Shame of patients neglected by health insurance system

As technology turns the world into a global village, one of the greatest beneficiaries has been healthcare. At the click of a button, we as doctors, get to reach out to colleagues, both locally and around the globe, and consult about patient care in real time.

Unlike a phone call where one speaks to just one colleague, our interactive platforms engage multiple specialists at once; giving the advantage of diverse opinions and shared learning at the click of a button.

Even more importantly is that these platforms have provided an avenue to seek help for patients, seeking to ease their burden of disease. We inquire about where to access rare medications and medical technologies at affordable prices; we enquire about intensive care unit (ICU) bed availability directly to the colleagues who manage these units; we search for blood for our patients right here; and even more importantly, we get information about access to medical donations, donor-funded services and information about free medical camps for our neediest patients.

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Those among us who work in the public sector are constantly seeking ways to alleviate the suffering of their patients in the face of absent resources. They seek information about existing donor-supported treatment programmes where their patients can be enrolled.

The patients benefit from these efforts through free fistula camps, free surgical camps, access to chronic disease medications, and even enrolment into clinical trials for rare diseases. On these same platforms, we have fundraised to support extremely needy patients neglected by the system!

The goodwill is remarkable, with most vulnerable patients being given a chance to access sorely needed services and technologies. However, by nature of how healthcare providers are conditioned through years of training and service; it is very easy for them to lose focus on the urgent need to hold the government to account for this extreme dependence on charity.

For instance, in this era of technology, access to blood and blood products should be a no- brainer. Every single unit of blood in this country is uniquely labelled for tracking as part of blood safety. It is therefore a matter of having an online platform open to all relevant health service providers, with a national view of each blood unit, its specifications, where it is located, and when it is due to expire. That way, in the event of an emergency, the blood request is automatically picked up and a response mechanism activated to save life. 

There are certain medical conditions that fail to garner appropriate attention because they affect a small proportion of people at any one time. As a result, these marginalised patients will suffer untold misery because their needs are ignored in the grand scheme of health budgets and healthcare financing in the name of cost-effectiveness. They get relegated to mercy of well-wishers.

With advanced surgical technologies, many patients are getting a new lease of life. Fancy surgeries are able to side-step cancers, trauma-induced organ damage, and congenital abnormalities, enabling increased life expectancy, and hopefully better quality of life. However, these interventions create a new lifelong cost that is not factored in at the point of surgery; with no forethought to the sustainability beyond the operating room.

For instance, many patients eligible for kidney transplant are hesitant to proceed with the procedure, even when the surgery is fully paid for by private and social health insurance. This is because prior to surgery, their dialysis costs are fully catered for. However, post-transplant, the lifelong anti-rejection medications, are not paid for; creating a new cost that they can ill-afford; and one which will render the entire transplant investment useless if not catered to.

For decades, patients who have ended up with a colostomy or ileostomy following surgery have borne the brunt of denial of supportive care. A colostomy is an opening in the wall of the abdomen through which the large intestine comes through, diverting stool to come out, bypassing the normal passage through to the rectum and anus. When this diversion is done at the level of the small intestine, it is called an ileostomy.

Future surgery

These colostomies are made during life-saving surgery, may be temporary, with future surgery to restore normal anatomy; or may be permanent; with the patient having to live with them for life. With the stool coming out onto the abdomen continuously, the need for a collection device cannot be overstated.  Colostomy bags are designed to attach to the skin firmly without leakage, with an adhesive that does not injure the skin; and are flexible enough to be worn under normal dressing without much fuss.

Patients with colostomies and ileostomies remain unheard despite decades of surgical technology creating them. The bags are disposable, hence a costly affair to the patient, which no third-party payer wants to support.

We lived through a decade of the national hospital insurance fund and we are now in a new dispensation of the social health insurance fund, yet our colostomy patients continue to rely on well-wishers and donations to make do, simply because the cost is unsustainable to the majority of Kenyans, even the middle class. At which point do we convince these patients that their contributions to the healthcare kitty matters? When do we as a country cease with the despicable neglect that has turned them into beggars?

We must wake up to the reality that the world is getting less and less altruistic and that donors and well wishers are wearing thin pretty fast. The exit of major donors is not a punishment to Kenya, but a golden opportunity to redirect our priorities. It is time for our leadership to change course.

Healthcare, education and food security are non-negotiables in any civilisation. To appreciate the increasing need for local funding for our healthcare especially in the financial year 2025-2026 and respond appropriately is the hallmark of putting money where our mouth is.

We cannot be slashing the proposed health budget from Sh200 billion down to Sh136 billion when we have promised exchequer-funded primary healthcare and emergency/chronic disease care; when donor exit has left gaping holes in our healthcare funding; when there is a country-wide shortage of polio vaccine for our infant babies!

It is crime to commit people to pay for a social health insurance scheme that fails to meet them at their point of need, forcing them to live at the mercy of donations. Inability to handle our excrement in a dignified manner is the lowest one can bury human dignity. Our stoma patients must not continue to be subjected to this level of human rights abuse!

Dr Bosire is a gynaecologist/obstetrician