EXPERT: NO COUNTRY TOO POOR TO PROVIDE QUALITY HEALTH CARE FOR ALL

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.