COMPARING HEALTH SYSTEM IN KENYA AND SINGAPORE |
The World Health Organization (WHO) characterizes the healthcare system as “framework comprising everything being equal, individuals and activities whose essential plan is to advance, reestablish, or look after health. This incorporates endeavors to impact the determinants of health just as more straightforward health-improving exercises. A healthcare system is, thus, more than the pyramid of public-owned facilities that convey individual healthcare administrations” (Rehfuess et al., 2009).
This report looks to thoroughly analyze the human services frameworks of and Kenya dependent on social insurance financing, administration, and administration, administration conveyance, healthcare workforce, access to medication and innovation, and health data framework. Papanicolas and Smith, 2013 accentuate the significance of worldwide correlation of human services framework for policymakers, health ministers, and scholastics as an essential device in assessing a nation’s healthcare framework execution.
Also, the report targets breaking down healthcare coordination as an answer to the difficulties of continuing the healthcare system. Administration requests, staff deficiencies, and proceeding with cost expansion represent a usage challenge, and this requires the utilization of coordinated conveyance models to guarantee productive use of scant assets. As Porter and Lee, 2013 discuss healthcare system reconciliation centers around focusing on persistent results and worth where every individual from the healthcare system accommodates all the necessities of a patient overall, making the healthcare system “patient-based”.
Country Profiles
Singapore
Singapore is situated around 85 miles (137 kilometers) north of the equator at the southern tip of the Malay Peninsula (Lee, 2011). World Bank, 2018 assessed the all-out populace of Singapore to be 5,638,676 million individuals, with 100% of the individuals living in urban zones. Gross national income per capita (PPP) in 2013 was 76, 850 expanding to 364.2 billion USD in 2018(World Bank), with 4.4% of the GDP designated to health (World Health Organization, 2018; World Bank, 2018). As indicated by WHO, 2018, life expectancy at birth increased from 65.8 years in 1970 to 82.9 years for both genders in 2016, with ladies having a higher average future of 85 years compared with 80.6 years for men. Newborn child and under-five death rates, then again, have moderately diminished because of the enhancements in maternal and child wellbeing (MCH). In 2006, the new child death rate and the under-five death rate for every 1000 live births were 2.4 and 2.8 separately, and this mirrors a critical lessening from 20.5 and 7.7 in for baby and Under-five death rates individually in 1970 (World Bank,2018a; World Health Organization, 2018b).
In 1940, the primary source of death was mortality because of transmittable diseases, which represented 57% of the complete passings (Legido-Quigley and Asgari-Jirhandeh, 2018). Epidemiological advances in Singapore, however, have brought about a decrease in the level of crossings because of transferable ailments (37% in 1960, and 15% in 1980) (Lim et al., 2013). The ministry of health (MOH) information shows that the primary source of death in 2017 was Ischaemic coronary illness (IHD), malignant growth, and pneumonia, which represented 66% of passings (67%). The ailment trouble in 2015 was a sum of 705 071 DALYs lost to mortality and mortality, of which tumors contributed 55 %, 16% by CVDs, 11% by neurological, visual/sense/hearing issue, and 11% by mental and substance misuse issue. (Singapore Ministry of Health, 2017)
Kenya
Kenya is located in the equator of Africa’s east coast and fringes Uganda, Tanzania, Somalia, Ethiopia, and Sudan. The total population was estimated at 47,564,296 according to the enumeration of 2019 did by the Kenya National Bureau of Statistics (KNBS), 27% of which live in urban zones (KNBS, 2019).
The Kenyan government burns through 5.7% of GDP on wellbeing, and the full use of welfare per capita in 2014 was 169 USD and is among the most beneficial nations in Sub-Saharan Africa, as indicated by Bloomberg Healthiest nation Index 2019. After the declaration of the new constitution in 2010, social insurance degenerated, and this has seen a 57% expansion in wellbeing financial plan at the region level (Kenya Institute of Health Metrics, 2017).
Future during childbirth is 64 for guys and 69 years for females in 2016, and this is an expansion by an edge of 5.4 when contrasted with those in 1990 WHO information for Under-five mortality shows a decrease from 95.4 passings per 1000 live births in 1990 to 41 crossings for every 1000 live births in 2018. Maternal mortality likewise has decreased from 315.7 passings per 100000 live births in1990 to 257.6 passings per 100000 live births in 2016(World Health Organization, 2018b; World Bank, 2018b).
