Health Rights in Kenya

Sarah and I have been back from Kenya for a few weeks now and have had time to reflect on our trip—our many site visits, the HERAF conference, meetings we had with colleagues and a special breakfast with medical/nursing students.

The lessons learned were many and the importance of our partnership with HERAF clear. PHR’s commitment to building an international movement of health professionals dedicated to the right to health for all remains strong and energized as a result of these experiences.

In one of the closing sessions of the conference, I had the privilege of reading a letter written by Paul Farmer (PDF), an HAA advisor. He applauded HERAF, and all those health professionals in attendance, for their commitment to health as a human right. He stated:

A lack of health infrastructure is no reason for inaction; rather, it is a clarion call to action! Let’s talk about food, about sutures, medications, electricity, water and other basic goods…we must link all of our projects to re-building health systems, poverty alleviation and food security to governments and global health policy.

His final statement was: “So, let’s get going!”

In keeping with this message HERAF acknowledged that it has significant work to do in 2008—and the momentum and energy to make it happen. At the end of the conference, HERAF National Coordinator Miano Munene outlined several education and advocacy campaigns which HERAF will move forward over the next year. These include:

• Continuing to build a movement of health workers from across Kenya who are mobilized to advocate for health rights
• Raising awareness of health rights through education, outreach and media engagement
• Advocating for increased and effective health sector financing and improved civil society participation in the budget making process
• Addressing stigma in health settings through education and training as well as through policy promotion, especially around the HIV/AIDS Act of 2006
• Advocating for a strong national health workforce policy in Kenya to ensure quality, equitable health care delivery for all
• Supporting polices and programs that address women and girls unique vulnerability to HIV/AIDAS, and the human rights violations that fuel this vulnerability

These plans may seem ambitious, and they are. But we think HERAF and PHR can do it. We invite you all to join us on this continuing journey—keep checking the PHR Health Action AIDS page for updates, ideas and opportunities for collaboration, and please contact us if you have ideas or thoughts moving forward.

Together, we can change the health rights outcomes for millions and make the world a more equitable, healthy, prosperous place.

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On our last full day in Kenya we visited a grassroots AIDS service organization in downtown Nairobi named WOFAK, Women Fight AIDS in Kenya. Founded in 1993 by a group of women living with HIV, WOFAK presently provides care and support services to over 6,000 women and their families. As I walked into the simple, yet welcoming building that houses this amazing CBO, I saw a picture of Stephen Lewis. WOFAK”s executive director, Dorothy Onyango, proudly told me that WOFAK was the very first of the over 100 grassroots organizations in Africa presently supported by the Stephen Lewis Foundation—which to my mind is a sure sign of quality. Our partner organization here in Kenya, HERAF, is working closely with WOFAK on a national campaign, “Stop AIDS Now.” Dorothy explained how this project focuses on gender and HIV. She and her staff spoke of initiatives to change long held beliefs about women’s role in society and how they are challenging gender based attitudes and behavior. Empowerment support groups, community education that includes men, and advocating with policy makers to address the human rights violations against women, such as gender based violence and inheritance laws, are some of their frontline interventions. “It is an up-hill battle daily,” explained Helen, the co-coordinator of the campaign, “but we will continue.”

These courageous women seemed to be doing it all—providing a safe and caring place for women and their children while also recognizing the need to address the driving forces behind the feminization of the AIDS pandemic. When asked how they keep motivated to continue they responded by smiling and saying, “with the support of people like you.” With that they gave each of us a WOFAK t-shirt and asked us to put them on. “Now you are all soldiers for WOFAK,” said Dorothy.

PHR delegation with Dorthy Onyango, Helen Otieno and Charles Kaduwa from WOFAK.

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After a week in Kenya, on Thursday I attended a number of different institutions and discussions. Perhaps most moving and concerning was that involving a group of lawyers who researched and discussed violations against women in the Kenyan Healthcare system in a report entitled Failure to Deliver (PDF). Over a hundred women were interviewed about their experiences in the healthcare system, and the stories were frightening. They reported being hit, yelled at, bitten and ridiculed by healthcare workers for being pregnant. Those at highest risk were those also infected with HIV. Such discrimination and abuse was sobering, and although it is likely linked to the poor working conditions of the healthcare staff (underpaid, twenty hour workdays, hundreds of patients, poor facilities, lack of supplies), such behavior is intolerable and demands attention and support.

