In the era of a revolution in access to information, the Third World is a clear winner. Alternative media has given mainstream media a run for their money, and for them to survive they must adapt rapidly to stay ahead of the game.
The Arab Spring is credited to access to alternative media and we see this replicated everyday in our own country. Along with Nigeria and South Africa, Kenya dominates social media in Africa in a manner that is unprecedented.
The platforms have been used by every individual or group that is marketing, advertising, advocating or protesting. Locally, the civil society and labour unions are currently at the top of the charts in driving their agenda on these platforms, mobilising the public and creating awareness.
This has been demonstrated in the past 78 days, where social media platforms have been flooded with hashtags highlighting the Kenya Medical Practitioners, Pharmacists and Dentists Union’s grievances, enabling us to follow the intrigues of the ongoing strike.
#LipaKamaTender, #DoctorsStrike, HealthOnTrial, #DoctorsOnTrial, #DoctorsInJail, #HealthCrisisKE #CBASeven, #DoctorsReleased are some of the trending tags that have made headlines.
These tags have enabled the doctors to highlight their grievances to the public and even communicate to the higher levels of leadership. In the process, they have elicited strong responses from both sides of the divide.
But one of the critical observations from these interactions is the glaring lack of knowledge in the public arena about the right to health. Chapter 4 of the Constitution conceptualises the following relevant provisions for health:
1. Section 21 (1): It is the fundamental duty of the state and every state organ to respect, protect, promote and fulfil the rights and fundamental freedoms of the Bill of Rights.
2. Section 43 (1) (a): Every person has a right to the highest attainable standards of health, which includes the right to healthcare services, including reproductive health care.
3. Section 43 (2): A person must not be denied emergency medical treatment.
4. Section 46 (1) (a): Consumers have the right to goods and services of reasonable quality.
The drafters of these provisions intended to avert preventable morbidity and mortality while maintaining a healthy population. Why, then, has ignorance about these rights persisted? Some of the reasons include the following:
1. Lack of supportive Acts of Parliament that will define implementation of these provisions: Take, for instance, the case of the patient who died in an ambulance for lack of access to intensive care. It is critical that an emergency care Act defines what is regarded as emergency medical conditions; interventions categorised as emergency care; who pays for this care and modalities of how this is done; and who will provide this care from point of contact with the patient to transfer into continued care. In the case of critical care, when does emergency intensive care end and continued intensive care begin; what happens in case this care is not available, and who shoulders the economic burden of intensive care?
2. Poor public attitude: The biggest hindrance to access to the highest attainable standards of care has been the client. The poor state of health in Kenya has persisted for so long that it has been accepted as the norm. This has resulted in the blunting of the need to demand quality health care provision. Take, for instance, the mother who has been granted free maternity care. She is so grateful to access what she thinks is a free service that she fails to realise that she has already paid for it through her taxes. Instead, she is afraid to question why she is sharing a bed with three other women in labour. Or the breast cancer patient waiting for radiotherapy treatment for 18 months while the cancer progresses to stage four. In both cases, the patients don’t recognise their consumer rights to reasonable standards. The most outrageous attitude I come across is the notion that poor health standards are expected in the rural or less developed areas in our country.
3. Enforcement: Enforcement of these rights is a task that must squarely lie with the state and its various organs. It is critical to realise that enforcement of the highest standards of health must be separated from who owns the service point. Whether the care is in a state-owned or private facility, the quality must be standardised with respect to infrastructure, human resource, skills and supplies. The state must accept to mete out punitive measures to facilities that allow poor health outcomes, whether they are state-owned or not, including summary closure.
4. Health financing and universal health care: It is absolutely impossible to expect enforcement of the right to health without commitment by the state to meet the financial obligation. Each country must find a formula that works, but the ultimate goal is to ensure adequate fiscal commitment. Universal health care, if adopted, must be well thought out and efficiently rolled out for it to be successful.
To this end, it falls upon the state to take up its responsibility in ensuring this constitutional right is upheld at all times as mandated in Section 21 (1) of Chapter 4 of the constitution. This starts with passing the requisite laws, starting with the stagnant Health Bill. Civic education is critical, even to those who do not realise that affording health care is not equivalent to knowing your health rights. This awareness then helps in enforcement, as the populace can then demand of their government to maintain standards across the health sector.
The doctors’ strike has provided an opportunity to open this discussion and commit to taking the drastic measures required to turn around the state of health. Good health care is not a privilege, it is a right!