Driving reasons for unexpected passing in Kenya are HIV/AIDS, jungle fever, tuberculosis, lower respiratory contaminations, and diarrheal infections. An aggregate of 78.3% of DALYs are established by long periods of life lost because of unexpected passing (Frings et al., 2018; Burton et al., 2011). The leading national hazard elements of sudden passing incorporate ailing health, unsafe sex, dangerous water, hand washing, and sanitation (Frings et al., 2018).
Method
Systematic literature was reviewed utilizing Pub Med, PubMed, Google Scholar, Web of Science, WHO site, and Science Direct. The catchphrases utilized were “Singapore” and “Kenya” Healthcare system, health profile, healthcare financing, emergency clinic data framework, authority and administration, medication, and Technology in every nation. The pursuit additionally included essential social insurance, network wellbeing, and wellbeing combination by and large. The articles looked were distributed from January first, 2010 to March thirtieth, and it gave a comprehensive diagram of the kind of research done on the social insurance framework in Singapore and Kenya. To survey the present condition of wellbeing in the two nations, the information gave by administrative and non-legislative offices was utilized.
Results
The comparisons and contrast of each WHO building block are discussed in sections, and diagrams and tables are used where appropriate.
Health Care Financing
Singapore’s health financing system is governed by twin philosophies of individual responsibility while ensuring primary health care is affordable for all (Hussaini et al., 2016). Universal health coverage is funded through a combination of personal private savings, government subsidies, and multilayered health care financing schemes (Fong & Tambyah, 2013).
Figure 1; Sources of Healthcare Financing in Singapore. Source; https://www.slideshare.net/s.coffey/compulsory-savings-and-the-singapore-health-system
Singapore funds human services through a model called ‘S + 3M’; where S speaks to appropriations and 3Ms speak to MediShield, Medisave, and Medifund (Sturny, 2019).
Government endowments secure up to 80% of all the expense of care gave in essential consideration polyclinics and open medical clinics (Haseltine, 2013). Investment funds and protection programs which are critical in keeping up the general’s wellbeing and government assistance bolster the administration endowments.
MediShield is a clinical protection plot that was acquainted with giving financing assurance to individuals against costs from huge diseases. It is a general medical coverage plot custom fitted to provide deep-rooted disastrous assurance to huge bills and authority treatment costs brought about from illnesses, for example, kidney dialysis and chemotherapy. MediShield, which was presented in 1990, covers roughly 80% of the total population in Singapore today (Ramesh and Bali, 2017).
Medisave is a state-run necessary clinical reserve fund conspire financed from finance conclusions of 6.5% to 9.3% of each laborer and an equivalent rate from bosses. Withdrawals are carefully for installments of wellbeing administrations, for example, endorsed outpatient costs, hospitalization, day medical procedure, and health care coverage for people or their close family (Hussaini et al., 2016; Ramesh and Bali, 2017).
Medifund is a gift subsidize set up by the legislature in 1993 to cover poor patients. They experience issues bearing their hospital expenses regardless of inclusion from Medisave, Medishield, and government endowment. This gift guarantees that no resident is denied access to social insurance benefits because of failure to pay (Hussaini et al., 2016).
After the proclamation of the new constitution in Kenya in 2010, Kenya’s wellbeing financing has been changed under devolution (Okech, 2016). Therapeutic services in Kenya are financed from 3 essential sources; government use, cash-based consumption, and givers (Luoma et al., 2010).
The government funds health care through its national insurance scheme, the National Hospital Insurance Fund (NHIF) (Munge et al., 2018). NHIF covers 11% of the population (4.5 million Kenyans) while private insurance scheme covers 4 % of the community. NHIF deductions are mandatory for employees in informal sectors both in private and public areas while it’s voluntary for informal sectors. Contributions are calculated based on the graduated income index informal sectors and at a fixed rate in informal sectors. To cover the needy, the Kenyan government launched the Health Insurance Subsidy Program and provided a comprehensive package to cover outpatient and inpatient costs. This subsidy is financed by the government and supported by the World Bank and other developmental partners (Kabia et al., 2019).
In contrast with Singapore’s low OOP, Out of pocket payments is the primary source of healthcare finance in Kenya, contributing 78% of the total expenditure on inpatient and outpatient services. Both private and public hospitals charge user fees, and private hospitals are used predominantly by the wealthy because it costs more user fees (Kimani et al., 2004).
