Advocating for Equality in Healthcare and Other Sectors While Overlooking Equity is wrong.
At quite an early age, I understood what it meant to be treated equally. I went to a primary school where walking barefoot was a normality. And for some sort of solidarity I can’t explain, even those of us who had the car-tyre slippers removed them while at school to be at bar with the rest of our friends. We so much knew back then that equality leveled the ground for all of us. The problem came when it was time for studies, we were all taught at the same speed irrespective of our understanding and we thought that that too was equality.
Fast forward, I learnt that the so called ‘dumb’ members of our class are doing far much better than we could imagine. I then reconnected the dots and discovered that what we lacked back then was equity. The teachers never really took time to give extra care to the slow learners and society ended up painting them as foolish. How wrong we were. Thinking that equality and equity mean one and the same thing seems to be the root cause of most of our problems.
Equality is defined as the quality or state of being equal; the quality or state of having the same rights, social status and value irrespective of social or cultural differences. Equity on the other hand is defined as fairness, justice or impartiality in the way people are treated. Equality lacks fairness and justice in its definition which means that if we are to achieve anything of value as a people, we have to understand that we have different needs to succeed and not merely an equal treatment.
This thought of equity and equality rang through my head while at the 5th edition of the Nation Leadership Forum that was held up at the university of Nairobi auditorium. The discussion took center stage in discussing matters to do with health and in specific the aspect of UHC (Universal Health Coverage).
WHO defines Universal Health Coverage to mean that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. This definition covers the most pertinent issues of quality healthcare, user safety and the health financing in itself from the end user point of view.
In other words the goal of UHC is to ensure that people obtain the health services they need without suffering financial hardship when paying for them at a personal or even community level. While the Nation Leadership Forum discussed the health situation in the country, it didn’t so much exploit the aspect of promoting for equitable healthcare among its people. It tended to discuss more of the equality aspect of the healthcare system.
Makueni County that was the case study for the day had achieved almost 70% of the Universal Health Coverage. How did they do it? They developed a plan where each household paid Kshs. 500 to the county which ensured they got medical care all the time and this worked to solve the issue of healthcare financing. The county went ahead and forged sustainable partnerships with drug suppliers which ensured access to drugs any time they were needed. The financial contribution per household also ensured that there is money available to hire extra health care workers which means access to well-trained health workers.

What this means is that the county has made it possible to promote equality and equitable healthcare to its people. The contribution is one in which people can afford in one way or the other. And that means they have access to quality affordable healthcare as the rest of their well to do kin and friends. Justice means that irrespective of your economic status you are able to get the so much needed proper and quality health care. If it can be done at county level, it means it can possible be done at country level. I think the NHIF (National Hospital Insurance Fund) had a good intention from the onset until politics and corruption flooded the fund which made it impossible for them to achieve their objectives. I believe achieving universal health coverage must have been one of the goals.
WHO points out how we are to achieve equitable UHC. One, we need a strong and efficient well run health system that is priority oriented on the needs of the people. If a hospital in Siaya needs more general practitioners, do that that instead of purchasing heavy healthcare equipment that does not have operators to go lie idle there.
Secondly there should be a system that ensures that financing for the healthcare services is not partial by imparting hardship in payment to the citizenry. NHIF was one of them, it can still be turned around as we explore other ways also. Third is ensuring there is enough supply and access to essential medicines and technologies for treatments. Lastly is building capacity by training enough health workers, motivating them and ensuring availability so that they can meet the diversity of the patients’ needs at all times. Equity takes the center stage here more than giving everyone the same general treatment irrespective of ability.
This is not necessary for the healthcare sector only. It needs to run across other sectors too especially in promoting entrepreneurial growth because the informal sector employs far more individuals than the public sector. I was astonished some time ago when the Kenya Bureau of Standards visited our small startup maker space. They immediately remarked that as long we were doing soap we are classified as large irrespective of capacity and you can imagine that we are starting up with no sales. Instead of the initial Kshs. 11,600 paid to the bureau, it was now inflated to a whooping Kshs. 91,500. If we can classify a startup with such big companies as Bidco or even Unilever, it means we lack the basic understanding of equity.
As a matter of fact equity levels the play field according to everyone’s needs by considering that we all have diverse needs for us to succeed. Equality is giving a 2 year-old boy and a 25 year-old man the same amount of food or the same load to carry because we are “promoting equality.” Equity demands that we understand their capacities and their needs while matching them appropriately. That is what we call fairness and justice and impartiality.
Now in the education sector which I started with, let us imagine subjecting the students in the Northern part of Kenya to the same learning modalities as their counterparts here in Nairobi. Asking them to tell which ones is not an instrument of music and listing a violin or Saxophone could be unfair. Imagine I have not seen a saxophone with my eyes to this day but I used to meet such questions in my day. The same as asking children nowadays in Nairobi, in nursery school, to draw “Nyatiti” the traditional guitar, I bet many will be mesmerized at the mention of the word itself. The rest of the world has promoted equitable education a lot in line with equality in education. We shouldn’t therefore close our eyes to one at the expense of the other as a country.
I feel that it is far necessary now that we thought so deep about the essence of factoring in equity on a serious note to our various sectors of the economy. It could as well mean the thin line that means growth and moving forward as well as trudging backwards.
Equity is the solution to all the complaints that have filled our television sets on issues to do with injustices. Mark my words that at no time are we all equal except sometimes when it comes to our human rights and most important our stand before the greatest master of the universe; our God.
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