ACCESSIBILITY TO THE HEALTH CARE SYSTEM

CHAPTER ONE

INTRODUCTION

Kenya has a massively growing population but more than half of its population makes up the majority poor (Tumbo-Oeri, 2000). People living under the poverty line do not have enough earnings for their basic needs, food, water and shelter. They are therefore the people who rely most on government subsidies for health care. Unfortunately, they face many barriers in accessing health care and usually end up receiving poorer services than the minority rich population.

The Ministry of Health, MOH is the main organization that heads the Kenyan health care system. It gives the stipulations of health care and plays a big role in making the rules of the health care personnel. There are three main sectors of health care: the public sector which represents all government owned health care facilities, the private sector which collaborates private individuals and institutions and the non-profit making organ-izations which include organizations like churches which form health care facilities that are non-profit-making.

There are about 4, 700 health care facilities in Kenya that cater to the population of 44 million residents. The public sector serves more than half the citizens of Kenya and ac-counts for about 51% of all health care needs. The reason it takes precedence over the private sector is that more residents of Kenya can afford care at the government owned health care facilities as the prices are greatly subsidized and some services are offered free in public health care facilities. The main national referral hospitals in the country are the Kenyatta National Hospital, in Nairobi and the Moi Referral and Teaching Hos-pital in Eldoret, all of which are government-owned structures. This paper focuses on the government-owned health care facilities (public sector).

As a result of the high population, the Kenyan government has tried to provide equity in the health care system so as to effectively alienate human suffering and improve life-styles of her citizens. The Kenyan medical system is marred by many factors that render accessibility and delivery of health care difficult. These factors include poor govern-ance, overreliance on donor funds, corruption, nepotism, traditional and cultural beliefs of the citizens, a lack of a medical filing system, lack of efficient infrastructure, massive poverty and illiteracy.

One of the main economic activities that bring great revenue in Kenya is agriculture. This is a highly manual labour that requires lots of productivity and good health care of her citizens ensures great productivity at work too thus lowering the poverty level.

Proper health care is of importance in reducing poverty and increasing the economic growth because as it is, general unwellness of the citizens renders Kenya poorer. Most adults are unable to access proper medical care thus staying away from their workplaces on long sick leaves. These long sick leaves end up reducing the economic growth.

The set Millenium Development Goals (MDGs) focus on the improvement of health as well as enhancing human life on a global scale. There are 8 set MDGs and three of them relate to the improvement of health care provision to human beings. The three goals aim at improving maternal health, reducing child mortality as well as enhancing the fight against HIV/AIDS, malaria and other diseases. Kenya is currently battling the HIV/AIDS pandemic and malaria is one of leading causes of death in Kenya. Maternal health has lots of room for improvement in order to reduce the mortality of infants and loss of maternal deaths.

Inaccessibility to health care in Kenya is mainly evidenced by the gap between the wealthy and the poor citizens. The rich among the society are able to pay an extra amount to have their health care needs met appropriately and fast while the poor have no option but to accept whatever care they receive, at whatever time the care is availed. The health care of these poor majorities is greatly minimized by the favouritism greatly showed to the rich minorities.

The poverty level in Kenya in a study conducted in the rural areas in Kenya in 2007 linking poverty levels to the geographical conditions was estimated to be at 45%. This report showed that almost half of the 44 million residents of Kenya live under a dollar per day. This is equivalent to living under Kenyan Sh105 a day (Okwi et al, 2012).

Corruption is one of the biggest battles that affect both the Kenyan health care sector. Forms of corruption in the health sector are often conducted in many ways, including officials embezzling the funds set aside for the health care sector or individual personnel taking bribes in form of money and inequitable distribution of health care services and goods so that the poor majorities will not get all the medical attention, services and goods that the rich in the same ward receive.

This kind of attitude and inequality affects the effectiveness, accessibility quality and quantity of health care offered to the sick people. As a result the costs of health care for the poor shoot up as the personnel do not give them the required attention and could miss important details on health changes of the patients and the volume of services given reduces.

STATEMENT OF THE PROBLEM

There are many problems, which constrain the Ministry of Health to legislate for and ensure the delivery of adequate levels of quality health care in its facilities, including the following; under-funding of health facilities, inadequate capacity of the public health care systems, lack of amenities, inadequate staffing, and archaic health laws. This has resulted in the reverse of key health indicators and loss of health gains achieved since independence. The Ministry of Health has responded to these challenges by developing a national health strategic plan that contains the priority packages for the population (Republic of Kenya). As the Ministry of Health continues to implement the packages, the quality of health care continues to deteriorate at all the three levels of health care systems levels, i.e. primary, secondary and tertiary levels. The increasing prevalence and incidence of HIV/AIDS with its attending complexities and impacts have further complicated the problems. A major problem is the limited inpatient capacity with a bed occupancy rate of over 50% by AIDS patients. In addition, the length of stay is usually longer for AIDS patients, further constraining the scarce resources and adversely affecting admission of patients suffering from other ailments.

In spite of these constraints, the utilization of public health care services by the community is high, though patients continue to use the mission and the private health care services for acute cases, citing quality as the main reason. This is in consistent with findings that showed that cost-sharing program resulted in reduction in proportion of the number of patients using the public health facilities (Mwabu et al 1995). Government documents reviewed indicate that the government has a policy on improving access and quality of health care but do not know their (access and quality) effects on health care utilization

AIM AND OBJECTIVE OF THE STUDY

The aim of this study is to get sufficient information on the transparency and accessibility of health care in Kenya. This in turn will help create awareness of the challenges faced by Kenyans in relation to accessing and receiving health care and enlightenment on ways to better improve the health care sector.

The purpose is to contribute awareness of the benefits of improving health care provision to the Kenyan people as well as proper medical record storage which will be a step closer to efficient health care in Kenya.

RESEARCH QUESTIONS

To achieve the aim and purpose of this study, it is necessary to answer the following research questions:

1. What is the current situation on healthcare accessibility in Kenya?

2. What are the benefits of introducing a computer -based system in the Kenyan health sector?

SIGNIFICANCE OF THE STUDY

This study will benefit the management of the various hospitals at various levels of health service delivery. The results will further assist in making health policy decisions that are patient driven rather than basing such decisions only on perceptions of facility managers. On the other hand, patients will benefit because their actual needs will be included in healthcare decision making, thus ensuring services would be designed to meet their expectations. Improved service quality lead to better care, which further should lead to reduced morbidity and mortality rates. Also the results will benefit other scholars and researchers.

SCOPE OF THE STUDY

This study on the accessibility of health service in Kenya will carried out in the Kenyan health sector.