By Bassam Khawaja and Rebecca Riddell
Kenya’s government has made a conscious choice to expand the role of for-profit private operators in healthcare, while starving the public system of resources, effectively privatizing healthcare.
The private sector is often promoted as an efficient, innovative, and necessary provider of healthcare, and many understandably associate “private” with high quality. But in Kenya, privatization has failed to deliver on these promises.
We released a report last week with the Kenyan human rights organization Hakijamii, based on over a year of in-depth research and extensive interviews, finding that government-backed growth of the private health sector is excluding people from care, imperiling the achievement of universal health coverage, and undermining the right to health.
The Ministry of Health insisted in a meeting with us that private providers play a crucial role because of limited fiscal space in Kenya. But privatization is actually incredibly expensive.
Private companies aren’t donating their services—they operate to make a profit, and that money comes either directly from the government or users.
Individuals face much higher costs for private care, which can be twelve times higher than in the public sector.
And the government spends public money propping up private profits, sending at least tens of billions of shillings each year to the private sector, much of which ends up in the hands of global corporations and foreign private equity firms.
The high cost of private care guarantees exclusion and hardship. Medical care pushes more than a million Kenyans into poverty each year.
Community members described making big sacrifices to cover private sector bills—taking on debt, selling vehicles and livestock, or forgoing education.
They said they were turned away from private facilities where they couldn’t afford pricey deposits, stopped treatment because of high costs, and were even detained for failure to clear a bill.
And a focus on high end private healthcare does not reflect the reality of what people are forced to deal with.
Far from guaranteeing high quality care, the “haves” and “have nots” experience completely different private sectors.
The private sector has generally concentrated on the most profitable forms of care, neglecting less commercially viable areas, patients, and services.
In informal settlements, the private facilities that do exist are underregulated, under-resourced, and low-quality—and too often unsafe or even illegal.
Our researchers interviewed people who experienced serious and tragic consequences because of incorrect diagnosis and treatment at private facilities, including disability and the death of loved ones.
Privatization has also raised serious problems of transparency and accountability. Private providers are insulated from democratic processes and information about the extent of public support is extremely limited.
No government actor responded to our detailed questions about the full extent of public funding for the private sector, and the national government appears to be underreporting risks.
Existing secrecy is an invitation to corruption and self-dealing, and projects like the Managed Equipment Services arrangement appear to have wasted public money without consequences.
Meaningful and independent transparency and accountability mechanisms are necessary to ensure that public money is not wasted or used on private enterprise to the detriment of the public good.
The push toward privatization certainly hasn’t happened in a vacuum—international actors like the World Bank Group and the Bill and Melinda Gates Foundation have for years promoted the private sector as a financier and provider of healthcare.
They have provided massive loans to support policy reforms, conditioned financial assistance on pro-private sector benchmarks, and invested in private healthcare companies.
Under the guise of improving Kenyans’ access to healthcare, wealthy countries like the Netherlands and the United States openly seek to expand the market for their own domestic companies.
Kenya deserves a healthcare system that is based around public health and not on what is profitable.
With an upcoming election, the next administration will have a choice to make: invest in the public healthcare system or continue down the path of privatizing care.
Our investigation found that privatization simply isn’t working. The public health system is vibrant and impressive, despite being starved of resources.
With adequate resources and oversight, it provides a much better path toward affordable, accessible, and quality care for all Kenyans.
Bassam Khawaja and Rebecca Riddell co-direct the Human Rights and Privatization Project at New York University School of Law, where they work with former United Nations Special Rapporteur Philip Alston. They recently published Wrong Prescription: The Impact of Privatizing Healthcare in Kenya alongside the Economic and Social Rights Centre-Hakijamii. Follow them on Twitter at @Bassam_Khawaja and @Rebecca_Riddell.