We also visited a group called WOFAK (Women fighting AIDS). They are doing front-line work by providing care, support, job training and referrals for thousands of women and girls who are living with HIV/AIDS. Again they struggle with lack of resources, staff and discrimination against women, but are committed to their work and are excited about a facility that will be built by the Italians in the year to come.

I am so impressed by the work being done by these organizations, but feel overwhelmed by the task facing them. I am excited to return to the states to advocate for continued support and increased funds for the work being done in East Africa. This epidemic is far from over, and the socioeconomic issues continue to fuel this fire. The staff of PHR and HERAF have been inspirational in their work. I look forward to working with them in the future. There’s much work to be done!

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Inspirational, motivational, phenomenal…..are a few of the words shouted out by participants on Thursday afternoon when asked by the facilitator to describe their experience at the 1st annual HERAF conference. She paused, looked at the group and said: “and so are all of you!”

For 2 days our HAA delegation has had the privilege of sitting alongside 70 health care workers who traveled from across Kenya to address a shared vision: a country where “health is recognized as a fundamental human right with access to equitable, affordable health services for all.” The passion and commitment we witnessed to reaching this goal was remarkable.

We listened and learned as they challenged one another, confronted their government leaders and questioned policies that fail to promote human rights…. including the US policy that prohibits a person with HIV to freely travel to the US!

We discussed human resource shortages: inadequate government funding needed to build strong health care systems, stigma and discrimination within the healthcare work place and gender inequity. These barriers to the fulfillment of HERAF’s vision and the challenges ahead were candidly acknowledged, but I could not help note that the resolve for change was unwavering.

Of the many excellent presentations made there was one that resonated deeply for me…. “The Right to Health: Influencing the Gender Agenda in the Kenyan Health Care Setting,” given by Dr Peninah Ogada. Dr Ogada is an older woman who described herself as “recycled material.” Widowed at a young age in rural Kenya, she dedicated herself to her children’s well-being and education. She farmed, sold portions of her crops for money and worked hard to make ends meet. She recalled the many times she had to travel miles, often on foot, to the closest health clinic with a sick child, wait in long lines, pay fees she could not afford and then was frequently treated disrespectfully by those who called themselves “caregivers.”

Dr. Peninah Ogada speaks at a session of the HERAF conference.

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The HERAF Conference is over, but it was another full day for the Health Action AIDS delegation. Here is an overview of what we did today.

8:30 a.m. – 9:30 a.m. Meeting with the USAID Capacity Project
The Capacity Project is funded by USAID, and works with the Ministry of Health in Kenya to build and sustain the health workforce. Capacity Project works to improve workforce policies and planning, develop better education and training programs for the workforce, and strengthen systems to support workforce performance. Currently, the Capacity Project has implemented low-cost work climate improvement interventions in 5 sites throughout Kenya (it is expanding), which will provide a foundation for understanding what determines performance of the health workforce. Capacity Project staff members are very interested in workplace culture among health professionals in Kenya, as well as a pervasive negative attitude among health workers, an area that HERAF members have also identified as an advocacy priority.

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We thought you might enjoy this group photo of people from the conference.

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(Part 1)

During responses to Maina Kiai’s keynote presentation, Winifred Lichuma used the Treatment Action Campaign’s successful lawsuit against the South African government as an example of the power of the collective voice and spirit of the people. The lawsuit demanded that the government provide intervention to prevent mother to child HIV transmission among pregnant women. Having worked with the Treatment Action Campaign in 2001 and 2002, I remembered how TAC provided education and outreach through their Treatment Literacy mobile workshops—which engaged people in both urban and rural townships in changing the government response to HIV/AIDS. They based their campaign on the very progressive South African Constitution. Winifred acknowledged the Kenyan Constitution does not have the same progressive language as South Africa’s Constitution, but advocated for similar action and involvement in Kenya. Getting such language incorporated into the Constitution and getting similar levels of involvement in campaigns would greatly benefit Kenyans.

I remembered how TAC leadership was so involved and invested in their people. I thought about the words of one of my friends and personal heroes Mandla Majola, the TAC provincial organizer from the township of Gugulethu, who once told me that people are in need of leadership but in order to be a true leader the people must know and trust their leader, and the leader must know his or her community and people and to earn their trust. Mandla told me that sheep instinctively know not only the smell of their shepherd but also can sense the care of their shepherd. He gained people’s trust by getting to know them and profoundly caring about their welfare. The Treatment Action Campaign were some of the first activists I had ever met, and they moved me to want to be part of their work in South Africa.

