HEALTHCARE SHOULDN'T MEAN BEING BROKE OR BROKEN, YET IT DOES

“I traveled to Nairobi to meet you,” Linda* [not her real name] says to me, as we stand in the sun sipping our morning tea as we nibble on mandazi, a local sweet, spiced delicacy. We are both attending the 4th Annual Beyond The Bars Conference 2023, her, as a member of Sisters on The Outside, a coalition of formerly imprisoned women, me as a director of Clean Start Africa . “If you cannot help me, I will surely go to jail.” Her eyes are downcast, her voice soft, heavy with emotion. The only thing holding the tears so evident in her eyes from falling, is the tight dignity with which she holds herself. The forty-something tall, lanky woman wrings her hands as she turns her eyes to me. “Utanisaidia, ama nijitayarishe kurudi ndani?” [Can you help me, or should I get ready to go back inside [prison]?].

Linda*, a mother of three has a child with epilepsy. She has already served two terms in prison for selling illicit alcoholic brew locally known as chang’aa. She stopped after her second release and has been selling cooked food in the little food kiosks [kibanda] that seem to occupy every street corner in Mombasa where she lives. Business has been very poor. Layoffs, increased remote working and a severe economic downturn have driven customers away. The drugs she must buy her child cost Kshs.6000.00 [USD45.00] and she just cannot sell enough food to buy them all and pay for all the other needs of her growing family. He has bruises from his most recent falls, dark shadows from older bruises dot his body. The human rights activist in me.... the mother that I am, cannot allow this. But for the grace of God, there go I. Healthcare should not mean jailtime. Yet for many, it means going broke, getting into debt, or simply not accessing the desperately needed care until the condition is critical, sometimes fatal.

Healthcare affordability and accessibility remain among the biggest socioeconomic challenges in Kenya. With over half the population living below the poverty line, quality healthcare is out of reach for millions of Kenyans. This lack of access threatens progress and impacts everything from life expectancy to economic productivity.

Several factors contribute to the healthcare access crisis. Most glaring is the lack of adequate public health funding. Healthcare spending in Kenya accounts for just over 4% of GDP, far below the Abuja Declaration target of 15% that the government committed to. This underinvestment means limited infrastructure and personnel, with just 13 doctors available per 100,000 people on average according to WHO. The shortages lead to long wait times at public facilities and overreliance on an unaffordable private sector.

Poverty and unemployment also seriously hamper healthcare accessibility. With over a third of Kenyans unemployed and others in low-paying informal work, insurance coverage is limited. Less than 10% of the population have private healthcare insurance. The rest rely on personal savings or, in the case of larger bills, donations from the dwindling pool of able, willing donors in what is commonly known as “harambees”. Out-of-pocket spending accounts for over a quarter of total healthcare expenditure in Kenya, presenting a major barrier to access for millions unable to pay fees charged at both public and private facilities.

The high costs and lack of healthcare access are also closely linked with predatory informal lending and crime. With few affordable options, many low-income Kenyans turn to unregulated "shylocks" for loans to cover medical costs, often at extraordinarily high-interest rates. A 2016 FSD Kenya survey found that over 30% of Kenyans rely on these unscrupulous lenders to finance health expenditures. (1) The resulting crushing debt and desperation drive some to robbery, fraud, and even violence out of economic necessity or to pay back debts. Kenya’s police service has directly tied some crime spikes to the practices of lending sharks around medical expenses, underscoring the far-reaching impacts of unaffordable and inaccessible healthcare on socioeconomic welfare. (2) Solving the healthcare affordability crisis would help alleviate reliance on exploitative lenders as well as related motivations for criminal activities.

The challenges are even greater for certain vulnerable groups. Persons with disabilities (PWDs) face environmental and social barriers to care, while stigma also hinders utilization. Africa Disability Alliance data suggests almost half of PWDs in Kenya cannot afford medical care. Refugees also shoulder extreme healthcare access and cost burdens, with restrictions hampering inclusion in public insurance schemes. Those in remote, underserved areas similarly grapple with distance, transport limitations, and meagre clinical infrastructure. The African Union has called upon governments to ensure accessible and affordable healthcare for marginalized groups.

