East Africa's rural poor remain underserved in terms of primary and secondary health care services despite continuous investment in the sector.

Besides national budget allocations, the health sector in East Africa has received extensive funding in form of aid and direct support from multinational development partners. Despite this, however, the region is still grappling with universal health service delivery deficits especially in the rural areas.

In a presentation on community empowerment through health care, during the East Africa Health Care Federation conference in Kigali, Rwanda, it was pointed out that the rural poor face major challenges including high cost of health care and physical access to these services.

It was noted that most rural poor could not make use of the emerging health insurance services due to their costly nature, a lack of knowledge about insurance providers and limited supply of health care service providers.

“It is a fact, people are increasingly going for private health care services and we are doing our best to serve them, but there is need for increased availability of affordable health care service options for the poor,” said Mbogo Bunyi, from the SHOPS (Strengthening Health Outcomes through the Private Sector) project in Kenya.

“Barriers in using health care services exist on the demand and supply sides, cost and distance really affects people in rural communities, players need to come up with innovative ways of dealing with these obstacles” he said.

In his presentation, he added that on the supply side “catastrophic expenditures disempowers the communities and drives them further into poverty”.

It was noted that there is a big discrepancy between those who need health care service and those who actually benefit from them, indicating that the rural poor who need these services more have largely been underserved compared to the rich who were found to need these services the least.

Shortages, brain drain

Issues such as a need to address the shortage of health care professionals, and growing community trust in the existing health care systems, were raised.

Many health professionals have left their countries to find better paying posts abroad, leaving the region with a severe shortage of medical workers. For instance, according to the World Health Organization, Kenya has only 12 nurses/midwives for every 10,000 people.

Private sector players like Philips, AAR, the SHOPS project, PHARMAcess among others are championing innovative models for health care services targeting the rural poor. Although they have had some success, they said that a lot needs to be done to sustain their impact and increase reach.

For instance, Phillips has designed fully facilitated health hubs in rural areas that are fitted with health care amenities such as solar electrification and internet connection to enable data interface services. In these life centers, rural mothers can access pre-natal and post-natal services, the demand for which has been steadily rising.

The private sector players called upon other private and public sector stakeholders in health service provision to partner with them in finding innovative models to sustain and increase reach of these services.

“The issue of people who need our high end services but can’t afford them is an issue we face every day, we do our best but we cannot do enough,” said Dr Herbert Turagyenda from AAR medical insurance.

He noted that the committee of surgeons in Uganda, have on many occasions gone to rural areas and carried out pro-bono surgeries, but although they served some, much of the demand couldn’t be served.

He said that to reach the Millennium Development Goals, high end health service providers have to step out of their comfort zones to design and implement health care models that include the poor in their communities.

Kenya plans to expand health insurance coverage to about 25 million people by the end of this year while Rwanda has achieved a 96 per cent access to health insurance, largely by regulation.

Africa in the past 5 years has achieved a 17.5 year on year growth in health Per cent of growth in the health care sector, the largest part of this growth has been in the area of manufacturing and supply of pharmaceuticals

East Africa alone has over 45 factories producing drugs, but a big segment of the population cannot afford these drugs.