Guest post from Matthew Spencer, Oxfam’s Director of Campaigns, Policy and Influencing (@spencerthink)
Judith Amoit, a 27 year-old policewoman hit the Kenyan news last year when she lost her twins shortly after giving birth prematurely in the Nairobi West hospital. She was prevented from leaving the hospital to bury her children because she couldn’t pay the £20,000 bill. Judith was forced to appeal via the media to ‘well-wishers’ to help her pay her debt so that she could be released and retrieve her children’s bodies from the mortuary.
Judith sought care in a private hospital. Had free, quality, public healthcare been available, Judith would have been very unlikely to seek treatment privately. Free, public maternity services in Kenya do not include emergency surgery, which is one reason why detention in private hospitals due to unpaid bills is common.
It’s a familiar picture in the developing world, but Kenya ‘s burgeoning economy ought to be able to support free, public universal healthcare. The Kenyan constitution has enshrined the right of every citizen to access health care and attain the highest available standard of health. So why is it failing to deliver?
The most critical reason is the Kenyan government’s low spending on healthcare. Kenya spends just 6% of its budget on health. Another factor is the current unchecked growth of the private healthcare sector, siphoning scarce resources away from public systems, facilitating their stagnation and decline.
But it’s also because despite a growing economy and a growing population, Kenya’s tax income is flatlining. The countries which have made the most progress towards Universal Health Coverage have prioritised spending on health through general taxation. Yet Kenya is estimated to be losing $1.1bn every year to corporate tax incentives and exemptions – nearly twice its health budget in 2015/16
Kenya’s financial choices have resulted in a maternal death rate worse than that of many poorer or more fragile states. In the developed world, an average of one in 4,900 mothers will die from maternal causes during their lifetime. In Kenya, it’s a staggering one in 42. One in 42 mothers.
Earlier this month Oxfam produced an x-ray of the Kenyan tax system and an action plan to show how the government could begin to address the structural inequalities limiting the provision of pro-poor public services. Kenya’s economy is dynamic – it’s been growing at around 6% a year since the financial crisis of 2008, and it could be a middle-income country by 2030 – but it’s also dysfunctional. Kenya’s economy is the most unequal economy in the region which is creating new barriers to its fight against poverty. The wealth of Kenya’s richest 8,300 people equates to the combined wealth of the poorest 44 million. Many cannot afford hospital fees, and the tragedy of Policewoman Judith Amoit is not an isolated case. An estimated 2.8 million Kenyans fall into poverty or remain poor due to ill health each year.
My own personal link to Judith is the UK Chancellor (Finance Minister) Phillip Hammond. Hammond is the British representative on the board of the IMF, which is responsible for reviewing Kenya’s economic policy. I doubt he’s aware of it, but even the IMF, famously hawkish on public spending, recommends that the Kenyan government increase health investment. Hammond is also our representative on the EU Economic and Financial Affairs Council, which has just agreed a grey list of tax havens that are required to reform their ‘harmful’ tax policy. One of these tax havens is Mauritius, which markets itself to international companies as a ‘gateway to Africa’. Mauritius has a tax treaty with Kenya that allows companies investing there to pay less tax, thus depriving the Kenyan economy of revenue for public spending on services like healthcare.
So my link is either a hop and skip from Hammond via the IMF to the Kenyan health minister to the health system that saw a grieving Judith Amit imprisoned in hospital, or it’s a hop, skip and a jump from the UK Chancellor via the EU commissioner chasing Mauritius, to the income of the Kenyan government and the budget of the same health minister. If you’re reading this as a British voter then your MP puts you one step from Hammond and either financial chain.
The question of what we can all do to support the many citizens in Kenya and beyond who are seeking decent healthcare and education is something we will address in the next stage of Oxfam’s inequality campaign, but following the money will be at its heart. The world may feel more partitioned as nationalism grows, but we are all connected by the hard wires of global finance. We are never more than a few steps from the financial decisions affecting any other citizen in the world.