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GIKONYO: Reducing doctors’ fees has no effect on UHC

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By MBIRA GIKONYO
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Brian Taraji is an adventurous, alert and energetic two-year-old. A fortnight ago, Taraji swallowed a groundnut he had picked under the carpet. A period of silence, a persistent cough and a moment of gasping alerted his mother, Jayne Penda, that the two-year old had developed a problem. A doctor’s consultation and an x-ray showed that the nut was lodged in his chest and it was removed in a 45-minute endoscopic operation that did not require any cuts on Taraji.

Taraji received timely treatment chaperoned by adequate health resources including a specialised medical team with appropriate equipment. It would have been a different script if the Ear Nose and Throat specialist did not have a well-equipped theatre and a surgical team to save his life.

A proposal by Parliament to cut medical fees and charges is premature and will not contribute to the attainment of Universal Health Coverage. The standardisation of doctor’s fee capping both the minimum and the maximum that doctors in private practice charge already exists in the law and is governed by Section 23 of the Medical Practitioners and Dentists Act, Cap 253. In public and government run medical facilities, the government employed doctors work like all the other employees there and do not charge any fees at all, except for private patients.

What should be crystal clear is that the roll out of Universal Health Coverage, which in essence is government paid for healthcare that is offered free to the public, begins and remains confined to the government-run health facilities. This in itself is not new in Kenya and existed during the Mzee Jomo Kenyatta and part of the Daniel Arap Moi administrations until the structural adjustment programmes of the IMF demanded that the government introduced cost sharing in healthcare. Implementing the UHC is itself as simple as it was for the Mwai Kibaki Administration to introduce Free Primary Education. All that is requires is a decision on the part of the national government in consultation with the county governments, to decide and roll it out. No one and no sector of society is opposed to this.

Since these governments already pay for the health workers, the medical and pharmaceutical supplies as well as other related costs, the decision is not a difficult one. There are pilot UHC programs running in four counties with the aim of identifying any bottlenecks ahead of rolling out the programme in the whole country.

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This is an opportune time to open the doors of the Chinese-funded Kenyatta University Teaching and Referral hospital. We have a fully furnished hospital with the most modern diagnostic and treatment machines going to waste as the University and the Ministry of Health fight turf wars over who should run it. Yet this is a facility that can assist in the UHC at a referral level and also help decongest the Kenyatta National Hospital. doctors who lecture in Kenyatta University had offered their services to help this facility open.

The Ministry of Health is spending billions of shillings annually in ‘leasing’ of single use items such as syringes, while refusing to spend a few hundred or a few thousand shillings on surgical instruments that can safe a baby’s life.

What is the value of an X-ray if it shows the doctor that a child has swallowed a coin, but the child dies in the waiting bay because the hospital has no instruments to remove the coin?

What value is a CT Scan showing that a patient has cancer, yet we do not have radiotherapy facilities in each country or at least in half of them? Why does the government send free donated chemotherapy cancer medications to the private hospitals instead of the government hospitals?

All doctors, like all Kenyans, support the Universal Health Coverage programme. It should be implemented. However, interfering with private hospitals and private medical practitioners will not facilitate what remains a public sector programme. What the common man in Turkana or ordinary woman in Tana River expects is to walk to the local health centre and receive treatment for the common disease that ails them.

If they are referred elsewhere, they expect this to be within their county or a nearby county so that the costs of seeking healthcare are also minimised.

Dr Gikonyo is a consultant Ear, Nose & Throat specialist and Head & Neck Surgeon in Nairobi. E-mail: [email protected]



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Public officers above 58 years and with pre-existing conditions told to work from home: The Standard

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Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.

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However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.

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Uhuru convenes summit to review rising Covid-19 cases: The Standard

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President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow

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Drastic life changes affecting mental health

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Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.

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Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.

Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.

The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.

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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.

In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020.  It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.

A study by Dr. Habil Otanga,  a Lecturer at the University of Nairobi, Department of Psychology says  that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.

The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.

KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.

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Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.

As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.

“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”

Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.

“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.

Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.

“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”

Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.

“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.

Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.

Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.

She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.

Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.

“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added

Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.

“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and  also engage in   reading that would  help expand their knowledge.

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