The Health and Development Sector in Kenya - Essay Example

Running Head: Assessment of Heath and development sector in Kenya Name Course Institution Instructor Submission Date Introduction. Kenya is a developing country in East Africa region with a total land area of 582,646 km2. It gained independence in 1963 from British colonial rule. It is neighbor to Somalia and Sudan which have experienced political instability marred with civil strife but the country has remained relatively stable despite the effects of such on socio-economic status of the country. According to Kenya National Bureau of Statistics (2010), Kenya has 38.6 million people with a growth rate of 2.8% annually with a majority population living in rural areas (World Bank, 2010). Under its current constitution (promulgated in 2010), Kenya is headed by a president with a devolved county government system comprising of 47 counties. Its last concluded general elections in 2013 were peaceful compared to the conflicted 2007 that sparked violence in the country. The health services are a devolved function in the current transition to county system. Kenya had an annual economic growth rate of about 2.2% in the 90’s with a further increase in GDP of 4.5% in the last decade (World Bank, 2010) which was disrupted by the political crisis in 2007. According to World Bank (2010) statistics, about 46.6% of Kenyans live below the national poverty level. It is one of the countries with highest levels of economic inequity in the society (World Bank, 2010). According to WHO (2013), Kenya is ranked position 147 0ut of 177 with a Human Development Index of 0.521. The country faces various health challenges including a high burden of communicable diseases (such as HIV/AIDS that is responsible for 29.3% of all deaths, malaria and Tuberculosis) and non-communicable diseases (Government of Kenya, 2011). Health services are provided by government, missionaries, Nongovernmental organizations (NGOs) and private facilities ranging from dispensaries to hospitals. The Kenyan health system is still weak due to inadequate infrastructure, human resources and other health inputs as well as financial and managerial problems. Financing of health care is by government, donors, (NGOs) and the private sector. However, the constitution of Kenya, vision 2030, MDGs and other policies provide a framework towards realization of health goals. Strong relationship with various developmental partners, strong private sector and civil society also strengthen the country’s growth potential (Government of Kenya 2010, 2011). Kenya is a leader in East Africa; it enjoys stability despite spill over from surrounding countries such as Somalia. It is the biggest economy in the region and has experienced growth over years but still inequalities exist among the few rich and the majority who are poor (UNICEF, 2013). There has been improvement in health education and service delivery over the last 10 years as will be exemplified by the various indicators to be discussed next. Compared to other countries in sub- Saharan Africa, Kenya has made notable milestones. The life expectancy according to WHO (2013) in 2011 was 60 years which was greater than that for Africa region which was 56years. During this period the infant and under-5 mortality rate was 48 and 73 per 1000 live births respectively against the WHO Africa region whose values were 68 and 107 per 100 live births, respectively. According to the Vision 2030 (Government of Kenya, 2011), Kenya’s has much to achieve regarding Millennium Development Goals (MDGs), the MDG’s 1(eradicate extreme poverty and hunger), 4(reduce child mortality rates), 5 (improve maternal health), and 6 (combat HIV, malaria, and other diseases). This is echoed by the African Union Maputo Plan of Action 6 whose target is to reduce poverty levels calling for need to implement these principles to achieve the targets. Heath indicators are a measure used to quantify if a goal has been attained. These are tools used to monitor and communicate key information of health in a population and aid planning (Friedman, M 2005).  They indicate the health, socio-economic status and hence quality of life in the country. In Kenya the indicators are maternal, infant and children under 5 years mortality rates, life expectancy at birth and the crude death rate and maternal mortality ratio. Others are the number of health facilities and medical staff per unit of population, vaccination coverage, HIV/AIDS, Malaria and Tuberculosis (TB). Infant mortality rate Infant mortality rate is the number of children who die before one year, per 1000 live births whereas under-five mortality rate is the number of children who die under 5years expressed per 1000 live births. According to UNICEF (2013), the infant mortality rate and under -5 mortality rates in Kenya for 2012 was 49 and 73 per 1000 live births respectively. Looking at the trends in Kenyan history, between 1960 and 1992 infant mortality rate declined significantly from 119 to 51 per 1000 live births and the under-five mortality rate reduced from 202 to 74 per 1000 live births (Government of Kenya, 2000). These indicators unfortunately increased in the 90’s where the infant and under five mortality rates in 1998 were 74 and 112 respectively, increasing again to 78 and 114 respectively (Government of Kenya, 2003). In 2003, the infant and under five mortality was 73 and 110 