I see in this Kenyan conference similar rumblings of intelligence, commitment, activism and demand for care, and I hear the frustration and burnout of health care workers feeling heavily burdened and demoralized. Activists and people living with illness, abuse and disregard are fed up and angry at a system that is not serving their needs. I know this tremendous anger can translate into tremendous energy, and I am grateful to have this exposure to human rights issues in Kenya.

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The conference has been very motivational and stimulating! The presenters were of  incredible caliber and the attendees have a commendable willingness to advocate for healthcare rights. Their freedom and commitment to discuss difficult issues and to question the current status of healthcare rights and healthcare is inspiring.

Part of the excitement to be agents for change may stem, in part, from the current charge that can be felt throughout Nairobi. General elections are scheduled for December 27 and Kenyans are anticipating the opportunity to elicit tangible change.

All too often we think of care for HIV-infected individuals in terms of access to antiretrovirals and testing for HIV. It is easy to forget the intimate relationship between development and health. This was one of the topics discussed at length yesterday. Instead of defining healthcare as physical wellness or the lack of disease/physical signs and symptoms, the concept of healthcare should be examined as a whole. Addressing healthcare issues includes also influencing physical, emotional and spiritual health and setting goals to decrease poverty and improve access to education, sanitation, access to clean water, employment and food security.

Another essential aspect of comprehensive health care discussed at length during site visits and at the conference, is how to best care for the health care worker. We heard from many sources how health care workers often do not seek their own health care at their site of employment. Stigma, lack of confidentiality, lack of space, and all too little emphasis on employee health are all contributing factors. As a result, retention and employee health suffer.

While visiting one of the clinic sites, we saw the one room clinic space currently set aside for employee health care. In an effort to provide better care to the health care workers (HCWs), one of the physicians is hoping to gain access to a larger space on the hospital campus to provide more services and greater confidentiality. Along similar lines, the other clinic has begun to take their voluntary testing and counseling services to each of the units, providing stigma training and offering testing. So far they have had a significant number of HCWs testing for HIV. I am looking forward to our meeting with another agency today, that has been attempting to increase care to HCWs by mobilizing professional organizations and taking small steps to improve work place satisfaction.

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Dr. Nyunya is Chairman of the Eldoret Branch of the Kenya Medical Association and leads the department of reproductive health at Moi University in Kenya. A longtime health and human rights activist, Dr. Nyunya works closely with the Health Rights Advocacy Forum, raising awareness of reproductive health and rights and the key barriers preventing women from accessing health care in Kenya.

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I have worked in HIV care for over 20 years and for the past 6 years I have spent much time working in HIV care and treatment programs in sub-Saharan Africa. But I haven’t been so openly exposed to human rights issues in a setting like this, where rights are discussed and debated among health care workers, human rights activists and policy makers, as I am at this conference. I am grateful to Physicians for Human Rights for opening my eyes and ears to concepts that previously never made it past the thinking stage.

Chris Shaw and Abel Onyango talk during a break in the conference

It’s the end of day, and I am tired and jet lagged, yet I can’t stop thinking about what has transpired in both the formal presentations and the personal conversations. I want to review my notes and remember what was communicated among and by my Kenyan counterparts who live and breathe these challenging issues of inequality, limited resources, human rights dilemmas and violations—some entrenched in their own policies or lack of policies and some emanating from the West and US policies that further stigmatize people and obstruct social, psychological and human progress.

In his keynote presentation Maina Kiai, Chairman of the Kenyan National Commission on Human Rights, spoke passionately on the barriers to health care and human rights. He reminded conference participants that government does not have money per se, that any money available belongs to the people and government is but an agent of allocating and ensuring available money is equitably delivered to the people. He challenged the participants to hold government accountable for the ethical delivery of this funding. He acknowledged the burden of poverty as an obstacle to ensuring human rights and health care, and he addressed the problem of corruption as one of many obstacles.

Chairman Kiai openly discussed the previous government’s diversion of 130 billion Kenya shillings from health coffers to overseas accounts, which to this day have not been returned. He detailed the types of health services and programs the stolen money could potentially have funded, and he encouraged all in attendance to be proactive in ensuring health service accountability. “When people in government take money hard questions must be asked.” Chairman Kiai used the Kenyan elections—known as “3 in 1,” whereby the President, Ministers of Parliament and local officials are elected together, based on party affiliation, rather than on indvidual merit or on their commitment to the people—as an example of not challenging and changing the status quo, even when the end result either hurts them and serves no direct benefit to them or their community.

