Health care system
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 initiatives 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 which work in close partnership with other health care providers in ensuring patient-centred 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 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 system (Ramesh & Bali, 2017). Increase in the number of the ageing 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 increase in technologies in the health sector, the cost of health has increased (Lim, 2017). The government of Singapore has made efforts in improving subsidy packages, especially for the elderly and has strengthened primary care.
The Kenya health system has made improvements but still face 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 were registered or B.Sc.N) (Gross et al., 2011).
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 invest 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