Health Rights in Kenya

Health Rights Advocacy Forum (HERAF)

Day 1

Attendees:

Health professionals; public health officials; people living with AIDS; the Campaign for Microbicides; health professional students; health workers living with AIDS; disability advocates; hospital officials, including Kenyatta National Hospital and other outlying hospitals; teachers; members of the media; health and human rights organizations, including the Action Group for Health, Human Rights and HIV/AIDS (AGHA); mental health specialists; women’s rights and reproductive health advocates; and sex worker advocates, among others.

Participants are from Uganda, Sudan, Rwanda, Tanzania, and across Kenya, including the Western, Central and Coastal regions.

Please see HERAF’s website for more information: http://www.heraf.or.ke/

Report:

The first speaker, Sister Elizabeth Bundala, with Medical Missionaries of Mary, reviewed the difficulties of providing care to approximately 1.5 million poor who live in the slums of Nairobi. One facility has seen more than 16,000 out-patients in 2008. The adult services saw 70 patients per healthcare worker per day, while the pediatric services have seen 156 patients per day per healthcare worker. One of her specific concerns was the fact that some government-funded clinical facilities that were completed as long as two years ago remain empty and without staff, leaving it to faith-based and other non-governmental organizations to provide care. Sister Bundala noted a concern that external funding is not reliable and relying on fluctuating gifts is not sustainable. She stated that NGOs should not be used in place of the government as a health care services strategy.

Hon. Prof. Peter Anyang’ Nyong’o, Minister of Medical Services, was scheduled to speak, but sent a  thoughtful and articulate representative from the Ministry, Dr. Stephen Muleshe, to read the Minister’s speech. He discussed the UN definition (Part of the UN’s International Bill of Human Rights) of the right to health as “thehighest attainable standard of physical and mental health,” noting that the right to health requires government to provide policies to aid the achievement of health.

The Minister’s representative reported that the significant improvements in Kenyan national health status that had been achieved by the early 1990s have been reversed by the high prevalence of HIV/AIDS. Some comments after the presentation by the Minister indicated some disagreement with this, as it was noted that the health dispensaries were short on staff prior to the epidemic. Other concerns were the task shifting that has occurred with nurses being required to do tasks for which they are not properly trained or experienced. There was a call for proper training and protection of nurses and patients in terms of job description expansion.

The Minister’s representative clearly and importantly stated that health rights is a central pillar of the government’s planning, including health rights as a central pillar of economic recovery. Kenya has extreme levels of poverty with half of the population living below the poverty level, with education, sanitation and nutritional needs in addition to health care needs. The national goal (in agreement with the UN’s Abuja target) of 15% GDP toward health has not been achieved, although the current 9% is an improvement. He also spoke of trying to reduce bureaucratic barriers, including an agreement in principle to move financing directly from the Ministry of Finance to health facilities rather than being directed through the Ministry of Health.

After tea, Mette Kjaer of HENNET provided a thorough review of the Health Sector Reforms, as well as Vision 2030, whichinclude efforts to decentralize health care services and to focus more on preventative rather than simply curative efforts. She reviewed the need for health sector reform and coordination of private sector and public health efforts, including an agreement or “Code of Conduct” with clarification of roles between government and non-governmental agencies. Her focus for going forward is to help bring rights implementation to the health sector. She also spoke about reducing the number of indicators from over 300 to about 40 to monitor program effectiveness. Currently, too often monitoring is of outputs not outcomes.

Each of the morning speakers reminded me of the difficulties of providing equitable health services without a plan for universal accessibility, including affordability of care. Of course the US is lagging far behind all the developed countries of the world in this arena. Kenya is developing a plan, but is seemingly having some confusion about how to proceed with an insurance plan to pay for private and public care versus government funding of care.

Dr. Otieno Nyunya from the Kenya Medical Association discussed sexual and reproductive health rights in Kenya.  He discussed“safe motherhood,” which includes work on gender-based violence, prenatal care,  assistance with unwanted pregnancies, etc. He noted that maternal mortality estimates are as high as 1,000/100,000, and 30-40% of maternal deaths in Kenya are thought to be associated with abortion.  Dr. Nyunya noted that widespread sexual violence may be associated with the high numbers of abortions. He indicated that theNairobi police recorded between 2,800 and 3,000 cases of rape in 2004 and 2005 , compared to hospital data from the same period recording over 16,000 per year.

Cultural issues, such as wife inheritance (which occurs when a man dies and  his brother “inherits” the widow), were discussed as a serious problem resulting in  increased vulnerability of women to HIV. Other cultural concerns discussed included women’s empowerment to say no or insist on condom usage.

We also heard from Steven Rulisa of Rwanda and Margaret Byabakama-Muyinda of Uganda, who both described some of the successes and challenges of meeting health needs in their countries. One of the remarkable efforts of the new Rwandan society was a constitutional mandate for a minimum of 34% women in their parliament which encouraged women to try for office and has resulted in women elected to 54% of the seats in parliament!

In the afternoon we heard from Dr. Irene Mukui from the National AIDS and STD Control Programme (NASCOP) on the situation of pediatric access to ART in Kenya. She reported that only about one-third of children who should be on anti-retroviral therapy are receiving that treatment (about 20,000 of 60,000 who are eligible for ART.) We also heard from Pauline Irungu from PATH International, who reported on the use of female condoms and the status of microbicidal research.

Energetic discussions followed most of the presentations. As we heard the issues today, it seems that an advocacy agenda is starting to develop. I anticipate tomorrow will be very productive.