The ministries handling health issues collaborate with other ministries and institutions in different ways. They include the Ministry of Water and Irrigation as part of the joint hygiene and health promotion messages), and the Ministry of Education in the expansion of school health programmes for primary (deworming programmes) and secondary schools (two tetanus toxoid immunisations and counselling on reproductive health and substance abuse). Collaboration will be strengthened with relevant research institutions in the country to develop operational research programmes that are relevant to health policy development.The Ministry of Local Government is a special case, as it is a co-implementor of health service delivery.
In all major towns and cities of the country, health services are provided by the city and municipal councils, complemented by the private sector. It is estimated that councils provide health care to some 15–20 per cent of the population. Various local and international organisations have been cooperating with the Government in provision of health services and innovations. One such organisation is PATH, an international non-profit organisation that transforms global health through innovation.
PATH has worked with local and international partners to increase the uptake of HIV and Aids, tuberculosis, family planning, reproductive health, maternal and child health and malaria prevention services in Western Province. UNICEF, in collaboration with Family Health International (FHI), is spearheading an initiative at the Coast and Rift Valley to create greater community awareness about the importance of early and exclusive breast-feeding. The Infant and Young Child Feeding (IYCF) project promotes mothers’ clubs to bring together new and experienced mothers to share ideas and learn from one another about how best to care for their children.
FHI has also launched a pilot programme in Kenya on cardiovascular diseases. Heart disease is on the rise in the developing world, and people on anti-retroviral treatment for HIV are especially at risk. FHI hopes that the project in Kenya will demonstrate the effectiveness of integrating cardiovascular screening into HIV services.FHI addresses HIV prevention, care and treatment through programmes, such as the Regional Outreach Addressing Aids through Development Strategies (ROADS), and Aids, Population,and Health Integrated Assistance (APHIAplus) projects.
Dow Chemical Company, a leading global chemical company, entered a partnership with the University of Nairobi (UoN) to support the International Year of Chemistry 2011 programme at the university. Chemistry has a certain role to play in promoting the welfare of mankind, be it the provision of clean water, promoting agricultural productivity, improving sanitation and public health, infrastructure development or provision of housing.
These are semi-independent institutions that operate under an Act of Parliament and perform important regulatory functions on behalf of the Ministry of Health. The organisations, for example the Pharmacy and Poison Board and the Medical Practitioners and Dentists Board, are charged with the definition of professional standards; the establishment of codes of conduct; and the licensing of facilities, training institutions and professional workers. The Central Board of Health supposed to be the Minister of Health’s highest advisory organ has not been constituted. From the work of the regulatory agencies, they often generate considerable revenues that finance their operations.
However, the legal position of the various boards and councils does not allow themto undertake effective regulatory functions. The legal gap has created a weakness in the administration of disciplinary measures in the health sector, which is the province of professional bodies. Cases of malpractice and negligence are rarely publicised or properly punished. There are laws governing almost every aspect of the health system, like licensing of professionals, but the Government still lacks adequate monitoring capacity. The Kenya Medical Research Institute is a showcase of a health parastatal recovering from a past of mismanagement to play a frontline role in medical research.
Various professional associations represent the interests of specific professional groups, including doctors, dentists, nurses, physiotherapists and others in the medical field. They are independent and are mainly involved in welfare activities for their members.
Whether for-profit or not-for-profit, the private sector is really only partially co-opted for health development. In the past years, collaboration between the ministries of health and the private sector has been irregular and not productive. However, there are now many private sector health foundations focusing on increasing access of specialised treatment by the poor.
In Africa, 80 per cent of people rely on traditional medicine because of its easy access, sustainability, affordability and cultural status. A recent workshop discussed new ways to incorporate traditional medicine into the health system. The workshop called for the establishment of policy and legislation, quality assurance and standardisation, capacity building, protection of intellectual property rights, and the halting of loss of biodiversity. It also recommended the development of a national policy on traditional medicine and the exploration of possibilities of initiating commercial production of traditional plants for medical use.
The Kenya Medical Research Institute is involved in a continuous study of herbs across the country. Through its Centre on Traditional Medicine and Drug Development, Kemri also undertakes ethnobotanical and ethomedical surveys and documentation of herbs used by herbal medicine practitioners to treat the population. Researchers at Kemri say they may be on the verge of a local herbal cure for herpes. The University of Nairobi has the Department of Pharmacognosy within its School of Pharmacy, which focuses on traditional and complimentary medicine . The department’s focus is on quality control/ assurance, safety, efficacy, toxicity, usage, current trends, national policy, legal status, cultivation, formulation into suitable dosage forms and commercialisation.