Health service delivery
Singapore’s health system has a mixed delivery model (Sammut, 2015). Prevention services are provided mainly through the Health Promotion Board and the Health Sciences Authority, which are MoH’s statutory boards (Legido-Quigley & Asgari-Jirhandeh, 2018). Primary care is delivered mostly by private providers, which cover 80% of all primary care services demanded, with 1400 private clinics offering primary care (Khoo et al., 2014). Government polyclinics administers 20% of primary care required, and Singapore has eighteen public polyclinics that offer subsidized outpatient care, pharmacy services, screening, immunizations, and dental care (Khoo et al., 2014; Tan, 2014). These clinics, however, serve the low-income population as most people use private general practitioner (GP) for primary care.
Outpatient special care is provided in specialized care centers that focus on individual cases such as cancer, cardiovascular diseases, skin disease, cancer, and diseases of the nervous system (Legido-Quigley & Asgari-Jirhandeh, 2018). The specialized care centers also conduct research, teaching, and training and offer a full range of treatment, which includes prevention and rehabilitation. Some public and private hospitals provide after-hours care with approximately 30 clinics throughout the country providing 24-hour care (Khoo et al., 2014)
General care is delivered at regional hospitals where tho-thirds of outpatient visits are usually subsidized. There are more than 11,000 beds in 15 public hospitals and 15 private hospitals, including community hospitals, chronic care hospitals, and specialized centers (Nurjono et al., 2019; Khoo et al., 2014). The acute hospital beds ratio to the population in Singapore is 2.6 per 1,000 total people. The private sector and services provide 20 % of secondary and tertiary care are more efficient and faster in the private sector than are in public facilities (Khoo et al., 2014).
Mental health care is offered in the Institute of Mental Health, which is an acute tertiary Psychiatric hospital. Service provided in the facility includes rehabilitation, counseling services, forensic services, psychiatric services, and extended-term care (Yeong & Sheng, 2017).
In the Kenyan Health system, services are administered by a mix of public and private providers. The private sector includes for-profit and not-for-profit, mainly faith-based and non-governmental organizations (Flessa et al., 2011).
In a comparison of the Singapore Health system, which is managed by the national government, Kenya’s health service delivery is fully devolved to county governments with only tertiary facilities (Level 6) operated by the federal government. Health service delivery is composed of six levels. There are 4700 health facilities, 51% of those being public health facilities (Muga et al., 2012).
Figure 2 Levels of health care delivery in the Kenya Essential Package for Health (KEPH) Source; https://www.sciencedirect.com/science/article/pii/S2211419X11001297
Level 1 is made up of community units providing promotive health services through household community health worker volunteers. Primary health care services are offered in dispensaries (Level 2) and health centers (Level 3) facilities (Mostert et al., 2015). Dispensaries represent the first line of contact in the health care system and provide more comprehensive coverage for preventive health care measures. On the other hand, health centers offer majorly ambulatory health services that are tailored as preventive and curative services. Level 4(district hospitals) concentrate on health care services at the county level and offer a range of remedial services (Ministry of Health, 2013). Level 5(Provisional hospitals) is a referral system for Level 4 and provide specialized care (Muga et al., 2012). The skilled care and training are offered in National referral hospitals (Level 6), which are managed by the national government, but they are semi-autonomous organizations (Ochieng, 2017). It provides specialized care, including rehabilitative, therapeutic, and sophisticated diagnostic services.
Health System Workforce
The ratio of the health workforce in Singapore in 2019 per 1,000 population is 2.5 doctors, 0.6 pharmacists, 0.4 dentists, and 7.5 nurses, and 0.4 optometrists and opticians. The total number of specialists is 2,781, and 58% of this work in the public sector. The ratios are low, considering that Singapore has an 8.5% aging population, which is expected to rise to 18.7% by 2030. Recent statistics show that there is a high percentage of foreign-trained doctors (two-third) in the country and a third of doctors in the public sector (Ministry of Health, 2019). Tay et al., 2014 estimates that 30% of nurses working in Singapore are foreigners.
There are 250 and 861 public and private dental clinics, respectively. Also, there are 2102 registered private primary care clinics and 20 public polyclinics and additional eight specialist centers which are managed nationally. For long-term care, there were 73 nursing homes and two impatient hospices that provided long-term services (Khoo et al., 2014).
