A health
expert says any country can offer its citizens the very the very basics of life:
health, good food, good shelter and a good education, regardless of their
station in life.
Delivering a
professorial lecture at the University of Namibia School of Medicine, Prof
Peter Nyarang’o advanced the thesis that no country on earth can claim to be
too poor to give its citizens quality health care.
His view is
that every effort must be taken to ensure that each citizen is treated with
dignity, particularly at the moment when they are most vulnerable, in desperate
situations or sick and hungry.
 |
| Prof Peter Nyarango |
“That’s the
moment when they need their county to stick its neck out and reassure them. The solidarity of the nation should be
reflected in how it treats the ones who are weak, poor, old or young,” he said
in an interview after the lecture.
Nyarang’o said
health was a social justice issue and so nations must strive to ensure that all
their nationals got the best health care possible.
He said what
made the difference between developed and developing countries’ quality of
health care were the systems put in place to provide care. He opined that time had come to question
whether governments should be seen as primary providers of services. His view
is that governments must slowly move away from direct service delivery to
become regulators, standards setters and allocators o resources.
Recently
President Hifikepunye Pohamba appointed a commission to go to the roots of this
issue. The Presidential Commission on
Health has since produced a scathing report which some people say is a litany
of indictments of the country’s health care system. Although the report did not
say when the rain started to beat the system, it was emphatic in saying that
there were few health workers; that the quality of health care was doubtful and
unsatisfactory; and that the resource basket was leaking too much along the way
to the actual patient.
Earlier in his
presentation, Nyarang’o had called for the generation of hard, counterfactual
evidence given that the actual cost of the package of services that patients got
was not known for certain.
He gave the
example of caesarean section operations which have been done since biblical
times. In some instances women who
desperately need them die before they can have it, while some of those that
access it pay through the nose.
“This is
something that should be readily available and affordable. We should be able to
link such costs to outcomes and the costs should be clearly broken down so that
we can see why we are spending so much.”
Nyarango’s
view is that although health care services at public health facilities may
appear cheap at face value to the patient, there were hidden costs which can
hemorrhage the state if not reigned in.
He called
also, for developing countries to develop strategies to avoid wastage, which he
said was a major problem in their health systems. He reasoned that in some
instances wastage in the use of drugs could be attributed to the manner in
which patients procure medicine.
Many people
with medical aid schemes seldom pay for drugs from their pockets over the
pharmacy counter. They do so through
deductions from their earnings to an almost faceless entity. For that reason they seldom ask their doctor
or pharmacist if they really need all the medicines prescribed when they fall
sick.
Tales of
promiscuous use of drugs abound. A woman
who once took her child who had a sore throat to a doctor said she was given an
anti-biotic, a pain killer, a cough mixture, multivitamin and lactobacillus,
which is used to replenish useful bacteria which antibiotics would have removed
in the intestines. Experts say one can
get lactobacillus from yoghurt.
“I ended up
with so many drugs that I simply kept them in the house until I gave some to my
neighbor and threw away the ones that had expired,” she said.
Nyarang’o said
whereas rational use of drugs requires that pharmacists use the simplest preparations
to treat diseases before using stronger drugs, that was not always the case. He
said the offshoot of this promiscuous use of drugs was very high resistance in
some cases.
Nyarang’o drew
parallels between his native Kenya and Namibia.
He said Kenya
had very little resources to spare for health.
As a result the country spent only 2, 6 percent of its Gross Domestic Product
on health. Namibia spends about three
times more. Dollar for dollar, Kenya,
whose population is about 40 million, spends the same amount on health as
Namibia, whose population is about two million.
As part of a
broader strategy, Kenya took a bold step to give power to the patient by making
health care affordable. Kenya eliminated the need to put the hand in the pocket
at the point of care.
In line with
this thinking Kenya set up a mandatory health insurance scheme nearly 50 years
ago. A state corporation called
National health Insurance Fund was set up to keep the money.
However, a
recent study revealed that the NHIF was shortchanging almost everybody in that
its operational costs were very high (nearly 50 percent) and it became a state
monopoly. The study also found out that
the NHIF was not ambitious enough to collect more.
Namibia does
not have mandatory health insurance. It
is only employees of government or the private sector who contribute.
Nyarang’o said
a free market does not work in health and so there is need for safe guards for
the contributors, who often do not know how much the services and products offered
really cost.
“Ideally there
must be an intermediary who negotiates good rates on behalf of the user.”
In addition to
universal health insurance, Nyarang’o advocates for the establishment of a
health trust into which donors and philanthropists can put money. The money can be used to subsidize
indigents. He said health insurance was
too complicated to be run as a government bureaucracy.
Well-placed
sources say that Namibia is already discussing within the context of social
security, whose Act among other things requires support to health care. Observers
say this is a major breakthrough in terms of having an existing law on
supporting health care.
