“Ladies and gentlemen, Kenyans’ dream of achieving oral health for all is unlikely to be realized because we have not made serious inroads into implementing our national Oral health Policy…” so ended Prof. Jacob T. Kaimenyi’s Inaugural Lecture Achieving Oral Health for All in Kenya: A Reality or a Myth?

The audience that filled the hall to capacity comprising University dons, legislators, permanent secretaries, medical practitioners, lectures, students and the general public were stunned to hear that Kenya, a country with a population of over thirty million people, has only 656 dentists. The Professor of Periodontology further shocked them with the revelation that the country has only one Dental Hygienist, 69 Dental Specialists and only 130 Community Oral Health Officers. The ratio of dentist to citizen is thus 1- 45 732 on the lower side, instead of the WHO recommended 1- 7000.

“You are the last person we expect to complain sir,” said an angry attendee. “As a colossus in the academia all these years, what have you done to change the situation?”

“Does it mean that from a population of over thirty million people, there are no Kenyan students to be trained in dentistry?” asked a member of the public.

It is widely acknowledged that Africa’s insufficient health workforce will continue to be a major constraint in attaining the millennium development goals (MDGs) for reducing poverty and disease. The High Level Forum (HLF) in January 2004 held in Abuja, Nigeria recognized the challenges posed in developing Human Resources for Health (HRH) and the need for actions and strategies to accomplish this.

The crisis is appalling in Sub- Saharan Africa which suffers from 25% of the world's burden of diseases and has an estimated 750 000 health workers that serve over 682 million people. By comparison, the ratio is ten to 15 times higher in OECD countries. This estimated workforce of doctors, nurses and allied health workers in sub-Saharan Africa compose 1.3 % of the world's health workforce.

To achieve the Millennium Development Goals, the minimum level of health workforce density is estimated at 2.5 health workers per 1,000 people. Out of 46 countries in Africa, only 6 have workforce density over 2.5 per population. Indeed, Africa’s health workforce density averages 0.8 workers per 1000 population; significantly lower compared to the other regions and to the world median density of 5 per 1,000 populations.

The African health system is woefully lacking in facilities to train health workers. According to 2004 statistics, two-thirds of sub-Saharan African countries had only one medical school while eleven had no medical schools at all. Kenya for instance has only one dentist school and “This school was established thirty years ago,” laments a staff at the school. “Seventy five per cent of its equipment, like in most government hospitals, is not working. It has never been expanded. How do we expect it to produce enough dentists?”

The lopsided distribution of medical staff compounds the problem further. In Tanzania, the city of Dar-es-Salaam alone had nearly 30 times as many medical officers and medical specialists as other rural districts. Only about 5 of Uganda’s 100 or so surgeons worked outside of urban areas.

The investment in health in OECD countries is predicted to increase ten-fold in the next 50 years. It is estimated that England will need 25 000 doctors and 250 000 nurses more than it did in 1997 by 2008.A further one million nurses will be needed over the next 10 years to meet the shortfall in the United States. This is predicted to drain Africa of the salient medical staff. It is alarming that more Malawian doctors may be practicing in Manchester, England than in all of Malawi.

“Supply” issues encourage African health workers to look for more promising work opportunities abroad. The biggest being the low level of compensation provided to most health workers in Africa. Cost of living adjusted wages indicate registered nurses make about $489 a month in Malawi. By comparison, monthly pay for a nurse in the UK’s National Health Service is about $2576. In Ghana and Zambia, the average monthly salary for a doctor is just over $400.

Due to years of neglect and under-investment in Africa’s health workforce and HIV/AIDS decimation of the health personnel, Africa is faced with a critical healthcare dearth.

“In Kenya, the budgetary allocation for oral health is 0.0016 per cent of the total health budget. How does one expect the department to deliver?” asks Prof. Kaimenyi.

It's true that the health care system is a mess, but this demonstrates not market but government failure. To cure the problem requires not different or more government regulations and bureaucracies, as self-serving politicians want us to believe, but the elimination of existing government controls. It’s time to get serious about health care reform. Tax credits, vouchers, and privatization will go a long way toward decentralizing the system and removing unnecessary burdens from healthcare business.

 Licensing requirements for medical schools, hospitals, pharmacies, medical doctors and other health care personnel should be easened or eliminated altogether. If this is done, their supply will almost instantly increase, prices fall, and a greater variety of health care services appear on the market. Government certificates do not necessarily mean competence but in most cases act as insulators against private entrants in the healthcare industry. Because consumers will no longer be duped into believing that there is such a thing as a "national standard" of health care, they will increase their search costs and make more discriminating health care choices.

Currently, a significant proportion of available health workforce works in the private sector and in many cases are not considered to be part of the available health human resources. If contractual mechanisms do not exist to engage the workforce in the not-for-profit and for-profit sectors, their potential contribution in health care may be lost.

There should be deregulation of the health insurance industry. Private enterprise can offer insurance against events over whose outcome the insured possesses no control. One cannot insure oneself against suicide or bankruptcy, for example, because it is in one's own hands to bring these events about.

The industry should enjoy unrestricted freedom of contract to allow health insurers offer any contract whatsoever, include or exclude any risk and discriminate among any groups of individuals. With these measures, uninsurable risks will lose coverage, variety of insurance policies for the remaining coverage increase, and price differentials reflect genuine insurance risks. On average, prices will drastically fall, restoring individual responsibility in health care.

It is urgent that Kenya and by extension Africa addresses issues that make it difficult to access health care and health education. It is well known that some lecturers frustrate students who are pursuing some disciplines for fear of competition. Some only allow students from their ethnic tribe to pursue certain disciplines.

Why should a patient be on the queue for three years waiting to see a doctor at a referral hospital? Why should holders of nursing certificates from Uganda for example, be discriminated against or retrained to join the Kenyan health sector?

Our countries ought to review the bureaucratic barriers, taxation, licensing of drugs, corruption, poverty infrastructure that make it difficult to access medicines. Economic empowerment and opening up of our borders will empower citizens to make money and make choices for better health.