Whereas the quality of palliative care is generally satisfactory, particularly at faith-based hospitals, the cost remains relatively high due to the direct and indirect costs of securing the services. The upshot of this is that families end up paying a steep price for the care of terminally ill patients in part because the current public health insurance system falls short of expectation compared with the defunct NHIF.

Part of the reason palliative care at faith-based hospitals is attractive is that it offers better quality services and compassion by health professionals compared with public institutions, many of which are in a general state of decline and whose professionals are not as invested in their calling as their counterparts at private and faith-based institutions.

It is understandable that the public health system is beset with many challenges, not least of which is wanting remuneration of various cadres of workers, particularly professionals. Whereas this is a historical problem that has unfortunately been allowed to fester by successive governments, it is a challenge that can be addressed through political goodwill and streamlining the management of the institutions and their workers.

One other challenge that is not as easy to address is the lack of work ethic – or sustainable care-giving culture – that ails public health institutions. This is a more difficult challenge to address, as it will require a major culture change that will be difficult to birth given the current state of health sector union leadership.

Unfortunately, illnesses do not take this into account. They demand to be addressed as they happen and cannot wait for the day the health system will work seamlessly, which may never come anyway. To get around this, therefore, it is advisable to find how the challenges that patients and their families experience when seeking care are mitigated. This is especially critical for the terminally ill, who require not only require their  health conditions to be managed but also compassion and clear guidelines on what is best for patients and their loved ones.

One such intervention would entail finding how the direct costs of caring for the terminally can be reduced so that these debilitating conditions do not impoverish families or turn WhatsApp groups into veritable fundraising forums for the distressed. Needless to say, this is a tough call because institutions must balance between the need to generate profit and offering quality services.

Is there, for instance, a way the costing of critical medicines and medical equipment can be reviewed downwards? Can the public health insurance scheme be used to mitigate some of the costs that it routinely passes on to patients and their families? Can such services be sustainably devolved to local health centres without compromising the quality of care? Is it possible to subsidise the cost of such care for the elderly and the very young?

These are difficult questions and do not lend themselves to answers that are either simple or straightforward. They require making hard choices in terms of re-prioritising funding for health services and consulting with caregivers so that the arising solutions are both practical and cost-efficient.

In this regard, it is important for health scholars, policymakers and hospital managers to put their heads together, and where possible undertake on-the-ground surveys, to come up with suitable interventions that will benefit health institutions and patients alike given that it is next to impossible for private insurers to stand in this gap.

What health sector stakeholders need to come up with, if possible, is a system that will change the current course which, if left unchecked, will continue leading to sure destitution of families with terminally ill patients. The question is: Is this achievable given our present circumstances?

— The writer is the Editor-in-Chief of The Nairobi Law Monthly and Nairobi Business Monthly; Mbugua@nairobilawmonthly.com-