Why healthcare is such a key issue

A man and a woman are looking into the camera

Herima Mwakima returned home from Dubai with her savings to pay for her brother’s treatment

Herima Mwakima’s prudent financial plans were thrown into chaos by two medical emergencies.

The Kenyan single mother was working in Dubai as a nanny and well on her way to saving money to improve the lives of her two teenage children.

But then her younger brother fell ill, and a few months later she fell ill. He had acute kidney disease and needed dialysis, and she was diagnosed with chronic fibroids – painful growths in her uterus.

Life is precarious in a country where there is a lack of affordable health care. A twist of fate can destroy everything one has worked hard for.

Mrs Mwakima was clearly in pain as we spoke in a dimly lit room at her sister’s home in Likoni – a suburb of the Kenyan coastal city of Mombasa.

The 45-year-old looked tired and washed out and rested her head on one hand as she spoke.

She explained that she had to return from Dubai to help her brother, Sylass, using the money she had saved for her children. Other relatives moved in and the family land was sold. After all, that’s what families were for, he said.

Sylass Mwakima sat next to her and listened. His grateful smile broke as he spoke.

Scraping the money together

This is a familiar story as most Kenyans cannot easily access healthcare.

Almost four out of five citizens have no health coverage at all.

20% of the population belongs to the National Health Insurance Fund (NHIF) and 1% can pay for private healthcare.

The rest must try to live with various health conditions or scrape together money from meager resources, which may push them further into poverty. Otherwise, they rely on the kindness of family, friends and sometimes strangers in the now familiar crowdfunding campaigns.

Inside an operating room

Life-saving surgery can often be beyond the means of most Kenyans

Membership of the NHIF has not been mandatory until now, but that is set to change by the end of this year if the new president and government – due to be elected on August 9 – stick to the outgoing administration’s plans.

NHIF membership is part of the employment package of many formal sector jobs. The monthly fee of 500 Kenyan shillings ($4.20, £3.50) covers hospital care for members and their dependents – although medicines cost extra.

Despite plans to make membership compulsory, the government has not explained how it will be affordable for many whose low wages are eaten up by paying for food and rent.

Ms Mwakima said NHIF membership was unaffordable and compulsory payment would not change that.

Perhaps he could come up with 200 shillings a month, he suggested. But he had to go back to work first and that wasn’t possible without a fibroid surgery.

“It’s very difficult for me because it hurts, [there is] a lot of heavy bleeding. So I can’t do anything because I just feel weak,” she said in a soft voice.

She decided to ask members of her community for financial help.

Political battlefield

The leading presidential candidates, William Ruto and Raila Odinga, have policies they hope will address the health care problem that Ms Mwakima and others have faced.

Mr Ruto said he would reduce the monthly NHIF contribution to 300 shillings ($2.50) per household.

Mr Odinga has pledged to create what has been dubbed Babacare – after his nickname “Baba”. He has said that this will mean affordable, accessible and quality healthcare.

The former prime minister also wants to establish a fund for emergency care.

But any changes, even if she could afford them, will, of course, come too late for Ms Mwakima.

“I just trust God [that] I could get help and my condition could become normal. [Then] I will start fighting or fighting with my life,” he said.

Waving goodbye, she leaned against a concrete pillar in the family store, smiling through the pain, her brother standing beside her.

A week later, I found out that he managed to raise the money and did the operation.

“It went well. Thank God,” he said in a short WhatsApp message.

Now, perhaps, she can go back to helping her children in their dreams, as their future is still her priority.

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