Health is seen as one of the winners in Kenya's annual budget. Many in Kenya's health circles however argue that the COVID-19 crisis has simply highlighted the underfunding of the sector in past years.
"There is a saying amongst the middle class, that in Kenya you are only one illness away from poverty," explains Elizabeth Gitau, who heads the Kenya Medical Association, an organization representing medical practitioners. If you fall ill in Kenya — where less than 20% of the population has health insurance — you may have no choice but to spend your savings and ask your friends and relatives for money, just to pay the hospital bill.
Investing in health care has not been a priority for the government, Gitau says, which is why the Kenyan public has been footing the bill. For the 2020/2012 budget, Kenya has allocated 111.7 billion KES (€916 million, $1 billion) out of a total budget of 2.75 trillion KES. The question is whether the coronavirus pandemic has changed any of that.
As early as 2001, African Union (AU) member states signed the Abuja Declaration, pledging to allocate at least 15% of their annual budgets towards health care. At the time, African countries were reacting to a general under-funding of the health sector, but also to the HIV/AIDS pandemic, which had taken a devastating toll on the continent.
Almost 20 years down the line, Kenya's overall spending on health care has been straddling between 6% and 7% of the entire budget — so, half of the amount originally agreed — while Africa's most populous nation Nigeria spends as little as 4%.
In a 10-year review conducted in 2010, the World Health Organisation (WHO) rated Kenya, along with 26 other African countries, as having made 'insufficient progress' in achieving the declaration's goals.
A hospital bed stay is far too expensive for many Kenyans, prompting many to seek treatment abroad instead
"If we were at 15%, you would find that hospitals here in Kenya would be well equipped. The number of deaths would go down and people would live productive lives," argues Violet Mbiti. She led the civil society team advocating for reproductive, maternal, newborn and adolescent health in the leadup to the budget.
Her focus area, with maternal and newborn health counting as essential services, has seen virtually no budgetary increase for years — despite a decline in donor funding.
In Kenya, where the counties are responsible for the budget, health care should ideally make up a third of the country's budget — something that few counties have been able to achieve. "We should be at 33% of the county budget, and we're [currently] at about 21% of the budget — that is way below the norm," admits Peter Warutere, a member of the Nairobi County Assembly, who chairs the health budget committee.
"The priorities for the entire country must change completely," Warutere argues, "because in health we should rather look at preventive than curative measures to address matters."
Has the pandemic changed anything?
When the first coronavirus cases arrived on the continent in early March, African countries had already watched European countries like Italy and Spain, as well as North American countries, scrambling to get a handle on the outbreak. The projections for Africa didn't look good. So Kenya, like many other African countries, closed its borders and introduced preventive measures that other countries only introduced well into their individual crises. At the time, WHO's director general, Tedros Ghebreyesus, warned African countries to prepare for the worst.
Three months into the crisis, Kenya has just over 3,200 confirmed coronavirus cases, 78% of which the government says are asymptomatic or mild cases. Up until early June, all confirmed cases were hospitalized — something which Kenya has now announced that it will no longer be able to do due to the rising case-load. Like countries in Europe and North America, Kenya will now allow home-based care where possible for all mild COVID-19 cases.
Kenya's Health Minister Mutahi Kagwe speaks during a press conference in March 2020. Kenya has imposed strict measures to combat the coronavirus outbreak, but it is still being critcized for its limited healthcare budget
While many African countriesseem to have been able to curb the spread of the virus, both Mbiti and Gitau agree that the strict measures, which countries like Kenya had to take, highlighted the shortcomings of an already vulnerable health care system. Outside private facilities and the national referral hospitals in Nairobi, many hospitals lacked ventilators, intensive care beds and trained personnel. In June, the government earmarked a special fund for each Kenyan county to upgrade their isolation facilities to have 300 beds.
"COVID-19 has proven to us that: Yes, you can have infrastructure, but if the people are not healthy, who will be there to drive those cars and use those roads?" Mbiti argues.
In Kenya, the arrival of COVID-19 has meant that the government has had to reallocate funds from other sectors towards the emergency response. At the same time they received funding from international donors — in early April, 2020 the World Bank approved a $50 million package to help Kenya respond to the pandemic. In May, the organization approved another US $1 billion package to cushion the economic effects of the pandemic. The European Union meanwhile provided Kenya with €15 million worth of aid.
Will coronavirus be a game changer?
There's no question that health care should be on everybody's mind right now. In 2018, the Kenyan government launched its Universal Health Coverage project — essentially free health care — as one of the President Uhuru Kenyatta's main political agendas. But two years later, there have been no reports on the project's progress.
Gitau believes the problem goes back to issues of financing and implementation. Additionally, she says, much of the money goes into funding the big national referral hospitals, the Health Ministry itself and administrative costs. The government can write beautiful policy papers which other countries even adopt. "So it is not for lack of knowledge or lack of capacity. It is for lack of commitment to the health sector," she says.
Warutere, on the other hand, believes that while this year's budget still reflects pre-COVID-19 priorities, Kenya will see a stronger focus on health in the years to come. If countries are serious about containing the pandemic, he says, health should become the biggest budgetary consumer.