Among the key pillars set out to be achieved by the Jubilee Government, healthcare stands tall. The journey to attaining universal health care seems to have been flagged off. In the 2018/2019 financial year budget that was recently presented to parliament, the government allocated Sh. 44.6 billion to cater for the universal health coverage. Another significant event to the healthcare sector is the Cuban doctors who have been brought in to the country to assist in the revamping of the health sector and covering the shortage in health specialists in Kenya.
But what factors make the Cuban doctors be regarded as the saviors of our health sector?
Cuba is known for its healthcare system which has seen the country attain healthcare outcomes at par with most developed countries. This system earned the favor of the former secretary General to the UN who recommended it as an effective model for many countries. Cuba has managed to utilize medical diplomacy with approximately 50,000 Cuban medicalworkers being present in 67 countries.
The healthcare system in Cuba is described as a unified national health system that was developed in 1960s. The healthcare system is founded on the following principles;
- The state and social aspect of public health
- Free and universal access to health services
- Preventive approach to healthcare
- Comprised of scientific and technical advances
- Community engagement
Let’s see how Kenyan Healthcare sector compares to the Cuban healthcare sector:
Kenya has a population of approximately 50 million people according to recent UN population growth statistics relative to a population of 11.4 million in Cuba. The fertility rate of people in Kenya is noted to be 3.7 compared to 1.5 of the people of Cuba. The World Bank indicated that the per capita GDP in Cuba in 2015 was US $ 7,602.3 while that of Kenya was US $ 1,349.97.
Trends in Healthcare Access and Quality Index
The Healthcare Access and Quality assesses personal healthcare access and quality. The measure is based on mortality-to-incidence ratios from causes that had quality healthcare been available, death would not have occurred. The HAQ index is indicated on a scale of 0 to 100, where 0 is the worst and 100 is the best.
As indicated in the graph above, the Healthcare Access and Quality Index (HAQ) in Cuba has been above the global average between 1990 and 2016 while that of Kenya has been below the global average.
From the information presented, the change in healthcare access and quality changed by 0.00% per year between 1990 and 2000 and 1.3% per year between 2000 and 2016. In comparison, the average change in performance in Cuba between 1990 and 2000 was 0.6% per year and 0.7 per year between 2000 and 2016.
Expenditure in Healthcare Sector
As indicated in the graph above, Kenya’s health expenditure per person is sourced from three main sources; development assistances, government spending, and out-of-pocket. This differs from the healthcare system in Cuba where the main source for the expenditure is government spending.
In 2015, the ratio of doctors to the population in Cuba was 7.7 per 1000population which translates to 1 doctor for every 130 citizens. While In the same period, the ratio for doctors to the population in Kenya was 22 for every 100,000 population, which translates to 1 doctor for every 4546 people.The world health organization recommends a ratio of 1 doctor for every 1000 citizens.
Trends in Budgetary Allocation Health
The budgetary allocation for health sector reduced significantly with the introduction of the devolution of the health sector. Five years later, the budgetary allocation to the health sector was yet to match the pre-devolution budgetary allocation levels. The county governments have been continuously increasing their budgetary allocation to the healthcare sector.
In 2015, the World Bank indicated that Cuba spent 10.57% of its GDP on health, which was slightly more than the global average.
Remuneration of Doctors
The average salary of Cuban doctors in Cuba is $60 per month while Kenyan doctors earn at least $1,000 monthly. Despite the excellent health care system and the skilled doctors in Cuba, the highest paid doctor makes $67 a month after a raise two years ago. In contrast, after the raise in Kenya, the Collective Bargaining Agreement (CBA) signed with the Council of Governors (CoG) that the lowest paid doctor (Interns) will be earning an average of $2,000 every month including allowances and the highest will earn $5,800.
Cuban doctors in Kenya will be paid $8,800 monthly which is 99% higher than they received in Cuba.
a. Life expectancy
It is clear that life expectancy in Cuba is higher than that of Kenya. This may be a likely indicator that the factors contributing to people living longer, among which health is an important one, are more positive in Cuba relative to Kenya.
Females in Cuba live for an average of 81.3 years compared to Kenya where the average life expectancy is 69.
The life expectancy of males in Cuba is 76.7 years relative to Kenya where it stands at approximately 64.7%
The difference between the life expectancy for female and males is approximately 12 years.
b. Infant Mortality
Infant mortality for children under-5 is at 45.9 for every 1000 live births in Kenya compared to rate of 10.4 for every 1000 live births in Cuba. Infant mortality for children under-1 in Kenya was 36.3 for every 1000 live births compared to a rate of 8.6 for every 1000 live births.
From the data presented in the discussion above, it is clear that Kenya has a lot to learn and emulate from the Cuban Healthcare system. It is not yet clear how the 100 Cuban doctors that Kenya has imported will help revamp our “sick healthcare system” or how their success will be measured. It is clear, that the much-coveted success of the Cuban Healthcare system, extends beyond having the doctors to serve. Policies and process are equally as important. Kenyans should not expect the Cuban doctors to be miracle workers.