Derrick Mwenda Bundi
Kenya
I grew up in the lush green county of Meru, the upper eastern region of Kenya. The fresh air, sounds of chirping birds, and the refreshing sight of ornamental purple bougainvillaea and kei apple (kayaba) fences were the norm. Most importantly, we enjoyed fresh food from the farm. And good health. Growing up in the shadow of the Meru Prisons Dispensary, where my father worked as a nurse, I developed a profound empathy for those on the margins. Until later on, I was oblivious that the stark realities of inmates represented entrenched inequalities in access to healthcare. Looking back, the deplorable infrastructure then, coupled with little or no access to medication, painted a picture of despair and neglect for those behind bars. This is why I pursued pharmacy. My father’s dedication as a nurse in the public health sector inspired me. Through my pharmacy degree, I have envisioned myself as a global health professional committed to bridging existing inequalities by capitalising on innovative and traditional approaches.
I first visited a public ward during my clinical years and was ready to quit pharmacy school. The deplorable conditions spoke to the brokenness of our hospitals and, in a broader sense, the healthcare system. As a pharmacist, I now appreciate the glaring gaps in addressing the growing burden of non-communicable diseases (NCDs) in Kenya and the continent. The scourge of NCDs is now a reality in my life. My mother suffers from hypertension, and my grandfather has diabetes. These personal crucibles have inspired me to be a part of positive societal change. I have made it my mission to conscientiously work towards democratising access to quality healthcare for all without suffering financial hardship. This mission's crux is collaborative advocacy for good governance and evidence-based policy.
NCDs are here with us. They are wreaking havoc not only in our vulnerable health systems but also, on a more personal level, in our homes. The emotional, mental and financial burden is insurmountable. The Ministry of Health reports that the burden of NCDs claims over 39% of the deaths in Kenya and more than half of hospital admissions. The 28.6% reduction in household income due to NCDs exacerbates poverty levels, forcing families to allocate a more significant portion of their limited resources to healthcare expenses. According to the World Bank, by 2030, these losses could reach KSh 607 billion annually, significantly hampering economic growth.
The primary challenge I seek to address, which is faced in effectively combating NCDs, is governance. Governance issues encompass national and county governments' disengaged and uncoordinated approach to healthcare. A study by Moses et al. (2021) highlights that the major determinant of health system inefficiency is directly linked to poor budgetary absorption. The national government bears responsibility for ensuring cash flows to devolved units, while independent offices like the Controller Of Budget (COB) are mandated to ensure that budgets are implemented. It is critical to highlight that governance affects all aspects of the healthcare ecosystem, particularly healthcare financing. Healthcare financing directly impacts access to essential medications for chronic diseases, healthcare insurance costs, and human resources for health. There is a need to prioritise NCD response through adequate funding, ensuring that budgetary allocations are at least 15% of the national budget and a robust health insurance system.
In Kenya, a staggering 24.3% of health financing is out-of-pocket. A World Bank report estimates that, in Kenya, NCDs account for a significant portion of healthcare expenditure, approximately KSh 230 billion (about 3.4% of GDP) in 2016, due to direct medical costs and indirect productivity losses. The government covers around 4% of the national budget for health, which is insufficient given the rising burden of NCDs. To increase the disposable income available to Kenyans, the government needs to increase budgetary allocation to ease pressure on the pockets of ordinary citizens. Additionally, accountability is imminent in achieving the UHC agenda. But what exactly does accountability mean in the context of healthcare? It encompasses regular evaluations of health projects such as building cancer centres and primary healthcare interventions. This means ensuring that the drug supply chain system for public health facilities through Kenya Medical Supplies Agencies is waterproof and translates to the availability of essential medicines in hospitals. The government must ensure that it streamlines the operations of the national health insurance system through digitisation of systems such as contributions while ensuring access to services is assured for all Kenyans and prompt reimbursement to hospitals. Sustained advocacy for implementation of existing policies is an approach that can avert the situation. Advocacy can be researched or lobbied through the legislature and non-governmental organisations.
A well-financed and properly governed public health system reduces premature mortalities, assures access to medicines, and significantly reduces patients' financial burdens. A productive Kenya relies on a healthy populace, which is the foundation on which the right to the highest standard of health, as enshrined in the Constitution, is achieved.
I will achieve this by leading initiatives that place patients at the centre and engaging directly with them through their patient groups. Through my podcast, I hope to provide a platform for advocating for patient rights and authentic experiences with the healthcare system. These
recordings are critical in highlighting systemic gaps and providing solutions to existing challenges. Further, I aim to get involved in health policy research that addresses the existing governance challenges. By leveraging my pharmaceutical background, I would fill the existing research gaps by identifying barriers to access to essential medicines for patients living with NCDs. The need for a ‘healthy’ health system has never been more urgent. With a vision to transform the health system through actively advocating for universal health coverage contextualised to the challenges we face and our resources, I am confident that Kenya has an opportunity to boost its productivity.