On the other hand, the ratio of healthcare workers in Kenya per 10,000 population is 1.5doctors, 0.2 dentists, 2.7 clinical officers, 2.2 medical laboratory officers, 0.5 pharmacists, and 1.2 pharmaceutical technologists (Ministry of Health, 2013). It is also found out that health training institutions in Kenya have a low quality of curriculum development. And training institutions include Kenya Medical Training College (Public), private institutions and Universities, and Faith-based training institutions (Gross et al., 2011).
Leadership and Governance
Singapore’s Ministry of Health controls the healthcare system, and have the duty regarding policy direction, guaranteeing the nature of care and dealing with the general social insurance framework. The main jobs incorporate help arranging, supplier expense setting, cost control, wellbeing data innovation, framework administration, and money and necessities appraisal. Proficient bodies direct proficient through set practice rules and codes of ethics and leadership. Wellbeing sciences authority controls acquisition, gracefully, notice, and introduction of clinical items to guarantee that it meets security, adequacy, and universal quality principles (Ramesh and Bali, 2017; Liu et al., 2014).
Open medical clinics are overseen by a holding organization called MoH Holdings (MoHHs), which is an accessible medicinal services resources organization. Mohs is entrusted with the improvement of the physical and information innovation foundation (Legido-Quigley and Asgari-Jirhandeh, 2018).
Kenya’s medicinal services are overseen by the Ministry of Health and the national governments which are going by the Governor. Kenya has 47 province governments, and the devolution has taken into consideration better management and commitment of individuals in administration. In every nation, County Health Departments are controlled by the Ministry of Health. Essential consideration offices are under the administration of the County Health Department, which has a characterized region of duty and guarantees that quality medicinal services administrations are conveyed. Nation government gets clinical items, and hardware’s through Kenya Medical Supply Association, likewise oversaw by the MoH (Ministry of Health, 2013). The district governments manage wellbeing offices, rescue vehicle administrations, and drug stores. It additionally has a command to give entombment grants, permit food sellers, and advances essential social insurance (Davis et al., 2019).
Access to Essential Medicines
Singapore’s MOH keeps up a Standard Drug List (SDL), which reverberates well with WHO’s Essential Drug List (Ministry of Health, 2020). It is separated into SDL 1, and SDL 2, where SDL 1 adheres to WHO’s guidelines on fundamental medications and SDL 2 acquainted with costly sponsor medications (Tan et al., 2014). Medications recorded in SDL are around 570 medication readiness, and the expense for financed patients is S$1.40 per thing for drugs in SDL 1 and up to a large portion of the aggregate sum for the cost of prescriptions in SDL 2 (Liu et al., 2014). Patients pay the full charge of medications not recorded in SDL, and non-sponsored patients pay the expense of medicines recorded in SDL (Liu et al., 2009).
With total innovations entering the market at significant expenses, healthcare system evaluation (HTA) is assuming an inexorably essential job to illuminate their relative esteem and decide how best to distribute limited social insurance assets to guarantee the drawn-out maintainability of the medicinal services framework (Pearce et al., 2019).
The Government of Kenya (GOK) has self-rule over obtainment and gracefully of medication through the Kenya Medical Supplies Authority (KEMSA). It serves more than 4,000 open segment offices, and is the sole provider of pharmaceuticals for the public segment, establishing to appraise 30% of every physician recommended medication in the market (Luoma et al., 2010).
Notwithstanding KEMSA, Mission of Essential Drugs and Supplies (MEDS) likewise take an interest in getting and providing medication and wellbeing items. The indicative is significantly given by the USAID and the Center for Disease Control (CDC). Accessibility of essential medication has expanded in Kenya, and difficulties are as yet experienced in low-level offices (Masters et al., 2014).
Health Information System (HIS)
Singapore’s health system uses the National Electronic Health Record (NEHR), which was launched in 2011 (Wee et al., 2015). The NEHR is a secure system that integrates the patient’s health records across different healthcare providers. The launch of this robust system that links patient health care data across multiple health facilities has improved healthcare efficiency, performance, and quality in Singapore (Sinha et al., 2012; Wee et al., 2015).
Conversely, Kenya’s health system uses a web-based District Health Information Software (DHIS2) launched in 2010. DHIS2 is an open-source software platform developed by the Health Information Systems Program (HISP) (Karuri et al., 2014). All Kenyan District facilities and other selected facilities are connected to the DHIS2 server using mobile internet on computers. A study on the Strengths of DHIS2 shows that because of its technical feature of the software and proper management of data, DHIS2 has increased access to information and improved the satisfaction of all stakeholders (Karuri et al., 2014; Dehnavieh et al., 2019).
