Accessibility To The Health Care System

Project and Seminar Material for Nursing (Science)

Abstract

Kenya has a population of approximately 44 million people. Health services are provided through a network of over 4,700 health facilities countrywide, with the public sector ac-counting for about 51% of these facilities. The best quality of care is found at the national referral hospitals, which provide diagnostic, therapeutic and rehabilitative services. Kenya spent 5.1% of its Gross Domestic Product (GDP) on healthcare in 2002. Life expectancy is also on the decline. In 2006, the child mortality rate was 78 per 1,000 live births. Among the Kenyans who are ill and choose to seek care, 44% were hindered by cost and corruption. Another 18% were hindered by the long distance to the nearest health facility.

Basic primary care is provided at primary healthcare centers and dispensaries. The pur-pose of this paper is to create awareness of the current healthcare system in Kenya, its accessibility and enlighten on storage healthcare records. The research questions were: What is the current situation on healthcare accessibility in Kenya? What are the benefits of introducing a computer -based system in the Kenyan health sector? The results give a clear picture and what the healthcare system in Kenya operates and how the accessibility of healthcare facilities is experienced by the Kenyans.

Some Kenyans are unable to access healthcare services due to various reasons. One of them is the distance to the health centers in relation to transport and urgency for treatment. Another problem is the cost of healthcare especially in the rural areas where a good number of civilians are below poverty level. There are also the benefits that the healthcare system will gain from introducing a computerized method of medical record storage to better identify the patients and render better healthcare services.

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:

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

Chapter Five

Discussion and Conclusion

The aim of this study was so that the author could acquire data on the transparency and accessibility to the Kenyan government-owned health care system. The author concentrated in researching information that explained in detail the kind of barriers that Kenyans have to face in order to receive this basic right and maybe put a few pointers to how this situation can be solved.

There were two main research questions that the author thought and felt were very relevant in achieving this aim.

The questions were:

What is the current situation on healthcare accessibility in Kenya?
What are the benefits of introducing a computer -based system in the Kenyan health sector?

As always, the hardest bit in the solution of any problem is accepting that there is a problem. When people accept that there is room for improvement for the Kenyan health care system, then the government can work on tackling the issues at hand to make the system acceptable according the set international standards.

This research of this paper helped to highlight the issues that deter the accessibility to the Kenyan health care system. The author found out that the current situation on healthcare accessibility in Kenya poses a challenge to the government to do better in provision of funds so as to improve the facilities in the hospitals. It also calls for Kenyans to join hands and fight the vices that render this sector inadequate so as to also improve their well-being and lifestyle.

The current situation in Kenya in terms of accessibility is deterred by corruption, nepotism, poverty, illiteracy, cultural backgrounds, religious backgrounds, major outbreak of diseases, the huge number of patients, salaries of health care personnel, inadequate facilities, medical facilities and infrastructure in the hospitals and the donor funds.

This could be regrouped to show what the government must work on and what the citi- zens can help improve.
The government can handle and solve the following barriers that resulted from the ex- tensive research conducted for this paper:

Major outbreak of diseases
The huge number of patients
Salaries of health care personnel
Inadequate facilities, medical facilities and infrastructure in the hospitals
Donor funds

Throughout the years, most disease outbreaks are repetitive. For instance, between December 2006 and June 2007, there were numerous cases of the rift valley fever which claimed the lives of many humans as well as those of livestock in the North-Eastern region of Kenya. These re-occurrences could simply be handled by the government providing vaccination for the region because the residents herd lots of livestock for a living and the spread of this disease is rapid. The residents could not afford to act fast enough because of the cost of the vaccination. These types of outbreaks can be handled by the government to save the residents and eliminate human suffering. Other major outbreaks have been repetitive cases of water-borne illnesses and the residents cannot afford treatment early enough to save their lives without the government intervention.

