De­liv­er­ing on the prom­ise: To­wards a healthy na­tion

Whereas there is still ground to be cov­ered, the gov­ern­ment is mak­ing good its health prom­ise to Kenyans and is com­mit­ted to achiev­ing Uni­ver­sal Health Cov­er­age as well as other na­tional and in­ter­na­tional health tar­gets. The ul­ti­mate goal of achiev­ing hig

The Star (Kenya) - - Opinion Public Health Policy - @TheS­tarKenya BY DR CLEOPA MAILU

Health is insep­a­ra­ble from hu­man de­vel­op­ment. The de­vel­op­ment of a na­tion de­pends on the health and well-be­ing of its peo­ple. Many in­ter­na­tional dec­la­ra­tions and com­mit­ments at­test to this as is well am­pli­fied in the United Na­tions mil­len­nium goals which Kenya has un­der­taken to achieve.

The great health chal­lenges of to­day – among them in­fant, child, and ma­ter­nal mor­tal­ity, malaria, HIV, and NCDs – all im­pact on the ca­pac­ity of peo­ple to sur­vive and thrive. Ad­vanc­ing bet­ter health is a gate­way to de­vel­op­ment progress. And de­vel­op­ment progress is a gate­way to im­prov­ing health.

Since, in­de­pen­dence Kenya has steadily worked to im­prove the health of its 40 plus mil­lion peo­ple, more than half of whom live in ru­ral ar­eas. How­ever, the eco­nomic cri­sis of the 1980s cou­pled with the HIV/AIDS pan­demic in the 90s decade ag­gra­vated the lim­i­ta­tions Kenya faced in pro­vid­ing qual­ity care across the pop­u­la­tion.

These lim­i­ta­tions in­cluded pro­vid­ing health care ser­vices to ge­o­graph­i­cally dis­persed pop­u­la­tions; en­sur­ing ac­cess to health care providers in crit­i­cal re­gions and se­cur­ing ap­pro­pri­ate fi­nanc­ing to sus­tain and in­crease the health care in­fra­struc­ture at the na­tional and county lev­els.

PER­SIS­TENTLY HIGH LEV­ELS OF IN­FEC­TIOUS DIS­EASES

Along with tack­ling per­sis­tently high lev­els of in­fec­tious dis­eases, such as tu­ber­cu­lo­sis, HIV/AIDS, and malaria, Kenya has seen an in­creased preva­lence of chronic ill­nesses such as di­a­betes, cancer and car­dio­vas­cu­lar dis­eases.

In 1994, the Gov­ern­ment pro­duced the Kenya Health Pol­icy Frame­work pa­per which set forth a vi­sion of pro­vid­ing ‘’Qual­ity health care that is ac­cept­able, af­ford­able and ac­ces­si­ble to all’’ in the coun­try by 2010.

Our health­care sys­tem has evolved with the chang­ing needs of the pop­u­la­tion. The Health Pol­icy, the Con­sti­tu­tion of Kenya and Vi­sion 2030 serves as our roadmap to­wards in­creas­ing ac­ces­si­bil­ity, im­prov­ing qual­ity and en­hanc­ing af­ford­abil­ity of health­care for all Kenyans.

To re­duce the disease bur­den and elim­i­nate geo­graphic and fi­nan­cial bar­ri­ers to ac­cess­ing health ser­vices by Kenyans, the Na­tional Trea­sury has con­sis­tently in­creased fund­ing for the health sec­tor to sup­port in­no­va­tive projects which are cur­rently trans­form­ing lives across the 47 coun­ties.

Through the Health Pol­icy the Gov­ern­ment is com­mit­ted to the prin­ci­ple of Uni­ver­sal Health Cov­er­age (UHC) by diver­si­fy­ing fi­nanc­ing op­tions that in­clude pro­gres­sive elim­i­na­tion of out of pocket ex­pen­di­ture; es­pe­cially for marginal­ized and in­di­gent pop­u­la­tions and pro­vid­ing es­sen­tial ba­sic health ser­vices to its cit­i­zenry.

Our health­care fi­nanc­ing sys­tem, com­pris­ing sub­si­dies; elim­i­na­tion of user fee in pri­mary health care fa­cil­i­ties; the Free Ma­ter­nity Ser­vices and the Man­aged Equip­ment Ser­vice (MES) project, has helped keep health­care af­ford­able, es­pe­cially for the lower and mid­dle in­come Kenyan, while en­sur­ing sus­tain­abil­ity in the long term.

