Kenya's Health Status at 50:The Facts, Historical Momentums, Achievements and Setbacks at a Glance

As Kenya hits 50,there is a lot to celebrate on one hand over the five decades and also a lot to be desired with regards to the health sector. Over the years, the Kenyan health sector has been a vibrant one with a few milestones here and there. Let's have a look:

Current Status: Devolution wrangles threatening the Health sector

FACTS

• 4500 doctor(1 per 10,000)
• 37,000 nurses,
• 5000 health facilities
• components of the Kenyan health budget – a recurrent budget which covers staff salaries, maintenance, and pharmaceutical procurement, and the development budget, which funds construction of new facilities and program implementation.
• HIV most funded disease.

Historical Overview

• Independence day-1980s:life expectancy 40 to 60 years now 53 years
• 1990s -dawn of the HIV/AIDS pandemic
• 1900s-to date: persistence of infectious diseases and increase of cardiovascular disease, cancer and diabetes.
• 1970:nationalized and free health care system.

• 1992 - District Health Management Boards for cost-sharing health costs.
•  1994 : Kenya Health Policy Framework Paper(“quality health care that is acceptable, affordable, and accessible to all” in Kenya by 2010).
• Transforming the NHIF into a National Social Health Insurance Fund (or scheme), as was proposed by the Narc government, or Grand Coalition Government.
• 2007-2008 political violence affects the country's vibrancy through an estimated death of 1,500,displacement of thousands, rampant sexual violence,HIV/AIDS patients not accessing clinics and drugs and psychological trauma.
• Power sharing between President Kibaki and Prime Minister Raila in 2008 makes the Ministry of Health into Public Health and Sanitation, and  Medical Services and competition over roles and resources. 
• District Health Management Boards still responsible for distributing funds from Ministry of Finance.
• National Social Health Insurance Fund( “pay-in-advance” insurance scheme ) opposed by private health sector, civil service and teachers' union on grounds of preference for medical benefits.

RECORDS!

•  Kenya was the first country in Africa in 1963 to initiate a planned parenthood program, led by the then minister for Planning, T.J. Mboya, to ensure a quality population.
• Kenya was also the first country in Africa to establish a National Hospital Insurance Fund to ensure access to treatment (1996).

Achievements

•  A Health Management Information System (HMIS) developed to improve provision of health data.
• attention to the immunization of children, improvements in maternal care, access to health care by the under-fives and the creation of facilities for the same.
• 100,000 units of blood collected annually.
• June 2013: free maternal health services in public hospitals.
• October 2013: Kenya's First Health Festival At The Pride Inn Hotel In Wetlands.

Setbacks

• Highest net emigration rates for doctors in the world(51% leave).
• Shortage of  health personnel in Kenya.
• Inadequate disease surveillance, and maintain accurate statistics regarding disease outbreaks, and report of the same.
•   A national health budget dependent on donor funding with the percentage being 14.6% in 2006 with the US,UK,European Union, World Bank and the Clinton Foundation paving the way through the Kenya Health Sector Wide Approach (SWAp) Code of Conduct and the International Health Partnership (IHP+). 
• Ministers lacking a health background except Prof Sam Ongeri, repeat of the 1980s demise.
• Lack of professionalism in healthcare.
• Unresolved health related crimes, the cases of Clinix and NHIF sagas.
• Environmental degradation behind unsafe drinking water and health hazards.
•  increase in the incidences of diabetes, heart disease, cancers of all types and other diseases.
• Inability to provide proper nutrition to Kenyans.
• Lack of the spirit of Harambee( mutual social responsibility) in handling health consequences.
• Lack of universal access to affordable and quality health care.
• 70% blood deficit

Punch line:

Health is no longer a social issue as was the case in the 1960s-Prof Anyang' Nyong'

Margaret Tanui

Health writer

Mandela: A Health Hero Passes On

The father of South Africa, an antiapartheid fronteer,SA's peacemaker,lawyer,social activist,politician,philanthropist and a president, are just among the few iconic titles  that will be remembered as having defined Nelson Rolihlahla Mandela's  as he passed on last Thursday at age 95.

As the world will look on his battle with a lung infection ,pneumonia, prostate cancer and abdominal pains, The Health Guardian will focus on the health legacy that he left behind. He will be remembered centuries on as being an AIDS campaigner after realizing the dangers of HIV.Regarding the disease he was quoted saying ''We are facing a silent and invisible enemy that is threatening the very fabric of our society''.

His release from prison in 1990 at a time when there was an ongoing and unending debate on Aids by the African National Congress(ANC),Thabo Mbeki even questioning the cause of the very disease and South Africans not talking about it public.Mr.Mandela campaigned for more research on HIV/Aids after leaving office in 1999.

Un reports that South Africa has one of the highest HIV rates in the world with 6.1 million living  with the disease and the percentage rising from less than 1% to about 17.9% by 2012.A fact that the late Mandela tried to change by encouraging the ABC policy in the fight against the disease in the face of governmental hesitance to fund ARVs in South Africa.

Through the Nelson Mandela Foundation, he launched 46664 Aids fundraising foundation, after his prison number on Robben Island. The launch was world acclaimed by billions in 2003 in Cape Town and propelled by international celebrities: Beyoncé, Youssou N'Dour and Dave Stewart. The financial gains of most of Mandela's initiatives has seen numerous research projects funded and South Africans living with the disease aided.

