Patients or Customers? The Impact of Commercialised Healthcare on the Right to Health in Kenya during the COVID-19 Pandemic
Commercialisation of healthcare - that is the proliferation of market logic and mechanisms, including competition and performance incentives to gain private benefits - within the healthcare system is among the most prominent impediments to the progressive realisation of the right to health in Kenya.
The report shows that in recent years, health policies in Kenya have supported the development of market models in healthcare. For instance, the Kenya Health Policy 2014-2030 includes strengthening the role of the private sector as both a financier and a provider of healthcare services as one of its core objectives. International development actors have also contributed to higher private health sector involvement. As a result, between 2013 - 2021, the share of health establishments that are for-profit in Kenya grew from 33% to 43% in less than 10 years.
The research report shows the consequences of these policy choices on the enjoyment of the right to health, with a focus on individuals living in urban informal settlements. Based on 47 individual interviews and three focus groups in the informal settlements of Mathare, Mukuru and Dandora in Nairobi, Kenya, the report finds four ways through which the privatisation of healthcare can undermine the enjoyment of the right to health.
First, decades of healthcare commercialisation have resulted in insufficient public healthcare services. Kenya is remarkably short on medical resources that are vital to identify COVID-19 cases, such as reagents for testing, ventilators and acute care hospital beds. Healthcare services are starved of resources: domestic spending on health was as low as 9% of the national budget in 2020, far below the target of 15% to which the African Union States committed in the Abuja Declaration. Likewise, Kenya’s general government spending on health in 2018 accounted for only 2.17% of its gross domestic product (GDP).
Second, commercialisation is exacerbating inequalities in access to healthcare services. High-end private health facilities are largely inaccessible to low-income individuals, who instead rely on the limited available public medical facilities or low-cost private health services, some of which are offering substandard medical services. The COVID-19 pandemic has worsened these inequalities, with marginalised individuals facing geographical, information and financial barriers in accessing COVID-19 testing and treatment, with collateral impacts on access to other medical services.
Third, the public policies that have encouraged higher private sector engagement in healthcare over the last few decades have not been accompanied by sufficient regulation and monitoring of private healthcare actors, which has contributed to a proliferation of ramshackle private clinics, nursing homes and laboratories.
Fourth, and connected to the above, several private health facilities in marginalised areas are unsafe and offer substandard medical services. These facilities, often unlicensed, tend to employ unqualified doctors and the chemists were reported to sell expired drugs, resulting in episodes of misdiagnosis, unnecessary treatments.
However, Kenya recognises the right to health in its constitution, and has ratified regional and international human rights treaties which also recognise the right to health. Therefore, the Government of Kenya is obligated to proactively remove barriers that impede the enjoyment of healthcare, including by ensuring that the commercialisation of healthcare does not undermine the rights of individuals to access quality healthcare services.
GI-ESCR and PHM Kenya call on the Kenyan Government to strengthen public healthcare services instead of fuelling market models in healthcare. Commercialised healthcare ultimately creates a dual access system, where the right to health, and thus to a dignified life, depends on one’s socioeconomic conditions. In particular, the report recommends the following:
Increase government funding to health to at least 15% of the national budget to expand the availability of quality, well-coordinated public healthcare services
Ensure that all healthcare providers are strictly monitored and regulated at the national, county and local levels
Take concrete steps to ensure universal access to health insurance
Promote the development of a stronger public healthcare system accessible to all