Kenyatta National Hospital. The assistant director at the KNH
Paediatrics Department, Dr Irene Inwani, said about 18 per cent of
children referred to the hospital for specialized treatment die due to
lack of adequate facilities. Photo/FILE
A recent announcement by the World Bank
that it had approved Sh3.5 billion ($41 million) credit for Kenya’s
Health Sector Support Project is a major boost for the universal health
coverage goal that goes back to 1948.
The significance
of the funding is that it targets nearly 80 per cent of Kenya’s
population— the lot traditionally marginalised in access to health,
which the World Health Organisation regards as a fundamental human right
in its constitution.
According to the December 30
World Bank Press release, its funding is accompanied by a $20 million
(Sh1.7 billion) grant from the Health Results Innovation Trust Fund that
is supported by the UK and Norway, and helps countries to sharpen their
focus on health results.
“High out-of-pocket expenses
currently prevent more than half the country’s poor households from
accessing services they need, lowering their income and productivity,”
says the bank.
With 2015 beckoning and with an infant
mortality rate of 55/1,000 against the global average of 49.4/1,000,
Kenya is far from achieving universal health coverage not just for its
most vulnerable population, but most Kenyans.
HUGE CASH INJECTION
Despite
the huge cash injection, it is ironic that the country has squandered
more than 30 years in which it should have adopted the community health
strategy, considered by the Moi University Chancellor, Prof Miriam Were,
as the surest way to achieving universal health coverage.
The former chairperson of the National Aids Control Council has been championing primary health care since 1968.
That
is the year she quit teaching and enrolled at the University of
Nairobi’s School of Medicine, frustrated at seeing her Eastleigh
Secondary School students with sceptic wounds on their legs and pus
oozing from their ears being prescribed aspirin.
Although
she had to swim against the current of her peers’ opinion to specialise
in Public Health at a time the discipline was frowned on as ‘inferior’
and ‘not academic enough’, Prof Were never doubted that 85 per cent of
Kenya’s population, who were cut off from the formal healthcare system,
deserved support because they shouldered the burden of healthcare
provision.
Explaining her research topic at the
US-based Johns Hopkins University that targeted working with villagers
to take charge of their own health, Prof told the Nation:
“My
colleagues kept telling me, ‘How can ignorant women do these things?’
And I was telling them, ‘these people are already looking after the 85
per cent (of the population) that we are not looking after.’”
The
doyen of primary healthcare in Kenya believed then and now that unless
individual families are empowered to handle preventable diseases, they
would continue to suffer in remote villages or endure neglect by
overworked staff in congested medical facilities.
She
was convinced that the community healthcare strategy was the best way to
expand access to healthcare. When she joined university, the health
sector was desperate “with very few African doctors and very few African
registered nurses”. The situation prevailed even after she was awarded
her Doctor of Public Health degree in 1980.
The reason
was that “we didn’t have a school of Public Health in Kenya”, a
prerequisite for training staff to drive the PHC agenda.
“I
was designated as the coordinator of post-graduate development and I
was very happy that in 1983, we finally established the Master of Public
Health Programme,” she said. Today, other universities including
Kenyatta and Moi also offer Public Health courses with the latter
partnering with Amref on a programme.
But even with
Master’s programmes in place, it took two decades for the government to
appreciate the “very important” community health approach and only after
a major initiative—in which World Bank consultants were involved—found
out that massive investment in physical structures had failed to improve
the nation’s health.
It came as a shock that there
were more child and maternal deaths between 1999 and 2004 than in 1995,
Prof Were says. In spite of the big expansion of medical services, “we
are among the countries that don’t seem to be on track to achieve the
Millennium Development Goal (MDG) 4, which is reduction of child deaths
and MDG 5, which is reduction of maternal deaths,” the don says.
So,
why were maternal and child deaths increasing in spite of massive
infrastructure projects? “It was later recognised that until you involve
the people, you cannot really change the health pattern of a nation,”
the mother of PHC in Kenya told the Nation, adding that although they
had stepped up building health facilities, they were still located very
far from the people.
The few who reached the medical
centres were put off by long queues and acerbic-tongued nurses. Prof
Were explains: “If you have 200 people lined up, it is not easy to spend
time with each of them, so you just say, ‘What’s your problem?’ ‘This.’
‘What’s your problem?’ and you diagnose. “When you do
that, people don’t come back because they think you’re not taking them
seriously, but how can you talk to them in a nice way when there are 200
waiting? These are some of the reasons why we had what we call
worsening indices of healthcare.”
MEET THIS TARGET
This
is the background to the 2006-2010 health sector strategic plan, whose
roll-out began in 2008 under then Public Health Minister Beth Mugo. The
ministry and other players designated sub-location community units, of
which there are 2,511 to implement the strategy. The units are just
about a third of what Kenya needs. “If we can meet this target in the
next five years, we can change this country’s health status,” Prof Were
says.
Coincidentally, 2008 when Kenya adopted the
community healthcare strategy was also the year the Government of Japan
awarded Prof Were the Hideyo Noguchi Africa Prize for Heath Research in
recognition of her 40-year effort to bring basic health close to the
people.
Prof Were believes that if people are enabled
to deal with preventable diseases, such diarrhoea and malaria through
environmental sanitation, hospital beds will be freed to cater for the
emerging non-communicable diseases, including cancer, which are usually
ignored.
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