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Balancing quality and cost of women’s health care

The quality of health care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes, and are consistent with prevailing professional knowledge. It must be the right care, for the right person or population, at the right time. The quality of women’s health care in Kenya varies greatly among various providers: public institutions, private sector, non-profits, faith-based organizations and private practitioners.

Quality and cost of care are intricately related. Access to medical insurance, or self-funding dictates where women seek services. The lower income group have limited choices. Public health institutions have poor infrastructure and limited resources in personnel, equipment and supplies. This is in addition to bureaucratic governance hurdles, with direct consequences in the quality of service provided. Investments in public institutions can easily turn around dilapidated facilities into world class status, and make them the first choice for many. High quality of care in public facilities is the single most contributing factor to lowering maternal deaths in Kenya.

Private health facilities operate in a ‘business mode’, seeking a balance between service provision and profit. They are better equipped, have clear governance structures and strive to be better than competitors, including the public sector. Women must pay hefty charges to access such facilities, either directly or through insurance. But is the care necessarily better? There is no doubt that infrastructure and other resources in private facilities are better. There is a lower risk of dying. But there is a higher risk of unnecessary interventions, at best causing no harm but at worst leading to disability and in rare cases death. Any unnecessary intervention impacts on the cost of health care and insurance, thus further reducing the number of women who can access such services. Strict guidelines and adherence to medical ethics can mitigate against practice more bent towards profit rather than quality.

Faith-based facilities and non-profits have different modes of funding, taking a middle place between public and private facilities in terms of cost. They are more accessible to the wider population, stretching their services to the limit due to sheer numbers. Stretched services may inadvertently impact on quality.

Private office consultation is satisfying in lots of ways, but has its drawbacks. There is no solo Gynecologist capable of having specialised expertise in all areas of Gynecology. Cross-consultation with other specialists or group practice should be the norm, otherwise quality of care deteriorates with biased opinions. The most expensive may not necessarily provide the best of care.

Balancing cost and quality of care must be a deliberate effort for all providers. Every woman must be able to access care that is efficient, effective, acceptable, equitable and safe. This is the only way to improve our dreadful women’s health statistics.

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