Utilizes the National Electronic Health Record (NEHR), which was propelled in 2011 (Wee et al., 2015). The NEHR is a safe framework that incorporates the patient’s wellbeing records across various medicinal services suppliers. The dispatch of this vigorous framework that joins patient therapeutic services information over numerous wellbeing offices has improved human services productivity, execution, and quality in Singapore (Sinha et al., 2012; Wee et al., 2015).
On the other hand, the Kenya wellbeing framework utilizes an electronic District Health Information Software (DHIS2) propelled in 2010. DHIS2 is an open-source programming stage created by the Health Information Systems Program (HISP) (Karuri et al., 2014). All Kenyan District offices and other chose offices are associated with the DHIS2 server utilizing portable web on PCs. An investigation on the Strengths of DHIS2 shows that in light of its specialized component of the product and legitimate administration of information, DHIS2 has expanded access to data and improved fulfillment all things considered (Karuri et al., 2014; Dehnavieh et al., 2019).
Discussion
Health care system integration has been discussed as the solution the constant pressure and the growing challenges of inadequate supply and the rising demand for health services (Trankle et al., 2019). Singapore has developed two initiatives to improve integration of services; the Regional Health Systems (RHS) and CARITAS Integrated Dementia Care. The two efforts focus on primary care, prevention, and community-based management by using the principle of integrated service delivery (Nurjono et al., 2019). RHS system was introduced by MoH in 2012 and is led majorly by public hospitals that work in close partnership with other health care providers in ensuring patient-centered care and preventive services are provided. CARITAS Integrated Dementia Care was launched to meet the growing needs of persons with dementia (PWD). It offers comprehensive, individualized, accessible, and responsive care for PDW and is integrated with RHS (Lim, 2015; Nurjono et al., 2019).
Despite Singapore’s health system being rated as the second most efficient health care system in the world by the Economist Intelligence Unit, there are challenges in different sectors in the order (Ramesh & Bali, 2017). An increase in the number of the aging population presents a significant care challenge to the Singapore health system (Garza, 2016). According to the UN’s 2017 World population Ageing report, there were 886,000 people above the age of 65, and this number is predicted to be over 1 million by 2030. Chronic diseases have been associated with aging populations. These include cancer, heart disease, hypertension, and stroke. Managing these conditions, along with levels of disability, has increased the financial demands of the Singapore health system (How & Fock, 2014; Garza, 2016). Increase in aging population also present human resources issues and affect the health workforce. Additionally, due to population transitions and an increase in technologies in the health sector, the cost of health has increased (Lim, 2017). The government of Singapore has made efforts to improve subsidy packages, especially for the elderly, and has strengthened primary care.
The Kenya health system has made improvements but still faces significant challenges. These challenges include high out-of-pocket costs, unequal distribution of health workers in different counties, brain-drain, and poor management. The overdependence of out-of-pocket fees to finance health care in Kenya has resulted in the impoverishment of households (Munge & Briggs, 2014). Salari et al., 2019 estimated that 1.1 million individuals are pushed into poverty in Kenya due to OOP. As compared to Singapore, Kenya has inadequate financial system protection for patients, and this is still a significant setback in realizing Universal Health coverage.
Export of healthcare workers represents a challenge to health service delivery (Miseda et al., 2019). Research shows that between 2004 and 2015, 482 nurses, 107 pharmacists, and 80 doctors intended to work in other countries. From 1999 to 2012, 7% of Kenya’s nursing workforce of 41,367 nurses designed and applied to out-migrate (85% of applicants are registered or B.Sc.N) (Gross et al., 2011).
The devolution of procurement of medicine to county governments has opened an avenue for corruption leading to mismanagement and scarcity of drugs in different county health facilities. Research has shown that the compromise of medicine procurement has affected the quality of essential medicines listed by the MoH (Kimathi, 2017). The World Bank has cited a lack of investment in the infrastructure as a serious implication considering that the GoK invests only 4.6% of GDP in the health system (World Bank, 2018b). The government should utilize a more considerable amount of the GDP for health expenditures, and also implement new programs for health education and training of health professionals to be evenly distributed throughout the country