Health Rights in Kenya

Hi all…for my first blog entry from the second annual Kenya Health Rights conference I’m beginning at the end..in other words, the best way to start to synthesize the vast amount of data and the number of powerful stories of health rights violations and opportunities presented over the last two days is to look back from the finish line…particularly because we ended with the most salient rationale for a rights-based approach to health…simply put, it works.

Anand Grover, the new UN Special Rapporteur on the Right to Health and a prominent lawyer and health rights leader in India, ended the conference by walking attendees through this results-based rationale for health rights. As Grover laid it out, whether you’re a health worker and/or citizen of Kenya or India (or, for that matter, the US), it turns out that we’ve already got waves of evidence that reveal the ineffectiveness and inefficiencies of non-rights based health systems.

Example: health system financing…During the conference, for instance, we learned that more than half of all Kenyans pay for health care out-of- pocket. In a country where 56% of Kenyans live on less than $2 a day, the lack of a health financing system based on principles of equity, access, and affordability has direct visceral consequences for a population that already live on the margin. Got asthma?…cough up the money for your life-saving preventive and curative treatments. Break your leg? Expect a crippling assault on your life’s savings and your kids’ chances to eat. Without a rational health financing system, the default is a out-of-pocket system that penalizes the poor and helps to exacerbate rather than address illness and inequity. The absence of rights, speaker after speaker powerfully voiced, equals the absence of health .

What’s the alternative? In Kenya, it turns out the problem is not the absence of alternative health financing tools.. in fact, we heard a variety of local NGO leaders and health care workers debate the merits and drawbacks of several health financing options that exist in some form in Kenya already. We learned of the tax-financed supply-side system largely used to staff public facilities…we learned of a demand-side insurance schemes, including one known as the National Hospital Insurance Fund…we learned of innovative community-based health financing models tied to micro-credit enterprises (which, in its largest example, covers 200,000 people in one of Kenya’s provinces). we learned of the private for-profit insurance programs that differentially select (or cherry-pick) the healthiest patients by excluding others with pre-existing conditions (like HIV)…in fact, like in the US, Kenya has a dizzying fragmented collection of health financing options. and, like in the US, Kenyan patients, especially the most vulnerable, continue to fall through the cracks.

But, as Dr.Lukoye Atwoli and other rising leaders for health rights in Kenya voiced during the conference, the challenge before Kenyan health care workers and patients is to learn how to demand and help achieve long-sought and needed results for all Kenyans. With this results-oriented focus, health workers, patients, and advocates can cut through the noise of health financing options and ask, quite simply, what works?

So with a pragmatic eye to results, a few presenters over the last two days shared examples of what’s worked. In some parts of Kenya, for instance, certain communities have begun to implement a recent initiative by the Kenyan government to strengthen local village and district-level governance and management. While evaluations are underway, anecdotal evidence indicates that community engagement, a key driver of any rights-based approach to health, may be working. At the international level, we learned of countries that have successfully applied for and, in cases like Rwanda, invested Global Fund money in programs that enhance affordability, access, quality, and equity through rights-based health financing structures and health workforce development programs. And, not surprisingly, concrete improvements in health have followed.

For me, as a physician and health rights advocate in Los Angeles, the argument for a rights-based approach to health advanced here in Kenya is powerful precisely because of this focus on results. Regardless of personal or political beliefs or nationality, health workers who are committed to the best results for our patients are becoming increasingly aware that the way to results is through rights. And, if we agree that human rights are indivisible and interdependent, then so too are rights-based solutions. An advance in rights in one corner of the world bolsters efforts in another. As HERAF takes a step forward in health rights in Nairobi, I and other colleagues in Los Angeles and elsewhere look forward to walking with them. After all, it’s what works.

For more info on Dr.Atwoli, check out his blog at

http://kenyanpsychiatrist.blogspot.com/