Through the Kshs. 38 bil­lion Man­aged Equip­ment Ser­vice Project (Tiba Mashinani), Kenyans are en­joy­ing ac­cess to un­in­ter­rupted, qual­ity spe­cial­ized health ser­vices in 47 coun­ties and 4 na­tional re­fer­ral hos­pi­tals re­gard­less of their lo­ca­tion within the coun­try. To date we have in­stalled 144 dig­i­tal anes­thetic ma­chines in 85 hos­pi­tals, 129 dig­i­tal ster­il­iza­tion ma­chines in 95 hos­pi­tals,55 In­ten­sive Care Unit beds in three pub­lic hos­pi­tals,28 High De­pen­dency Unit beds pub­lic hos­pi­tals, 94 dig­i­tal x-ray sys­tems in 94 pub­lic hos­pi­tals and 48 dig­i­tal mam­mog­ra­phy units in pub­lic hos­pi­tals in ad­di­tion to 174 dial­y­sis ma­chines in 26 hos­pi­tals. The dial­y­sis ca­pac­ity has been en­hanced by 522 ses­sions per day across the coun­try. In­deed, spe­cial­ized di­ag­nos­tic and treat­ment ser­vices have been de­volved closer to the wananchi and in the near fu­ture, Kenyans will no longer need to travel abroad for spe­cial­ized treat­ment.

KMTC HAS DE­VEL­OPED 56 NEW CAM­PUSES IN 37 COUN­TIES

To in­crease hu­man re­sources for health the KMTC has de­vel­oped 56 new cam­puses in 37 coun­ties up from 31 cam­puses in 25 coun­ties, in­creas­ing stu­dent en­roll­ment to 40%. This is a ma­jor step in em­pow­er­ing young peo­ple ac­quire clin­i­cal skills as well as pro­mote eq­uity in ac­cess to med­i­cal ed­u­ca­tion op­por­tu­ni­ties. We en­deav­our to have KMTC foot­prints in ev­ery county.

These ef­forts to im­prove health­care, un­der­taken since 2013, have also con­trib­uted to ma­jor im­prove­ments in child and ma­ter­nal health in­di­ca­tors. Deaths of chil­dren below five years of age mor­tal­ity have de­clined from 74 to 52 per 1000 live births and in­fant deaths from 52 to 39 per 1000 live births. In ad­di­tion, ma­ter­nal deaths have come down from 488 to 362 deaths per 100,000 live births trans­lat­ing to 2,000 moth­ers saved from preg­nancy and child birth re­lated death an­nu­ally. Through the Free Ma­ter­nity Ser­vices pro­gramme, we have dou­bled de­liv­er­ies in health fa­cil­i­ties from 600,323 in 2013 to 1.2 mil­lion in 2016 and in­creased pri­mary health­care uti­liza­tion from 69% in the fi­nan­cial year 2013/2014 to 77% in 2015/2016 as a re­sult of fore­gone user fees.

Sim­i­lar im­prove­ments have been made in HIV/AIDS that is cur­rently sta­bi­liz­ing at below 6 per cent. Be­cause of dis­tri­bu­tion of 14 mil­lion arthemether – com­bi­na­tion ther­apy (ACT) doses, and 12.6 mil­lion long last­ing in­sec­ti­cide treated mos­quito nets (LLINs), the num­ber of house­holds own­ing treated bed nets has in­creased to 63% from 44% lead­ing to a drop of malaria preva­lence from 14 per­cent in 2010 to 8 per­cent in 2015.

RE­DUCE SPEND­ING AND IN­CREASE AC­CESS TO HEALTH SER­VICES

Through NHIF, we en­deav­our to re­duce cat­a­strophic spend­ing and in­crease ac­cess to health ser­vices to pre­vi­ously marginal­ized health pop­u­la­tions. Through the Health In­sur­ance Sub­sidy Pro­gramme for the Poor (HISP) and the Health In­sur­ance Sub­sidy for Older Per­sons & Per­sons with Se­vere Dis­abil­i­ties many Kenyan’s are now en­joy­ing ac­cess to both In­pa­tient and Out­pa­tient cov­ers, qual­ity ser­vices due to re­duced out of pocket spend­ing and im­proved health in­sur­ance cov­er­age from 14 mil­lion)in 2013 to 21.3 mil­lion in 2016. This com­mit­ment to­wards Uni­ver­sal Health Cov­er­age rep­re­sents a large shift for the cit­i­zens of Kenya.

NHIF is also ex­pand­ing med­i­cal cover to in­clude Non-com­mu­ni­ca­ble dis­eases, in par­tic­u­lar the in­tro­duc­tion of the Chronic Ill­ness Care Pack­age, cov­er­ing hy­per­ten­sion, CT scan, Re­nal Dial­y­sis, MRI, cancer, di­a­betes and Re­ha­bil­i­ta­tion.

To en­sure Kenyans get ac­cess to af­ford­able qual­ity health­care we have in­tro­duced pro­fes­sional fee and ad­ver­tise­ment reg­u­la­tion for doc­tors and den­tists and have also adopted mo­bile ap­pli­ca­tions for the pub­lic tover­ify reg­is­tra­tion sta­tus of the Med­i­cal and Phar­macy prac­ti­tion­ers.

Whereas there is still ground to be cov­ered, the gov­ern­ment is mak­ing good its health prom­ise to Kenyans and is com­mit­ted to achiev­ing Uni­ver­sal Health Cov­er­age as well as other na­tional and in­ter­na­tional health tar­gets.

The ul­ti­mate goal of achiev­ing high qual­ity of care will re­quire strong part­ner­ships be­tween the na­tional and county gov­ern­ments, de­vel­op­ment part­ners and the pri­vate sec­tor.

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Mother and baby at a Kenyan hos­pi­tal/

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