respectively showing a slight decline (Government of Kenya, 2003). Figure 1 below illustrates this and shows more action is needed to achieve the targets. This was attributed to poverty, increasing HIV/AIDS and limited financial allocation to health. Figure 1 Adapted from KDHS 1999/2009 The current decline reflects progress Kenya is making towards Attainment of Millennium Developments Goal (MDGs), in this case MDG number 4 whose aim is to reduce child mortality rates, specifically between 1990 and 2015 by two thirds (Government of Kenya , 2011), which the country still away from this target. However according to the Kenya health policy 2012-2030, the health challenges have been identified in the country and interventions aimed at improving these indicators are in place to fast track the realization of MDGs and Vision 2030 for its citizens. Life expectancy Life expectancy is the average number of years an born infant is expected to live under current mortality conditions. It is another key health indicator. The Life expectancy in Kenya has significantly risen over years. During independence (1963), it was 40 years, in 1993 it was 60 years (Government of Kenya, 1994c), then declined to 51years in 1998 to the lowest in 2002 before rising again. According to UNICEF (2013), it is currently 61.1 years showing an increase from earlier years as shown by the table below. The decline from 90’s is attributed to a rise HIV/AIDS and poverty levels. The Kenya’s vision 2030 health policy targets a life expectancy of 72 years representing about 16% change from current level showing the need to fulfill various health obligations to meet this. Country 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Kenya 47.98 47.49 47.02 45.22 44.94 47.99 48.93 55.31 56.64 57.86 58.82 59.48 61.1 Table 1 Adapted from: http://www.indexmundi.com Maternal mortality ratios Maternal mortality ratio is defined as the number of women dying during pregnancy and childbirth expressed per 100,000 live births. It is a key development and maternal health indicator. The death of a woman’s sister during perinatal period used to determine maternal mortality ratio. According to Kenya Demographic Health survey 2003, the maternal deaths were 414 per 100,000 while the 1998 survey was 590 per 100,000 live births. The reported 2008-2012 maternal mortality ratio was 490 (UNICEF, 2013). The trend shows a decline which however doesn’t show much change showing a need to still improve maternal health. HIV/AIDS prevalence HIV/AIDS scourge is still a challenge to Kenya but changes have occurred. The surveys carried out nationally show a prevalence of 6.7% in 2003, 7.4% in 2007 (NACC, NASCOP, 2012), 6.3% in 2008-2009 (Government of Kenya, 2010), 6.2% in 2011 and according to UNICEF, 2013 the prevalence in 2012 was 6.1%. The table below illustrates the values in earlier years. There is a general decline in the HIV/AIDS attributable to several increased awareness of the disease, increased condom use, prevention of mother to child transmission, increased financing and the use of anti-retroviral but it still poses a challenge as the main cause of morbidity and mortality in the country hence should still remain a priority. Malaria In Kenya, Malaria is among the most prevalent conditions responsible for more than 30% morbidity yearly. There has been an increase in use of insecticide treated bed nets (ITNs). KDHS 2003 showed 6% use of ITNs while Kenya Malaria Indicator Survey (2007) revealed 48% household use while 2008-09 KDHS recorded 56%. This show some improvement which was reflected by a decline in incidence however Government of Kenya (2011), shows the targets have not yet been met. Other improvements have been made in malaria prevention and control such as use of Artemisinin combined treatment (ACT), environmental control, preventive given treatment to pregnant mothers. Drug resistance still poses a major challenge in this important health indicator. Other indicators are crude Birth and Death rates. Crude birth rate is the number of births per 1,000 and Crude death rate is the number of deaths per 1,000. Both determine the population size. According to the Government of Kenya (2003), both crude birth and death rates declined since 1963 to 1998 from 52 and 20 per 1000 population to 35 and 12 per 1000 respectively. The crude death rate in Kenya declined to 9 per 1000 before increasing again. Increased awareness and use of family planning explains the changes in crude birth rate over time. According to UNICEF (2013), the crude death rate is 8.5 per 1000 population while 35.5 per 1000. Childhood Vaccination Coverage According to the Government of Kenya (2010), the estimated immunization coverage was 63% in 1989 which increased to 79% in 1993. The Government of Kenya (1999) indicated that children with vaccination card in 1993 were 69 %and in 1998 was 55% which increased to 70% in the 2008-09 KDHS. According to Government of Kenya (2011), the 2008-09 targets was immunization coverage of 85% but 77% was achieved. Access to health facilities has been the challenge but improvements have been made which need further interventions to bridge the gap. There was no major difference between urban and rural coverage but regional disparities that need to be balanced is evident. The improvements made have not kept pace with the country’s population growth. The Kenyan government’s policy is to increase health