (Horn Observer)​.
  • Undermining Trust in Health Institutions: Corruption erodes public trust in health institutions. When people perceive the healthcare system as corrupt and ineffective, they are less likely to seek medical care when needed, leading to worse health outcomes and further entrenching poverty​ (World Health Organization (WHO))​.

Efforts to Combat Corruption

The Kenyan government, along with various organizations, is making efforts to combat corruption in the healthcare system. Initiatives include:

  • Enhanced Transparency and Accountability: The Ethics and Anti-Corruption Commission (EACC) has launched reports and conducted surveys to identify corrupt practices and recommend measures to enhance transparency and accountability in the health sector​ (UNODC)​​ (Citizen Digital)​.
  • Collaboration with International Bodies: Partnerships with organizations like the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) aim to strengthen anti-corruption efforts. These collaborations focus on improving governance, ensuring proper use of funds, and promoting transparency in procurement processes​ (UNODC)​​ (World Health Organization (WHO))​.
  • Policy and Legislative Reforms: Efforts to reform policies and legislation are ongoing to create a robust framework for preventing and addressing corruption. This includes stricter enforcement of the Public Finance Management Act and the Public Procurement and Disposal Act​ (Health.go.ke)​​ (Citizen Digital)​.

Conclusion

Corruption in Kenya’s healthcare system significantly impacts the quality of care, increases costs, and deepens poverty and inequality. Addressing this issue requires a multi-faceted approach, involving stronger governance, enhanced transparency, and collaboration between government entities and international organizations. Only through sustained efforts can Kenya hope to provide equitable and efficient healthcare for all its citizens.

References

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