Doctors in Kenya are set for another strike to press for better pay as Tanzania reels from a one-month boycott that ended two weeks ago — a pointer to an ailing health care system that is slowly falling apart.

It is emerging that the Kenya government has reneged on a return to work formula agreed upon with the doctors union last year. Although the doctors were paid a 30 per cent increment on their allowance, the state failed to include senior medical officers in the raise.

Tanzania is battling the effects of a month-long strike as doctors demanded their risk and on call allowances, per diem and increment of eligible payments which the government has not paid since 2008.

Now health experts and economists are calling for a quick dose in fixing the healthcare system in the region.

For something so central to Kenya’s economic well-being, healthcare is still in the doldrums.

“The healthcare system in its current form does not operate efficiently in areas like drugs, personnel, and facility utilisation,” said David Muthaka, an economist at the Kenya Institute for Public Policy Research and Analysis.

Health insurance in the region is taken by only a small minority, and social security mechanisms to cushion the poor against health expenditure are inefficient at best, often, completely non-existent.

Most East Africans are forced to pay for health care out of their own pockets. In 2007, the out-of-pocket expenditure as a percentage of private health care stood at 44 per cent globally. In East Africa, however, the figure stood at 51 per cent in Uganda and 75 per cent in Tanzania. Kenya has the worst — 77.2 per cent of private health expenditure came from the pockets of patients.

For Kenya, which spends nearly 20 per cent of its budget on healthcare, the overall morbidity and mortality remain high particularly among women and children with the maternal mortality estimated to be 414 deaths per 100,000 live births with diseases like malaria, diarrhoea being the biggest killers.

Malaria alone accounts for one-third of all new death cases reported in Kenya for children under the age of five years.