Mr. Mandela compared the fight against HIV/Aids with apartheid and constantly urged people to talk about HIV/Aids "to make it appear like a normal illness" thus placing South Africa as the pace setter in Aids response.

As being the integral figure in the anti-Aids movement,Mr.Mandela was key in setting a firm ground in creating a an Aids free country and influencing many on a global scale to act and change and save billions.

Other Contributions in Health:

• Nelson Mandela Award for Health and Human Rights.
• Under his 'golden age of hope' as SA's president: free healthcare for children under 6 and pregnant women(1994),free healthcare in public health centers(1996) and 500 clinics upgraded.
• Nelson Mandela Children's Hospital.

Other Facts:

• Lost his two sons through a car accident and Aids respectively.
• The Current cinematorial depiction of him is a 2013 film,Mandela:Long Walk to Freedom. Released before he died.

R.I.P Nelson Mandela…

Margaret Tanui

Health writer

Reflections on World AIDS Day

And as the country marked World AIDS Day in all counties, a lot was boiling under the bridge with the devolution crisis   in the Ministry of  Health being the most current hindrance to the fight against AIDS with health workers threatening to strike if all health services do not remain a central government affair as it is a national disaster.

Reports from Kenya Aids Indicator Survey(KAIS) 2012 reveals that children as young as 10 years are engaging in early sex increasing the percentage of HIV infections through risky sex behaviour.KAIS also puts Nyanza as the leading in people living with HIV while Nairobi, Coast and some parts of Rift Valley showing high reduction in the same.

The Standard yesterday reported that HIV is the most highly funded disease in Kenya at an estimate of sh 40 billion annually with 95% being donations which is a fact that highlights the need to reduce HIV infection in the country amidst the challenges surrounding the disease being supersistion,religious ignorance, denial, and fear of testing.

An interview with Helen Lukakha Irusa from AMPATH asserts that Kenya is among the leading countries when it comes to AIDS awareness but poor in taking responsibility for their health thus with new policies like the mandatory HIV testing for pregnant mothers at hospitals are just among the many avenues that can aid in encouraging Kenyans to take control of their lives besides the traditional ABC policy. Being in the 21st century does not rule out the startling realities that Kenyans are still in denial and think AIDS is witchcraft related, that they cannot get the disease ,that once one is tested then that’s it and they are safe or the worse being that AIDS is just like Malaria and that one can die anyway, from an accident so no need to accrue the disease with the seriousness that it needs.

The good news from KAIS is that there is a 6% reduction of HIV infection in the country and shows that if we all do more  the number can go a notch higher. David Cunningham, one of the founders of Family Impact, puts it in perspective when he says that 'even if everyone lived right,HIV will still be here in 20 years' which is true in the sense that it is just not about preventing new infections but also taking care of the already infected over time. So let us forget the popular life principle of 'everyone for themselves and God for us all' as  whether we are infected or not as all of us are affected by HIV one way or the other.

Margaret C Tanui

Health writer

Beyond Operation Jijue UJipange Health Drive Poster….

According to the Ministry of Health,Eldoret records the highest rates in child birth, death due to cancer(cervical cancer) and HIV/AIDS, a wrong that Tunza Family Health Network and Population Service International(PSI)  has been making right for 2 months around Eldoret through universities, colleges and polytechnics with the focus being family planning, cervical cancer and HIV and the target being the youth(18-30 years).Although Operation Jijue Ujipange was meant to reach the youth, the initiative generously opened its doors to anyone who had a need for breast and cervical cancer screening,HIV testing and advice on family planning.

An interview with Judy Mutua,a team member from Tunza,rates Moi university as the best when it comes to health awareness and response to health campaigns such as these, this in comparison to University of Eldoret(formerly Chepkoilel campus),Rift Valley Technical Training Institute(RVTTI) and Eldoret Polytechnic. Feedback from the team reveals that a total of 941 community members(students and non-students) came for cancer screening alone! A record that points to an effective mobilization system at the campus through word of mouth, use of posters and student organizations so kudos to all!

For those who have the health brochures and may not have time to read them or find medical jargon a bitter pill to swallow, in lay man's language, the health drive team advises students and the public on the following:

-cervical cancer screening is only for those who are sexually active or smoke,however,a HPV(virus causing cervical cancer) vaccination is important for girls(9-13 years) which protects them for 7-8 years.

-An e-pill is not a magical pill that solves all sex-related problems as it doesn’t protect one from HIV/AIDS and STIs and also 1 single e-pill is equivalent to taking 8 of the normal family planning pills thus a detriment to the uterus ladies. Seek medical help on safe pills from a certified health practitioner.

-Avoid unprotected sex thus use condoms available at the campus clinic and at dispensers in hostels.

-Go for HIV testing on a yearly basis unless advised otherwise or in case of a possible risk exposure and not every month as most do as it loses meaning!

-There is a great need for peer education with regards to health matters as many are in the dark or simply choose not to care at all

My two cents:

'Read the brochures on family planning, cervical cancer and HIV and do not rely on what is only mentioned here, stay informed!'

….final note…

…do you care about your health and that of your friend?

Margaret C Tanui

Health Writer