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Prof. Miriam Were: Community Health Networks, The missing Piece in Devolving Healthcare Systems

  Jan 13, 2016

Community health advocate  in child and maternal health, a  great reformer of public health systems locally and globally, key HIV/AIDS preventive strategist,  Co-Founder of  Uzima Foundation, a promoter of access to healthcare in Kenya, and currently, the Chancellor of Moi University, are just but a few of the many gigantic caps Professor Miriam Were wears.

Invited as a guest Lecturer during the Master in Healthcare Management Cohort 2 session by Module lead Dr. Marie- Louise Cantamessa, Professor Miriam Were as always rose up to the task of kindling the minds and hearts of the participants with her strong charisma in community based healthcare approaches.

An embodiment of transformation in public health, Prof. Were dutifully rose to the topic of discussion; Health systems Ethics and Governance, a topic health philanthropist will agree to term as one of the white elephants in the government’s agenda. Here are Professor Were’s insights during the lecture.

Healthcare as a public right

Access to healthcare should be made democratic, as healthcare protects health, and health is preconditioned for realizing opportunity. Justice requires society to protect opportunity; consequently, giving justice special moral importance to healthcare. Health is not just the absence of diseases, but rather the collective functionality of a human being’s physical, mental and social well-being. Thus, individuals have a legitimate moral claim or right to healthcare.

Healthcare a communal, social good

Irrevocably, common/social good through providing medical care for all in need fosters a sense of community and of security.

The cost of health continues to be exceedingly high, and it is crucial that the government builds strong health systems which cut across all levels of the social strata. In the 80s, it was predicted that the millennium would see the country’s health systems promising opportunities in improving access to healthcare. Then, community health workers were largely deployed, a tact in which the government would not have to make use of, come the millennial. Community health approach is becoming the most important initiative in both developed and developing nations.

Centralised health systems have become difficult to maintain and run efficiently. First level services in healthcare would work seamlessly with a communal based health strategy.

As a mode of devolving the health system in the country, the ministry of Health should critically look into systemic approaches of deploying more and more communal health workers.  Preventive level initiatives can be easily taken care of at the communal level.

Community health level management of epidemics such as Cholera in certain parts of the country has been successful in making preventive healthcare achievable.

70% of the outpatient services, are mostly preventive cases; diseases which can be efficiently treated in the communal level. Communal health has to be harmonized to ensure that health conventions are effective. The general public health system is currently facing challenges in developing national healthcare systems, as well as the county level health system.

On the Attainment of Universal Global health  

The declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC) in 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. Although it was among the first conventions to spearhead global health, the decisions arrived at during the convention were not as fruitful.

Why it didn’t work; medical practitioners had not involved other stakeholders, and so the implementation strategy could not match the imminent needs in accordance with the attainment of universal global health. A few years later, World Health Organization in 2008 reproduced the same strategy from 1978. The need to collaborate in strengthening health systems is being understood now, more than ever.

Private Sector with Public Financing

This is commonly thought to offer the best combination to ensure efficient, high-quality, low-cost primary healthcare. State providers are monopolistic (and highly unionized), technologically laggard, and perhaps corrupt as well. However, powerful incentives for the private providers to inflate costs, a relentless lobbying pressure to attend to the needs and wants of the middle-class rather than the poor. Preventive services are best handled by public programs

Concluding the session, Professor Gilbert Kokwaro alluded to the theme of the topic, mentioning that success stories from community based health approaches are existing, with Ethiopia embodying the strategic plan to improve healthcare access in the country.

“Ethiopia has been able to attain its health strategies, a tower built by over 30,000 community extension health workers. When such incentives are taken care off at the community level, the country is also able to manage the top tier level of health care provision.

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