Is Kenya a failed state? Healthcare points to yes

Maslow’s hierarchy of needs comprises a five-tier model of human needs, with needs lower down in the hierarchy needing to be met before individuals pay attention to needs higher up.

From the bottom of the hierarchy up, they are classified as physiological needs comprising food, water, shelter and rest; safety, encompassing health and security; love and belonging addressing friendships and intimate relationships; esteem, involving accomplishment and prestige; and lastly, self-actualization, which speaks to a sense of having achieved one’s full potential. In brief, the three main tiers speak to basic needs, psychological needs and self-fulfilment.

This theory speaks not only to an individual’s journey to self-actualisation but also to a country’s rise to self-actualisation. It is really not possible to look at what is happening to our country and not feel the need to take a hard stop and reflect on where we are headed.

In Kenya, we are no longer descending to the bottom of the pyramid; we may as well have tossed it out of the window. Right at the bottom of the food chain, we have threatened our food security by selling fake fertiliser to farmers, who are meant to fill our granaries! We are selling the idea of providing shelter to people who aren’t sleeping out in the cold, yet they have no access to sustainable clean water sources if the cholera outbreaks we have had this past year are anything to go by.

Despite the investment we have put in security, we still live in a country where bandits attack children in class and get away with it with no repercussions. Even worse is how our security forces are used as target practice in North Eastern Kenya in this year of the Lord, 2024!

As if that is not enough, after all the pomp and flair that went into launching primary care, flagging off 100,000 community health volunteers to round up the sick and those threatening to be sick to head to the health facilities for early intervention, we have spent the better part of the past three weeks allowing health services to run aground with no visible attempt to bringing an end to the doctor’s strike.

When public healthcare comes to a standstill, the person paying the price is Wanjiku. What is even more astounding is how the government script runs like a broken record, year in, year out, with every industrial action. The first order of business is to ignore every notice served to the concerned offices of the intent to institute industrial action should the government continue to ignore the call to resolve the thorny issues arising.

Once the industrial action takes off, the immediate response is to run to court and declare it illegal. This will be followed by public demonstrations and half-hearted attempts to be seen to be seeking a solution. Once the steam runs out, the next level involves intimidation and threats of jail for disregard of court orders.

By the end of last week, the doctors’ strike was pretty much at intimidation level. It makes one wonder, at which point do we as a country expect different results by doing the same exact thing?

As a country, Kenya is likened to a well-dressed lass, all decked out to impress in public, but who cannot even afford the rent of her bedsitter. We cannot continue to exhibit our 10 per cent over-privileged self to the public, pretending to be at the level of self-actualisation when the landlord has served notice to the 90 per cent who are sleeping hungry and dying of preventable health conditions, simply because we treat our healthcare providers with disdain.

It is beyond comprehension that the two most critical dockets in the country that are responsible for the most basic needs of all Kenyans, the Ministry of Interior and the Ministry of Health, took the lead in the corruption index! We are neither safe nor healthy but we brag of being a lower middle income country. Sick people who cannot sleep peacefully at night cannot in any way grow the economy of a country. We can only slide down to oblivion, with no one left to tax.

It has been argued that doctors owe it to the public to provide care to the sick because the taxpayer’s money has been spent to educate them. This may have been true two decades ago. Unfortunately, it is time to disabuse this notion. For the last nearly two decades, three in every four doctors graduating from university with a degree in medicine have been privately educated by family or non-government scholarships, whether locally or internationally. This statistic is worse at specialist level where four in five have spent top dollar to acquire the necessary skills to provide highly skilled services to the sick.

The truth is, as heavily taxed Kenyans, we do need to ask the real questions, what exactly is our tax money intended for? At the very rudimentary level, we need to be food-secure. It should not be negotiable that our farmers are supported to feed us as a country. Access to clean water should not be a privilege but a basic human right.

With these basic needs met, we need to be safe. Safe from both internal and external security threats; and safe from disease and ill health. Once these core priorities are in place, the rest will fall in line with little effort.

It is my humble plea that government steps up and negotiates with these service providers with clean hands. Healthcare is a service industry. No amount of investment in infrastructure and equipment is going to replace those skilled enough to put that investment to use; to provide care.

Doctors, nurses, clinical officers and all other allied health personnel are NOT the ones who owe the country a robust health service, the government does. As aptly put, they are highly skilled hired help. So, the government must own up to the fact that it is responsible for procuring and retaining the health workers for effective service delivery. It is not the public’s concern what the internal issues look like; the public simply wants an end to the theatrics and restoration of services by those it elected to power to do so.

At this point in Kenya, we are far beyond strikes borne out of government refusing to meet its end of the bargain. We should be negotiating how to fund high level, advanced health innovations and services, not stage-managing unnecessary industrial action in such a critical sector!

Dr Bosire is an obstetrician/ gynaecologist