Various government and donor efforts seek to promote healthcare accessibility, though more action is urgently required. These include exempting fees for mothers and children under 5, introducing subsidized National Health Insurance Fund (NHIF) coverage for citizens, expanding medical infrastructure into underserved counties, and regulating private sector costs and practices. Preventative and primary care also need greater emphasis per WHO guidance. The situation is dire. The current solutions, inadequate to address the complex challenges. The solution has to come from elsewhere. And they need to do so fast. If Linda* cannot consistently obtain the quality care she needs for her child, she will do whatever any mother would, whatever it takes for her child to be well. Even if it means going back to jail.

Signing her onto the membership-based subscription healthcare provider, Checkups Medical , is a no-brainer. The combined tech-enabled, fintech, health-tech-driven model provides solutions combining five of most patients, and caregivers’ pain points - affordability, quality, convenience, reliability, and traceability. With payment unlocking the next level of benefits, members like Linda* can pay for healthcare in installments. The nurses and medical team are deployed to the member’s home or place of work/school and the consultations can take place where the patient is. This means Linda* does not have to close her “kibanda” to take her child to the clinic, waiting long hours and losing vitally needed income. That’s not all. At CheckUps, we source medication at an average of 15% below RRP AND deliver it to the patient. For families caring for loved ones with chronic patients, or members with disabilities and on long-term medication, the ease and convenience are not just a good-to-have. They are the difference between their loved one constantly getting vital health tests to make sure that long-term usage of medication does not result in undetected organ damage and further complications. The post-delivery follow-up calls increase the chances of compliance. Already, CheckUps are reporting a 60%-70% compliance rate for chronic patients with a concomitant reduction in symptoms over a 6-8 week period.

For Linda*, prior to knowing about CheckUps, she hoped that I would find the money somehow. I probably could, for a month or two. But then what? This way, she has a dignified, independent way of managing her family’s healthcare without resorting to crime. And her child can have a normal childhood. Healthcare costs should not push people to the edge. Access to healthcare should not mean loss of income or of work. With this new protocol, it does not. Instead, it allows for quick deployment of affordable, high-quality, dignified care for all without the high infrastructural costs that traditional healthcare models demand. I've been championing affordable accessible healthcare as part of my campaigns since my radio days 2013. I've ploughed through more iterations of pathways to accessible healthcare than I care mention. Then last year, I revisited the CheckUps model. I think we may be onto something great here.

2024 loading…. Dignified Healthcare Access, You Have a New Champion!

References:

WHO Country Cooperation Strategy Kenya Medium-Term Support Strategy 2014 - 2019 https://www.afro.who.int/sites/default/files/2017-05/who-kenya-country-cooperation-strategy-2014_2019.pdf

World Health Organization. (2019). New perspectives on global health spending for universal health coverage. https://apps.who.int/iris/handle/10665/330091

Krystle Kabare, [October 2018] Social Protecton and Disability in Kenya https://www.developmentpathways.co.uk/wp-content/uploads/2018/10/Disability-Report-Kenya.pdf

Ouma, B. O., Maina, J., Thuranira, M. N., Macharia, P. M., Alegana, V. A., English, M., Okiro, E. A., & Snow, R. W. (2018). Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. The Lancet Global Health, 6(3), e342-e350. https://doi.org/10.1016/S2214-109X(17)30488-6

WHO Country Cooperation Strategy Kenya Medium - Term Support Strategy 2014 – 2019 https://www.afro.who.int/sites/default/files/2017-05/who-kenya-country-cooperation-strategy-2014_2019.pdf

Struggling To Thrive: How Kenya’s Low-Income Families (Try To) Pay For Healthcare https://www.fsdkenya.org/wp-content/uploads/2016/03/16-03-22-Struggling-to-Thrive-Report.pdf

Oyaro D. & Gogo, S. [2020] The opportunity for financial inclusion in health insurance coverage

https://www.fsdkenya.org/inclusive-finance/the-opportunity-for-financial-inclusion-in-health-insurance-coverage/