Paul M is an openly HIV positive man who has been an energetic presence at the conference. He is so justifiably angry when he speaks to us about the unjust US policy requiring HIV positive individuals to have their condition stamped on their visas and limiting their US visits to two weeks. This policy further stigmatizes an already over-stigmatized group of people. It doesn’t make sense to him or to anyone else at the conference, which is packed with nurses, doctors, journalists, anthropologists, ministry of health officers, pastors, social workers, policy makers, human rights activists and people living with HIV and or AIDS and their collective energetic frustration and anger is encouraging.

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Having now spent a couple of days in Kenya, I am learning a lot about the healthcare crisis they are facing. Yesterday we visited the Kenyatta hospital which is the tertiary care center for much of Kenya and the teaching hospital. We also talked with the Director of Programs for AMREF, a foundation which provides services to rural communities and those affected with HIV, TB and malaria by use of airplanes and education strategies.It is clear that severe shortages in healthcare workers (some estimates are as low as 1 provider per 100,000 patients) along with stigma and discrimination toward women and those infected with HIV are severely limiting this country’s ability to achieve its healthcare goals. Today’s conference focused on creating relationships with others in the healthcare industry who are committed to ensuring healthcare is a human right, that should not be reserved for the rich or urban citizens.

At first I felt overwhelmed by the work that lies ahead for this community. Like many complex systems, ensuring quality healthcare for all is not an easy task. But today examples were cited that make sense of how this group moves toward advocating for this right. I am struck by the diversity and commitment of the group, and the sense of community I immediately felt. I am incredibly appreciative of Physicians for Human Rights for inviting me to such a forum to learn and advocate; and for their vision in creating such a forum to bring allies together. I look forward to learning ways that I and my US colleagues can help the ongoing struggle.

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Paul Moses Degwa is a longtime HIV activist. In this podcast, he speaks about health systems and stigma.

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We spent yesterday at the Health Rights Advocacy Forum Conference. The agenda was phenomenal, including well-known Kenyan speakers and a range of topics including: basic health rights, advocacy for health care workers, the impact of development partners on health worker policies and health sector reforms. The sessions were informative, yet overwhelming. It was all I could do to try to soak it all in and attempt basic processing of the information.

One of the topics touched on throughout the day was the issue of brain drain, the loss of trained health care workers from developing nations to wealthier nations. Health care worker shortage in Kenya is a complex issue. Kenya actually has a surplus of trained nurses but a shortage of funding to provide positions for all of them.

[Suzy Jed, MSN, APRN-BC and the American and Kenyan teams in the Kenyatta National Hospital HIV Comprehensive Care Clinic Laboratory]
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Lissy and Sarah have been telling you about what the Health Action AIDS delegation has been doing. The delegation includes Physicians for Human Rights staff, but it is also made up of three health professional members of the Health Action AIDS Campaign. In this post, I’d like to give you a brief introduction to the health professionals who have come from the US to be part of this delegation.

• Suzanne Jed, MSN, APRN-BC is an Instructor in clinical Family Medicine at the University of Southern California. She currently provides care to HIV-infected adult and pediatric patients at the Maternal, Child, and Adolescent/Adult Virology and Infectious Disease Clinic and is Program Development Director for the USC Pacific AIDS Education and Training Center. Born in San Jose, Costa Rica, Suzanne is a native Spanish speaker. She relocated to the United States to pursue her nursing education. A graduate of Vanderbilt University School of Nursing, she practiced family medicine for five years prior to transitioning into the field of HIV/AIDS care and education. She has traveled extensively and has provided training and mentoring in HIV/AIDS nursing in Ethiopia.

• Mark Rolfe, MD is a family medicine practitioner with a special interest in HIV medicine. He established his practice in this area in 2001, and treats over 100 adults with HIV in rural Maine. He is board certified by the American Board of Family Medicine and board certified in HIV medicine by the American Academy of HIV Medicine.

• Christopher Shaw, RN is an HIV/AIDS certified nurse in the Infectious Disease Department at Massachusetts General Hospital in Boston. Christopher has been working in the HIV field since 1985, when he cared for patients in a South Bronx hospital and a hospice in Greenwich Village. Among many projects, he has helped set up HIV treatment sites in South Africa, educated health workers about treatment in Ethiopia, and co-founded “Sibusiso” (a Zulu word meaning blessing) a non-profit organization based in Boston that partners with HIV programs in the KZN and the Eastern Cape provinces of South Africa to support health care workers.

