Leaving no one behind: realism vs optimism in Kenya

This post, written by Laura Kerr, Policy Advocacy Coordinator at RESULTS UK, is the fourteenth in our blog series which aims to explore how the Sustainable Development Goals can be implemented to include all social and economic groups. The blog explores a case study from RESULTS UK’s new report, Who Pays for Progress?, to assess the reality of ensuring that no one is left behind in the post 2015 agenda.


 “As we embark on this collective journey, we pledge that no one will be left behind”

These are powerful and ambitious words in the preamble of the recently agreed Sustainable Development Goals (SDGs) outcome document.  Finishing the work of the Millennium Development Goals and ensuring that everyone has the same rights to development and a life free from poverty is one of the few aspects of the SDGs that everyone agrees on.

However, we live in a world where 836 million people live in extreme poverty. One in five children do not receive their basic vaccinations. 57 million children of primary school age are out of school, and one in three of the world’s population do not have access to adequate sanitation.

So in reality, is it possible to leave no one behind and achieve sustainable development for everyone? Taking healthcare as an example, the only way to ensure no one is left behind is through the delivery of universal health care (UHC).

In our new report, we looked at the story of Mary Ruto in Kenya. Mary was three years old when she fell ill. At first, she was diagnosed with a common eye infection. However, she soon developed swollen lymph glands and, as her condition worsened over many months, local doctors were unable to make the correct. As a result, her parents turned to expensive private clinics (at $45 a consultation) but still without success. After nearly 10 months, Mary was referred back to a public health facility. From there she was sent for a biopsy for tuberculosis (TB), at a further cost to the family. The tests showed Mary had extra-pulmonary TB and was suffering from malnutrition caused by her long illness.

In total, Mary’s family spent over $500 seeking diagnosis before she received the treatment that she needed.  As a result of having to cover these costs, Mary’s family lost the small business they owned.

After nine months of treatment, Mary made a full recovery.  Nonetheless, her story highlights the enormous challenges of providing a health service that can reach everyone. Health workers who are trained and capacitated to make rapid and accurate diagnoses, public health facilities and interventions that are accessible and free at the point of use for the people who need them most, the precarious balance between supply and demand for public and private health systems, as well as the political complexities of defining domestic health priorities, all need to be balanced as countries strive for UHC and thus to ensure that no one is left behind.

It’s three weeks since the Addis Ababa Action Agenda was finalised but it’s essential that the conversations around financing, especially for health, must continue.

In Kenya, only 5.6% of the national budget is spent on health, a long way off the 15% target agreed by states in Abuja in 2001. This has a direct impact on the quality and cost of public health services.  In Kenya, RESULTS UK estimates that 48% health is financed through out-of-pocket expenditure and the WHO estimates that globally, user fees for health push 150 million more people into poverty each year.

If we are to truly ensure no one is left behind, we need UHC, and UHC needs to be properly financed.  An increase in domestic health budgets, especially reaching the Abuja target, would go a long way to making this finance available, but other sources of finance will be required to fill the health financing gap. RESULTS UK recommends an increase in both domestic resources and development assistance. Conversations have begun about how this finance might be provided, but there is still a long way to go.

The MDGs drove progress on health and development that we had never seen before. I’m optimistic that the SDGs will continue that progress, and efforts will be made to ensure that no one is left behind. However, without a dramatic increase in finance for health, both domestically and from bilateral and multilateral donors, the vision and ambition of the SDGs will never be fully realised.

Notes:

Link to report: http://results.org.uk/sites/default/files/DRM%20Report%20final%20LR%20%28Spreads%29%20.pdf

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