Full Answer Section

Unlike acute conditions which might involve a one-time cost, chronic diseases necessitate ongoing expenditure over years, placing immense, sustained financial strain on households.

Data and observations supporting this description include:

• Patient Diaries/Surveys: Anecdotal evidence from local clinics and health centers reveals numerous instances where patients with chronic conditions, particularly those without stable formal employment or comprehensive insurance, express difficulty affording medications or follow-up appointments. Patient exit interviews often highlight financial hardship as a primary reason for non-adherence.
• Local Clinic Records: A review of patient records in public health facilities in Kisumu shows high rates of “did not attend” (DNA) for follow-up appointments and delayed initiation of prescribed treatment, which, upon inquiry, are frequently linked to lack of funds.
• National Health Accounts: Kenya’s National Health Accounts consistently show that OOPE constitutes a significant percentage of total health expenditure (often exceeding 25-30%), indicating a heavy reliance on individual payments rather than pre-payment mechanisms like insurance or robust public funding. While Kisumu-specific granular data on OOPE for chronic diseases is less publicly available at a detailed level, it mirrors national trends and is exacerbated by high local poverty rates.
• Community Health Volunteers (CHV) Reports: CHVs working in various sub-locations within Kisumu frequently report that families struggle to afford even basic chronic disease medications, forcing difficult choices between healthcare and other necessities like food or education. This is particularly true for conditions like diabetes, where daily insulin or oral medications are critical.

Rationale for Selecting This Issue

I selected high out-of-pocket expenditure for chronic diseases due to its profound and multifaceted impact on patient health, economic stability, and the overall functionality of the healthcare system in Kisumu.

1. Direct Impact on Health Outcomes: As a healthcare professional, I routinely observe the direct correlation between affordability and adherence. Patients who cannot afford their medications or regular check-ups often experience disease progression, complications, and ultimately, poorer health outcomes, including increased morbidity and premature mortality. This undermines the very purpose of healthcare.
2. Exacerbation of Poverty: Catastrophic health expenditure, often triggered by chronic disease management, can push households into or deeper into poverty. Families sell assets, take out high-interest loans, or reduce spending on other essential needs, creating a vicious cycle of poverty and ill-health. This is a severe economic injustice.