Mostly, road accidents are some of the major causes of huge hospital queues in Kenya. Accidents occur too often leaving lots of injured persons and others die instantly. The government has tried to mobilize Kenyans to drive carefully and stop driving under influence but unfortunately, there are always cases of accidents. This campaign for safe driving and building more roads to avoid too much traffic should continue. Some of them result from poor roads where there are too many potholes or because of lack of street lights. The government should put more street lights because after leaving the capital city, Nairobi, street lights are very rare. The last thing that the government can do is eliminate unroadworthy cars because in some accidents, the car undergoes a mechanical difficulty that the driver cannot control.

The salaries of the health care personnel need a thorough review because these people have too much work in comparison to the money they make out of it. Compared to the WHO standards, the health care system in Kenya is still lacking enough personnel be- cause most doctors or nurses go in search of greener pastures in other countries and the rest who stay in Kenya will only work in the main capital cities where other social amenities are readily available. That deters accessibility of health care in rural areas where majority of the Kenyan population resides.
Lack of medical facilities and infrastructure should be worked on because things like thermometers, blood pressure meters, EKG machines and saturation meters should nev- er lack in any health care facility. This could also be readily availed so that personnel from different departments do not have to share them and in doing so, many lives could be saved. Other facilities like hospital beds and linens should also be improved so that patients do not have to share them because this is unhygienic and the spread of infection is very high. Sometimes, patients from road accidents have to share a single bed in spite of their fractures and their medical history.

Donor funds are very wrongly misallocated which makes them a barrier to accessibility to health care. When donations come, they are not distributed fairly to the patients who need them the most but rather, there is lots of corruption and injustice in sharing them out. This ends up missing the target and the government should ensure that these are correctly shared out to the whole country, not just to the capital city. The government must ensure that hospitals in rural areas get a fair share too.

The citizens on the other hand can handle and solve the following barriers:

Corruption and nepotism
Poverty
Illiteracy
Cultural backgrounds
Religious backgrounds

Corruption is always conducted by two parties. The government has tried to ban corruption in all the public facilities including the health care centers and it’s the responsibility of every Kenyan citizen to put an end to it by saying no. The patients should join hands and refuse to pay extra money just to get better treatment because trying to bribe the personnel only serves to make the lives of other citizens who cannot afford to pay extra more difficult and their health care is greatly undermined.

Poverty has led many Kenyans to form an opinion that they can never get treated at the hospitals and so when they fall sick, they wait for the disease to really advance before they go for medical attention. This kind of attitude ends up costing these patients more and the fact that cost was the main reason they did not seek medical attention in the first place means that they get poorer in terms of finances and lifestyle. They should seek medical attention immediately and try to take advantage of the government subsidies on the health care services as well as the free medication, guidance and counseling that is availed at the hospitals.

Illiteracy can also be handled at an individual level where the person puts effort in looking at the updates as provided for by the government. In case the person cannot read or write, there is always a member of the staff and other media like radio and TV that always spread health care information so that people know their rights and why when it comes to their health it’s better to prevent than to cure.

Cultural and religious beliefs should also be an individual’s efforts because the person can critically think about the impact that these institutions pose on his/ her health. For instance, if the tradition encourages having more than one marital partner in the polygamous family setting and the religion bans all sorts of contraception, the individual must then look at the health risks this poses on them.

They could look whether having too many unplanned for children is healthy for them or having to contract other illnesses in the process. In some religious beliefs in Kenya, some people believe that only God should heal and they cannot go to the hospital. In case of accidents for instance, where the patient has a really big wound, sometimes they have to think of the pain and the risk that the wound poses to him because clearly, it’s a call for medical attention and the patient understands that they could die from it.

The second research question about the benefits of creating a computerized filing system in the government-owned hospitals is an effort that the government should carefully allocate funds to as it can end up saving many lives. The personnel would have a proper medical history before devising ways of treating patients that would make their work easier in case the patient does not remember details of his/her health history. Other important information like allergies and other medication in use could also save time and cost because the doctor would have sufficient information regarding the contraindications of medication and thus eliminating unnecessary suffering of the patient.