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Animal Farm Musings on UHC

By Shakira Choonara
on August 31, 2015



“All animals (patients) are equal, it’s just that some are more equal than others”


I recently attended the Leadership Management and Governance Training for Health Systems Strengthening in Africa. The training is hosted by Amref Health Africa in Kenya. It was an exciting two weeks, during which I had the opportunity to interact with numerous senior level managers/ academics across Africa who offered on the ground insight into specific health systems challenges. As always when visiting another country, the highlight is visiting health facilities/ hospitals. Dare I say, we often get lost in the publication process or our research activities and tend to forget the realities on the ground especially those faced by healthcare providers and patients. As part of the Amref training, we were taken to the Kenyatta National Hospital (KNH).


Public Area Emergency Unit

Public area emergency unit


KNH is the oldest hospital in Kenya (it was founded in 1901 and became a state corporation in 1987). It is the largest referral and teaching hospital in the country which has a capacity of 1800 beds and has over 6000 staff members. The emergency unit reminded me of most of the public hospitals in South Africa (i.e. mostly the malfunctioning ones). One could see that front-line providers are trying their best. One of the hard-working doctors stated that while they try and provide care for everyone, in some cases patients stay up to two weeks in the emergency unit  due to lack of beds or they are referred back to the lower levels of care due to limited oxygen tanks. There were extremely long lines of people waiting to be treated, floors were cracked, walls unpainted and a terrible stench. These are the conditions under which providers have to work and under which patients have to wait. As an example of limited resources, up to 4 patients sometimes sleep on one bed in the orthopaedic unit. It wasn’t all doom and gloom, though. I must say the critical care unit was spotless and well-maintained. However, overall the stark contrast between the public and private wings of KNH cannot be ignored, because just a few floors up (high up where the wealthy usually reside), one enters the private wing of the hospital. Just as in most countries, you know when you’re in a “private” facility. The floors shine, the air is fresh and crisp, healthcare providers are happier, and there aren’t long lines to access care. Trust me you won’t even know that you’re in the same hospital!



Private lounge VIP room

Private lounge VIP room


The private wing is further divided into different classes, from the general private room to a VIP room. Yes, a private VIP room, in a hospital! Perhaps the VIP room is worth considering for your next trip to Kenya? Compliments of wealth of course, a VIP patient could enjoy a lounge, a massive bathroom (the Jacuzzi sort) and the room also includes excellent views of Nairobi. It was at this moment that I could not help but think of one of my favourite novels, George Orwell’s Animal Farm. Kenya alongside other developed and developing countries has been moving towards universal health coverage (UHC), yet there continues to be palpable inequity between the public and private sector as evidenced by differences within one hospital. It is worth noting that revenue generated from the private wing does go towards KNH as a whole, but still! Moreover, Kenya’s National Health Insurance Fund (NHIF) is a massive government scheme but only covers those who are employed. I’d argue that if we’re really trying to achieve UHC, all revenue generated should be equally distributed amongst all patients, and schemes should not exclude the unemployed/ people who need healthcare the most but cannot afford it. I must then pose this question: is UHC in our present day context really about ‘health for all’? Or is it about providing health for “all animals (patients), under the assumption that some will always be more equal than others, especially if they have money”?


View from Private wing

View from Private wing


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