Published in The Daily Nation.

Above: A private clinic in Kibera, Nairobi. © Zulekha Amin/Hakijamii 2021

By Philip Alston and Nicholas Orago

Efficient. Innovative. High-quality. Claims frequently made about the private healthcare sector. Amidst a pandemic that exposed significant shortcomings in Kenya’s health system, who could be against expanding access to care? Sadly, for all but the wealthiest, these claims are often little more than fairy tales. Government-backed growth of the private health sector is excluding people from quality care, imperiling the achievement of universal health coverage (UHC) and detracting from the constitutional right to health.

Over the decade, the role of the private health sector has exploded. This is no accident. Policymakers, urged on by development actors, have pursued public-private partnerships (PPPs), offered generous tax incentives and free medical supplies, and included private facilities in national health programs. The concerted push for the private sector, coupled with neglect of the public system, amounts to stealth privatization. But that has not delivered on the promise of access to UHC. In a new report, we found that privatization is undermining access to quality and affordable healthcare, draining public resources, and threatening the right to health.

Privatizing care is not saving anyone money. Individuals face overwhelmingly higher costs for private care with providers focused on increasing their profit margins and maintaining the bottom line. Respondents described excessively high prices, up to 12 times higher than in the public sector. It is also more expensive for the government.

The full extent of government support is not publicly available, but it sends tens of billions of shillings yearly to the private health sector through National Hospital Insurance Fund (NHIF), payments to private healthcare providers, and PPPs, much of which ends up with global corporations and foreign equity firms. Secret lucrative deals lead to corruption and self-dealing, as apparent in Managed Equipment Services, which has not delivered value for money.

The high cost of private care guarantees exclusion and hardship. Medical care pushes more than a million Kenyans into poverty each year. Many respondents described making big sacrifices to cover private sector bills. Many said they were turned away from private facilities where they could not afford pricey deposits, stopped much-needed treatment due to high costs, and they, or their loved ones, were detained in private hospitals for failure to clear a bill.

Despite a constitutional prohibition on denial of emergency medical treatment, people said private providers refused them or their kin the service due to their inability to pay. The private sector focuses on the most profitable forms of care, neglecting less commercially viable areas, patients, and services.

Relying on the NHIF instead of investing in the public health system is a step backwards. With adequate resources and oversight, the public health sector can better provide affordable, accessible, quality care.

Mr. Alston (@PhilipGAlston) John Norton Pomeroy Professor of Law at New York University School of Law is a former UN Special Rapporteur on extrajudicial executions.

Mr. Orago (@nw_orago) is Executive Director of the Economic and Social Rights Centre-Hakijamii.