Behind the Curtain: What a Workshop on Economic Modelling Taught Me About the Cost of Care
A five-day health economics workshop in Nairobi brought together stakeholders to examine the true cost of Kenya’s response to non-communicable diseases. Focusing on stroke and chronic kidney disease, the experience highlighted a critical imbalance: too much spending is directed toward costly late-stage treatment, while prevention, early screening, community education, and timely intervention remain underfunded. For the author, the workshop revealed that every health policy and clinical decision carries economic consequences for patients, families, and the health system. It also reinforced the urgent need for pharmacists to contribute more actively to NCD planning, cost-effectiveness discussions, and pharmacoeconomics in Kenya.
I recently spent five days at a technical workshop on health economic strategic planning for non-communicable diseases, hosted in Nairobi and convened by NCD Alliance Kenya, the Ministry of Health's NCD Division, and the African Pharmaceutical Network. The workshop built on earlier work where the same teams had mapped out the key activities needed to strengthen Kenya's response to NCDs. The session's task was to examine the cost of those activities and ask a sharper question: would investing in them actually pay off, in health and economic terms.
Groups were split by disease area, covering diabetes, sickle cell disease, road traffic injuries and colorectal cancer among others. I joined the stroke and chronic kidney disease group as a pharmacist, offering input on drug availability, treatment pathways, and what access looks like once a policy decision has travelled far from the patient it concerns.
Before costing began, we worked through the situation on the ground to establish context.The picture was loaded more than I expected going in. Stroke affects an estimated 372,800 people in Kenya, closely tied to hypertension, which affects 28 percent of adults, of whom only 7 percent have their blood pressure adequately controlled. Chronic Kidney Disease (CKD) affects an estimated 3.14 million adults, and renal services exist in just 2 percent of facilities nationally. Care, quite literally, thins out the further you are from a major hospital.
What stayed with me longest wasn't a statistic though. It was a pattern. Almost everything we costed pointed in the same direction: the money is going to the expensive, late stage end of care, the dialysis, the acute stroke admission, while the cheap end, the education, the early screening, the trained community health worker, gets a fraction of the attention. We ran the numbers three ways, cost against benefit, cost against health gained, cost against clinical outcome, and each one said roughly the same thing. Catching this earlier is not just kinder. It is cheaper.
I kept thinking about a single figure from the situation analysis. Nearly a quarter of households dealing with an NCD are pushed into poverty by it. Not by a rare disease, not by an accident, but by conditions that, caught and managed earlier, are largely survivable without a family losing everything. Sitting with that number while watching a room debate where 25 to 28 billion shillings should go, split across CKD and stroke respectively, made something click. Every one of those shillings is a decision about which families keep their savings and which don't.
Somewhere in the middle of those five days, I started applying a mindset I hadn't used so deliberately before. Everything is economics. Every chair, every reagent, every desk someone sits behind, costs someone something. Nothing in a hospital is free, it is only ever paid for by someone, somewhere, whether that's a donor, a government, or the patient themselves.
And that is where the workshop turned personal for me. Watching treatment costs consume such a larger share of the budget, I found myself asking a question I don't think I've honestly asked before. When I dispense a medicine, am I only asking whether it works, or am I also asking whether it's worth what it costs, to the system and to the person paying for it. What does cost effectiveness actually mean in my hands, at the counter, not in a spreadsheet. And uncomfortably, is there a version of good clinical care that still quietly pushes a patient toward the poverty this workshop kept putting numbers to.
I left with two questions I'm still sitting with. What can I, as one pharmacist, do differently for the patient in front of me? And what would it take for pharmacists collectively to have a seat at the table where these thirty billion shilling decisions get made, not just at the counter where they get carried out. Kenya has real distance left to cover on NCDs. I came out of that workshop believing pharmacists have more to offer that journey than we've been asked to give especially in pharmacoeconomics.