accessibility and health workers at rural set up which has improved since independence but urban areas still has the majority of doctors especially the major towns with a minority in rural areas. This asymmetry is part of the challenges to be solved to ensure equitable service delivery. The health system has a mandate to ensure that Kenyans citizens become free disease and disability from health. In Kenya, several strategies and policies exist with objective of solving the existing health challenges and to meet the targets of MDGs. Among the key health policies are health service accessibility and coverage peripheral areas, maternal and child health, increasing financing and consolidation of prevention and curative services just to mention some. Most of them have basic issues to be considered which is quality and sustainability through increased financing and better management. Several policies have been formulated in Kenya (Government of Kenya, 2011) aimed at improving health status including the Vision 2030,the Kenya Health Policy (2012 – 2030), Health Sector Plan (2008-2012), National Health Sector Plan II (2005 – 2010); the first Medium Term Plan (MTP) (2008-2012), Health Policy Framework (1994) and the National Health Sector Plan I (1999 – 2004) among others. The Kenya Health Policy, 2012 – 2030 guides the country’s development plans in accordance with the constitution, Vision 2030; regional and global agreements. The policy affirms the commitment of the government and its stakeholders such as NGOs, private sector and civil society to the health of its citizens. It is all inclusive and comprehensive focusing on health for all by decentralization and in keeping with the constitution. It aims at implementation of issues articulated with a projection in 2030 to achieve a reduction in mortality by 14% yearly. However it is expected that Non communicable diseases, communicable diseases and injuries will each contribute to 47%, 39% and 14% of deaths necessitating measures to handle these changes. Various global partners in Kenya support the health sector accounting to about 14.8% of funding.  USA is the leading financial donor through USAID, PEPFAR and the President’s Malaria initiative. Other partners are Britain, Germany, Netherlands, Denmark, Japan, the World Bank and United Nations (through UNAIDS, UNFPA and UNICEF). Other charities and organizations partnering with Kenya in health sector are the Aga Khan Foundation, Clinton Foundation, Catholic Relief Services and Lutheran World Relief.  In 2007, the Kenya Health Sector Wide Approach (SWAp) Code of Conduct was developed to coordinate these development stakeholders to work together and avoid duplicating their activities and funding (CSIS, 2014, World Bank, 2010, 2014 & Government of Kenya, 2011). The chart below illustrates the bilateral patners in kenya. Source: Global Health Policy, Center for Strategic & International Studies (CSIS), 2014 To achieve vision 2030, health sector is a key pillar through provision of accessible, quality and relevant health services to have a healthy workforce. Increasing allocation of resources, improvement in health personnel and facilities, better health management are among the strides made. However, challenges still exist due to infrastructural constraints, inadequate human resources, increasing cost of medical care, financial constraints, HIV/AIDS Pandemic, increasing non communicable diseases and high poverty levels. References Friedman, M., 2005. Trying Hard is Not Good Enough. Vancouver, Canada: Trafford Publishing. Government of Kenya, 2003. Kenya Demographic and Health Survey, 2003; Preliminary Report, Nairobi, Kenya. Government of Kenya, 2010. Health Situation trends and distribution, 1994 – 2010, and projections to 2030. Government of Kenya, 2010. Kenya National Bureau of Statistics, Kenya Demographic and Health Survey 2008-09, Nairobi. Government of Kenya, 2010. Review of the Kenya Health Policy Framework, 1994 – 2010. Nairobi Government of Kenya, 2011. Kenya Vision 2030: second annual progress report on the Implementation of the First Medium Term Plan, 2008-2012. Nairobi Government of Kenya, 2008. Kenya National Bureau of Statistics, Kenya Facts and Figures, 2008. Nairobi Health Systems 20/20, 2008. Health Systems Fact Sheet: Kenya. http://www.indexmundi.com International Health Partnerships Initiatives, 2012. Joint Assessment of Kenya’s Health Sector Strategic Plan (KHSSP). Nairobi. Joint United Nations Programme on HIV/AIDS, 2004. 2004 Report on the Global AIDS Epidemic, Geneva Kenya Institute for Public Policy Research and Analysis, KIPPRA, 2009. Kenya Economic Report 2009. Nairobi: Kenya Institute for Public Policy Research and Analysis. The Global Health Policy Center for Strategic & International studies (CSIS), 2014 at http://smartglobalhealth.org/pages/kenya The Kenya National AIDS Control Council (NACC) and the National AIDS and STI Control Programme (NASCOP),2012. The Kenya AIDS epidemic update 2011. Nairobi, Kenya. UNICEF, 2013 at http://www.unicef.org/infobycountry/kenya_statistics United Nations Millennium Summit, 2000 World Bank, 2001. African Development Indicators. Washington DC: The World Bank World Bank, 2010. World Development Indicators 2010. Washington DC: World Bank. World Bank Group, 2014 at http://www.worldbank.org/en/country/kenya World Health Organization, WHO, 2013. World Health Statistics 2013. Geneva Read More