What the COVID-19 pandemic has primarily exposed is the severe strain on healthcare that has been caused by the privatization of medical services. Throughout the world, massive cuts in public expenditure on healthcare have been accompanied by far-reaching privatisation of the health sector, rendering public hospitals severely under-equipped and lacking resources, as nurses, doctors and other health care workers receive poor remuneration and work in poor conditions. All this while, as the case of Kenya, private hospitals continue to increase costs of their operations and medical services while consuming most of the health insurance funding available in the country.
To clarify understanding of the extent and nature of the crippling of public healthcare systems as a result of the privatization of the sector, it is important to get a clear picture of the impact of the COVID-19 pandemic in communities throughout the world. It is also important to look at how the working classes are responding to the crisis and the challenges arising therefrom.
To begin with, COVID-19 is not the first outbreak of a highly contagious disease of this magnitude in the world. In the past two hundred years, the world has witnessed outbreaks of several deadly diseases with similar devastating consequences as the COVID-19 pandemic. Seven of the ten worst pandemics in human history have occurred between 1850 and 2012.
The key factor that has aggravated and accelerated these outbreaks is the increased concentration of people into smaller parcels of land and the cramming of huge urban populations into concentrated neighbourhoods. These crammed neighbourhoods often lack basic housing and sanitation standards, especially in the informal settlements in urban areas where people live in inhumane conditions, with poor access to basic amenities.
Why do people find themselves living under these inhumane conditions?
The concentration of millions of human beings into these informal settlements in urban centres is created by the current unjust economic system. Under this economic system, employment opportunities are mostly found in the urban areas. Therefore, many people are forced by circumstances to find their way into urban centres to look for work. The result is that more and more people get concentrated into urban centres, finding shelter in wherever their meagre incomes can afford.
Besides, there has been rapid increase in trading activities all over the world. Locally, this has led to the expansion of markets, supermarkets and hypermarkets as well as small sole proprietor businesses across the country. On the international level, there is increased movement of goods and services across countries, with raw materials as well as finished goods being exported and imported among different states. The rapid rise in the population has led to increase of schools, hospitals, universities, religious premises and social gathering centres. The combination of these factors has led to an exponential increase in human interactions within and across countries. These conditions enable a pandemic such as COVID-19 to spread so far, so quickly.
With the increase in human interactions all over the world, occasional emergence of contagious diseases is inevitable. But whereas the outbreak of diseases is inevitable, their containment and treatment is a different matter. Given proper responses, these outbreaks do not have to turn into pandemics, spreading throughout the world. More so, these outbreaks do not have to become deadly, nor out of control. Besides these outbreaks occasioning massive losses of human lives, they have also disrupted the means of livelihood of millions of people all over the world.
COVID-19 pandemic bears a striking resemblance to previous outbreaks that have plagued the world. Throughout the world, the number of infected people continues to rise on a daily basis, and the entire global economy has almost ground to a halt. In Kenya, the COVID-19 pandemic couldn’t have come at a more difficult time. Even before COVID -19, majority of people in the country were living in debilitating penury. The pandemic only made it worse. Majority of Kenyans cannot access proper and decent medical facilities in the overcrowded public hospitals with the few private hospitals being accessible to only a small number of people. Most people find it difficult to access basic needs. Inequality is on the rise, with abject poverty increasing in the midst of superabundance of wealth among a few. Unemployment rate stands at over 40%. Urban centres are crammed with millions of people who can barely earn two dollars in a single day. It’s a hand to mouth existence for most people, relying on casual jobs wherever they can find them. These casual jobs, such as those in the construction or industrial sectors, markets, mama mboga and mama dhobi, handcart pushers, cobblers, hawkers, among others provide niggardly incomes that are barely sufficient to keep one alive until the next day.
Even the health workers on the frontline against this pandemic have not been spared by the difficult economic conditions in the country. The few public medical facilities in the country are understaffed and ill-equipped. The doctors, nurses and clinical officers serving in these facilities work for lengthy hours with poor remuneration. Social security is non-existent with majority of workers being hired on short term contracts. The responsibility for healthcare and social security, even among workers in the healthcare sector, has been shifted from employers and loaded over to the workers.
While poor conditions continue to bedevil the public health sector, private health facilities are springing up, with the most advanced private hospitals that are properly equipped and stocked with modern facilities and medicine being concentrated in wealthy neighbourhoods and leafy suburbs in urban centres. Access to these private hospitals is impossible to majority of the people. The paltry wages and salaries received by majority of workers are hardly sufficient to afford the services offered in these private medical facilities.
The problem caused by this inequality is that it denies healthcare services to majority of people in dire need. Accessibility and affordability of the best and most modern medical facilities by a minority of the middle class and the wealthy while ignoring the healthcare needs of majority of the people is not only a gross misallocation of resources and violation of human rights of the many but a serious lack of national planning. Any country which prioritizes the needs of the minority at the expense of the majority is in urgent need of radical change. Kenya is such a country.
The current economic set up which places healthcare services under the control of the private sector presents a paradox to the system. On one hand, proper healthcare is made difficult to access by the working class who cannot afford the exorbitant costs in private medical facilities. On the other hand, the economy needs a healthy and productive workforce to sustain and perpetuate the system. This system cannot resolve this paradox. Resolving the paradox means the system obsoleting itself. How, then, can this this paradox be resolved?
Only the working class can resolve this paradox. What this paradox presents is primarily a struggle for resources between the haves and the have-nots. Beneath this paradox underlies the understanding of what needs to be done in order for each member of society to enjoy decent lives and means of livelihood but are prevented from doing so by forces of the exploitative system.
The prognosis is straightforward: As society needs to produce wealth in order to sustain its population, and as production requires members of the society to be in good health, it then goes without saying that each citizen should have access to decent healthcare. According to the Constitution of the Republic of Kenya (2010), access to decent healthcare is a right for every citizen. With access to decent healthcare being a right for every citizen, the heath sector should then be under the control of the citizens themselves, since it is for their benefit that the sector exists. It should never be under the control of private interests.
What then is the way out for the health sector in Kenya?
Placing the health sector under the control of citizens means that the sector becomes wholly public and universal. It means that access of medical services would be enjoyed by every citizen of the country and that these services would be free for everyone. Nationalization of healthcare would put an end to further alienation of citizens from medical services and stop further discrimination in access to decent healthcare.
The COVID-19 pandemic provides the opportunity to institute egalitarian alternatives of the health sector. Unless healthcare is firmly under the control of the people through a proper nationalization programme, majority of the population will continue being helpless and hopeless victims of pandemics, now and in the future.
The struggle to contain corona virus should then go hand in hand with the struggle against the privatisation of healthcare services. The defeat of the corona virus should signal the defeat of agents of neo-liberalism profiteering from the health sector. Healthcare workers are on the frontline in combating the corona virus pandemic. They must remain on the frontline together with the rest of the working class making demands for every citizen in the country to own and benefit from decent universal healthcare services.
Lewis Maghanga is a member of the Revolutionary Socialist League.
