Poverty, an illness away

By Joseph Wachira Kimani

Financial Advisor, I&J Insurance Agency

Every year, thousands of Kenyans are pushed below the national poverty line due to direct medical bills. Today, medical bills are one of the most significant financial burdens facing Kenyans in this modern era. This has led to a more significant concern that most Kenyans are only an illness away from poverty. The worst bit is that, for anyone who cannot access medical care soonest it is required, there is a cost that comes with catastrophic irreversible effects: progression of the illness which may require more money to treat and the most unfortunate, death. The picture is dire in cases of terminal conditions. Late diagnosis of new cancers and failure to promptly spot recurrences in those surviving the disease is contributing to premature deaths in Kenya. For most patients, the cost of treating cancer is the biggest barrier to accessing treatment. The cost of treating cancer remains way above the reach of most households in Kenya dealing a blow to efforts to save the lives of thousands of patients suffering from the disease.

Kenya has made great strides in improving key health outcomes for its population over the course of the last decade. Despite the country having an extensive network of both private and public health facilities, it has not removed the actual barrier to access to health care: cost, both direct and indirect. The government has even gone a step further and put polices to abolish user fees at public dispensaries and health centres, removing charges for maternal health services at all public healthcare facilities, and working to dramatically expand national health insurance coverage.

Despite these advances, the reality is that the direct and indirect costs of healthcare remain a barrier to access and, in turn, better health for majority of Kenyans. The government’s efforts to eliminate user fees have not solved the cost problem, since a large number of visits continue to take place at private facilities, and stock outages often force the poor to purchase drugs from private pharmacies. The end point? Healthcare becomes the most expensive undertaking in Kenya today, more than the family’s basic costs. Studies show that some households spend more than the equivalent of an entire month’s income on healthcare. Moreover, even when accessing free services at primary care facilities, families often have to pay for transportation and evacuation as well as prescribed drugs and tests that are not available at the primary facility.

This high spending is the direct consequence of hospitalisations, for which the question is not if the household will experience the event, but when. The high healthcare costs result in foregone and incomplete care. Ultimately, what people spend on healthcare is a function of what they are willing and able to pay within their budget constraints. This therefore implies that the costs of healthcare both deter people from seeking care when they fall sick and prevent them from completing full courses of treatment. How? You would ask. Most households delay or forgo needed healthcare mostly because they do not have available enough money to fully fund the cost of care. Kenyans find money needed to visit a provider when they fall ill, but do not then have enough to finance the necessary drugs or tests prescribed. Consequently, they will postpone or forgo these follow-ups or cut their treatment period, buying only a portion of the prescribed medication. The fact that many do not receive the care they need suggests that our estimates of healthcare spending underestimate the true cost of the country’s healthcare needs.

These costs constitute a significant financial barrier to healthcare access in a country where 43 per cent of the population lives below the poverty line. This is especially true since the experience of large healthcare costs is not infrequent. Such high spending on healthcare is often the consequence of the poor quality of services, which results in patients not getting a proper diagnosis or the right treatment in a timely fashion. Not only do repeated visits to health providers and additional tests and drugs increase the total cost of healthcare for the family, but prolonged illness also carries high opportunity costs in terms of lost income.

Talking about income…Most families in Kenya today rely on their own savings and family networks to pay for healthcare. The first place Kenyans turn to pay for healthcare is cash, either directly from their incomes or from savings. When costs escalate beyond the savings, new sources of financing must be sought. Here, resources in the form of remittances or gifts from relatives and friends become important. It is important to note that families already have tight budgets: every shilling spent on healthcare involves a trade-off with other important budget items like children’s education, capital for businesses, and basic expenditures like food and rent.

So what happens when one falls ill or worse of diagnosed with a terminal condition in Kenya? What if there are no savings that can handle such an eventuality? The family result to raising funds from friends not to mention dispose assets acquired at throw away prices in race against time. From twitter by @heykelechi “Being poor now just leads to being poorer. Cannot pay to clean your teeth, next year, pay for root canal. Cannot pay for a new mattress? Next year pay for back surgery. Cannot pay to have that lump checked out? Next year, pay for stage three cancer. Poverty charges interest!” That is the reality! Families are falling back to poverty when an illness knocks at the door. Is this it then? Acquire assets only to dispose them to handle an illness? There must be more to this. We must break the narrative that most Kenyans are only an illness away from poverty. Poverty is both a cause and a consequence of poor health. Poverty increases the chances of poor health. Poor health, in turn, traps communities in poverty. Let’s engage and approach it differently.