Pat Daoust, MSN, RN is Campaign Director of the Physicians for Human Rights Health Action AIDS Campaign.

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The Health Action AIDS delegation will spend all day today and tomorrow participating in the 1st Annual Health Rights Advocacy Forum Conference. We’ll be blogging about some of the conference happenings in a little while. In the meantime you can read the conference overview and peruse the schedule of sessions.

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Political theorist John Rawls poses an intriguing question about human rights: If none of us knew where we would be born, if we would be rich or poor, healthy or ill, male or female, short or tall, American or Kenyan or Indian or Chilean, what human rights would we want to be guaranteed? What choices would we want to have about how to live our one wild and precious life?

Today for me was all about the choices we have in America—and the choices Kenyans have, and what that means for health and human rights and the way we live and work and grow and play and celebrate. So what do I mean by choice?

[Sarah Kalloch, HERAF Chairman Andrew Suleh, MD and Suzy Jed, MSN, APRN-BC at Mbagathi District Hospital]

The Choice to Live: In 1997, Mbagathi District Hospital, near Kibera slum, opened its first AIDS centre. Options were limited: there was no treatment, no ART, but there was counseling and psychosocial support—and a special kind of community dealing with sickness, and despair and death mixed with glimmers of hope. Ten years later, people living with AIDS who come to Mbagathi have a choice. The hospital’s Comprehensive Care Clinic has 3500 people on ART. We met one patient—a man in his 20’s or early 30’s named Boniface. Boniface is HIV Positive. But Boniface has choices. His CD4 count when he began ART at Mbagathi in 2004 was about 200. It is now over 800. Boniface has chosen to celebrate by becoming a peer counselor at the hospital: a few minutes after he left our delegation, we saw him giving a talk to patients in the AIDS clinic waiting room, coaching them, supporting them, connecting them, and making them feel like they can fight this disease. People with AIDS in Kenya have a choice now: they can get treatment. They can live for years and years. They can take care of their families and be part of their communities. We know prevention is critical, and many argue it is more cost effective than treatment, especially in Africa. But I wouldn’t want to tell Boniface that—would you?

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After our visit to Mbagathi District Hospital, we went on to Kenya’s largest referral, teaching and research hospital: Kenyatta National Hospital. The facility has ten floors of wards, and a staff of 4,000. In fact, KNH is overstaffed. A mere five minutes away from Mbagathi District Hospital, the halls of KNH are filled with white coats, and specialists crowd the stairways. The Comprehensive Care Center is two stories tall—a gleaming white building on the sprawling KNH grounds.

And while a single ward may be ready with 10 senior physicians, Kenyans have great difficulty getting care at the hospital. It is a tertiary facility—the last stop in Kenyan healthcare—if you manage to afford the referrals, transport and patient fees. While all services at the Mbagathi CCC are completely free, the CCC at KNH requires patients to pay a monthly consultation fee of 300 Kenyan Shillings, about 4 US dollars. This is a prohibitive cost for most Kenyans: it’s just not possible. And yet KNH receives nearly 50% of all government funding to the health sector in Kenya.

Beyond the numbers and underneath the paint lies a very different, and often unexpected, story. Improving AIDS care in Kenya is not just about the size of the CCC, or the quality of CD 4 machines, or the salaries for staff. US dollars and Kenyan Shillings don’t translate to the improved access and quality so desperately needed. The solutions involve looking beyond the individual facilities and the medicines and the most obvious numbers. We will not find all the problems at one clinic, and we won’t find the solutions in one place either.

[The Health Action AIDS delegation with staff at Kenyatta National Hospital]

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I woke up this morning thinking that I knew what to expect. But you can never know what to expect, and I’m grateful that I was wrong.

I thought I’d visited Mbagathi before. I’d seen the grounds and spoken with physicians and clinicians, but I hadn’t understood the true strength of the facility and the Comprehensive Care Center. We were lucky enough to share experiences with health workers at the Mbagathi CCC, including nutritionists, peer educators, counselors, HIV/AIDS trainers, and physicians. The facilities were minimal—simple tents set up for group counseling; one room with three wooden benches for discussions on second-line treatment and training health workers on HIV/AIDS-related stigma.

