Rural healthcare -  Access to healthcare is skewed in most developing countries and Kenya is no exception. Though the local scenario is bad, we are much better off when compared with some of our neighbours. Presently our doctor to patient ratio is way below World heath Organisation recommendations. Current attempts at reversing the trend are plausible but will take at least 10 years for any real impact to be made. Given that a third of our doctors are based in Nairobi, the situation is grim in rural areas. If the capital city is considered together with towns within a 150 kilometre radius, the figure rises to 50 per cent of doctors in the country. These figures show that we have another decade of difficult times ahead. The main drive for many private healthcare investors setting up shop in cities is the patients' ability to pay for services. As such, one is able to recoup investments in a reasonable time. Working in an environment without investigative tools and tests is also frustrating. As a colleague quips, "a doctor is only as good as the investigative tools accessible to him". Many rural practitioners have to do without even basic investigations and equipment. The main reason is that these cost money and rural patients cannot afford them.

But what makes patients not afford them? The economic disparity between urban and rural populations is a known fact. As such, rural folk cannot afford to pay even the recommended consultation fee.

Should a doctor setting up a CT scan in Moyale pay the same VAT as one based in Nairobi? Or someone who is setting up a quality reference laboratory in Tseikuru?

Perhaps the commissioner of VAT should, through the Ministry of Health, offer incentives to woo medical investors in such areas. Paying VAT for purchase of a CT scan or an X-ray machine that will be set up in a remote area, among poor people, increases the cost of the services.

Given that no financial subsidies are given for such investments, most doctors resort to borrowing from banks at exorbitant rates.

The government grants tax waivers to investors in certain areas; maybe it is time it did the same for those in healthcare. This would encourage people to invest in underserved areas.

As remote as Liboi

What would encourage one to make such an investment and work in an area as remote as Liboi if no such incentives exist? At present doctors posted to remote areas are almost certain to quit since lack of relevant investigations and tests leaves them frustrated.

As a practitioner in a rural area, almost all your patients will not afford to pay the minimum set consultation fee. It is no secret that most rural-based doctors charge way below recommended rates.

If you try and provide good lab investigations and imaging tests, patients cannot afford it since VAT and bank interest rates make the prices to shoot up.

Aspiring county leaders from marginalised areas should come up with strategies to address this disparity, especially where specialised services are concerned.

Initiatives such as offering free housing and rates waivers may woo some specialists. In particular, it is time the Ministry of Finance scrapped VAT on expensive health equipment meant for marginalised areas.

NGOs and private equity funds should start funding healthcare entrepreneurs venturing in rural areas. Lowering interest rates on loans for healthcare investments in such areas is also a good idea.

Business Daily/02/11/2011