They constitute a rather heterogeneous group with a variety of objectives, interventions, technical and reporting requirements, and funding modalities. Some offer support through funding, whereas others prefer to continue their “off-budget” support for projects in specific areas or targeted at special population groups.
Morbidity and mortality
The tools used for data collection disaggregated the patients in two main age group, above five and below five years of age. This is because some diseases affect more children aged under five. Malaria is the leading cause of morbidity (32 per cent), followed by the respiratory system diseases (24.8 per cent), diseases of the skin, including ulcers (6.5 per cent), diarrhoea (5.2 per cent), pneumonia (3.29 per cent) and accidents, including fractures and burns (1.8 per cent). Rheumatism, joint pains kill 1.7 per cent, urinary tract infections (1.3 per cent) and intestinal worms (1.2 per cent). Malaria and respiratory system diseases remain the highest cause of morbidity in children under five years of age, followed by diarrhoea, intestinal worms and eye infections. Among children above five, malaria remains the major cause of mortality, followed by lower respiratory infections and HIV and Aids.
Maternal and child health care
In June 2011, the United Nations Population Fund released a report on The State of the World’s Midwifery. It contained new data on the midwifery newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Kenya is 530, compared with 413.4 in 2008 and 452.3 in 1990. The under five mortality rate in every 1,000 births is 86 and the neonatal mortality as a percentage of under fives mortality is 33. Infant mortality has dropped by 32 per cent from 77 deaths per 1,000 in the 2003 survey to 52 deaths per 1,000 in the 2008-2009 survey. Post–neonatal mortality declined by more than 50 per cent from 44 deaths per 1,000 in the 2003 KDHS to 21 deaths per 1,000 in the 2008-2009 KDHS. The number of midwives per 1,000 live births is unavailable. The lifetime risk of death for pregnant women is one in every 38.
The most commonly used impact indicators on mortality are adult mortality rate (AMR), maternal mortality rate (MMR), under-five mortality rate (UMR), infant mortality rate (IMR), neonatal mortality rate (NMR) and other similar measures. Improvements in the mortality indicators show the impact of interventions meant to improve the health of the population. These include integrated management of childhood illness (IMCI) developed by the World Health Organisation (WHO) and Unicef. IMCI focuses on the wellbeing of the whole child and aims at reducing deaths, illness and disability. It is also meant to promote improved growth and development in children under five.
IMCI emphasises on both preventive and curative elements. Its components are: improving case management skills of health care staff in health facilities; promote accurate identification of childhood illness in outpatient settings; and ensures the combined treatment of all major childhood illness, emphasising on prevention.
Kenya has little provision for mental health. The country’s mental health programme, which focuses on community mental care, gets 0.01 per cent of the health budget. There is only one psychiatrist for every 500,000 people, with only a third of these psychiatrists working in the public sector. There is only one mental referral hospital in the country. Kenya has no disability benefit for people suffering from mental illness.
The National Population Policy for Sustainable Development (Sessional paper No. 1 of 2000) has strategies and objectives on fertility, mortality, family planning, reproductive health and reproductive rights, gender perspectives and HIV and Aids. The Government has fully embraced the concept of reproductive health in the delivery of care. Currently, three-quarters of facilities in Kenya provide a full range of reproductive and child health services. Facilities with trained personnel are now offering integrated reproductive health services and training is being strengthened to ensure quality of care. According to the National Reproductive Health Strategy, reproductive health comprises family planning and unmet needs, safe motherhood and child survival initiatives, promotion of adolescent and youth health, gender and reproductive rights, management of sexually transmitted infections (STIs)/HIV and Aids, management of infertility, and other reproductive health issues.
Family planning needs
Family planning knowledge is almost universal. Ninety six per cent of women aged between 15 and 49, and 98 per cent of men in the 15 to 54 age bracket know at least one modern method of family planning. These men and women have a rational approach to planning their families. The pill is the best-known family planning method followed by are injectables and condoms. Contraceptive use, especially of modern methods, has increased sharply in Kenya.