[Lissy Desantis, HERAF Chairman Dr. Andrew Suleh and Pediatric AIDS Counselor Judy Ouko at Mbagathi Hospital, Nairobi]

In the women’s general ward, there are 30 beds. This morning, there were 50 patients, and nearly every bed had 2 women sleeping head to toe, wrapped in their own blankets. Yet Mbagathi is much more than overcrowded wards and the bare minimum facilities. Mbagathi is a model Comprehensive Care Center in Kenya, not because of the quality of its training room or the videos it has playing in the children’s waiting room. It is a model CCC because of the staff that comes to work every day. Including Judy, who counsels children receiving ART and conducts anti-stigma training among her fellow health workers, reminding them that “Before we point a finger, [health workers] must realize that we are all at risk.” Also Boniface, a peer educator at the CCC living positively with HIV. His CD 4 count has increased from 200 to 887 in eighteen months on treatment at Mbagathi. And Dr. A.J. Suleh, Chair of the Health Rights Advocacy Forum and Practitioner in Internal Medicine at Mbagathi, one of the only staff actually employed by the Kenyan Government.

And that’s the twist to the story: the majority of the dedicated and motivated staff at Mbagathi, all of whom work in tiring conditions with minimal facilities, are set to be moved from the facility in February of 2008. They are employed by Médcins Sans Frontières, whose three-year agreement with the Kenyan government has come to an end. It’s now the government’s responsibility to staff this clinic, to promote the comprehensive care of HIV positive patients, and to promote the well-being and psychosocial support of its health workers. And while there is pressure on the government to do this, the workers at Mbagathi who will remain after February are worried. The numbers of patients will only increase, training needs will only increase, and the need for psychosocial support—for patients and providers—will only increase. The Kenyan government’s promises aren’t enough for these health workers. And they won’t be enough for the patients seeking care either.

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As promised in my previous post, I’ll be sharing the plans of the Health Action AIDS delegation each day. Today our group will visit two hospitals and meet with two partner organizations.

9:00 a.m. – 11:00 a.m. Visit to Mbagathi District Hospital

This tour will be led by Dr. A.J. Suleh, Chairman of the Health Rights Advocacy Forum and Chairman of the Kenya Medical Association’s Nairobi branch. Mbagathi District Hospital is a key health facility in Nairobi, and has been at the heart of providing comprehensive HIV/AIDS care in the face of the unfolding epidemic in Kenya. Mbagathi handles 10,000 patients, 1,000 of whom are children. The hospital also has 5,000 adults and 500 children on antiretroviral therapy and performs 150 consultations daily. Mbagathi District Hospital offers VCT, DTC, PICT, and PMTCT services, as well as TB care and counseling, among other services.

Mbagathi is a public health facility funded by the Kenyan government, and it also receives support from the international donor community, including the Clinton Foundation. As a provider of comprehensive HIV/AIDS care and treatment, a recipient of public funding and a target for international funding, Mbagathi District Hospital is critical for identifying advocacy needs for health workers in Kenya.

The PHR delegation will first meet with senior MDH staff for an overview of services offered, as well as recent successes and challenges in providing HIV/AIDS prevention, treatment and care. The delegation will then tour the complete hospital facilities, including the wards, and have a chance to shadow MDH nurses and doctors and exchange with Kenyan colleagues.
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This week is a very exciting week for us here in Kenya. The Health Rights Advocacy Forum (HERAF) will be hosting the first conference of its kind in Kenya, assessing Kenya’s commitment to the right to health. Health workers from throughout the country will be attending the conference in Nairobi, and we have a group of doctors, nurses and PHR staff coming from the United States to support the conference and stand in solidarity with Kenyan colleagues.

The Kenyan health sector faces incredible challenges, but HERAF’s work over the past seven months has shown that Kenyan health workers are up to the task. The annual conference will address 4 key issues in Kenya: realization of the right to health, financing for health, support for the health workforce, and stigma and discrimination in the health setting.

The Health Action AIDS Campaign doctors and nurses will also visit Kenyatta National Hospital, the largest referral and teaching hospital in Kenya, and Mbagathi District Hospital, a flagship comprehensive care center for HIV/AIDS. However, these visits are just the beginning. They’ll also have a chance to meet with key partners in health workforce development and HIV-prevention among women and girls, to share PHR’s work across the globe and to learn from the experience of service providers on the ground here in Kenya.

Through Saturday, I’ll be posting an overview of what the Health Action AIDS Campaign has planned each day, and the doctors and nurses and others will blog with their perspectives on these experiences. This is an incredible opportunity to build connections across continents and forge the partnerships necessary to change the way health is imagined, demanded and delivered in both the United States and Africa.

Lissy Desantis is Kenya Program Associate for the Health Action AIDS Campaign, Physicians for Human Rights.

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