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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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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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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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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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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Welcome to PHR’s blog covering the first health and human rights conference for health workers in Kenya. The conference is being held by PHR’s partner group, the Kenya Health Rights Advocacy Forum (HERAF). We invite you to be part of this historic event.
This work began as a simple yet revolutionary idea: human rights violations are fueling the AIDS epidemic in East Africa. Health workers stand at the front lines of the epidemic, armed with knowledge and expertise on the most effective medical interventions—but are not necessarily connected to policy makers in charge of national programming. But combine health workers’ medical expertise with human rights knowledge and an advocacy orientation—and you have a powerful constituency for change.
In 2002, PHR met and partnered with a Ugandan AIDS activist who believed that if health workers in his country were educated on health and human rights, and mobilized, the health landscape in Uganda could change for the better. In the years since, health workers in Uganda have created a vibrant movement that melds their medical expertise with human rights advocacy to increase health funding, tackle the human resource crisis and end stigma in health settings.
This week we celebrate the growth and strength of a new network in Kenya—HERAF—which has been in operation for a year and has already engaged hundreds of health workers and students and held trainings and workshops on stigma, health financing, the human resource crisis, women’s rights and AIDS, and more. This conference will give members a chance to further explore key health rights issues facing Kenya and unite to fight them through innovative advocacy and engagement at the regional, national and international levels.
Keep checking this site. We will have posts each day from a number of conference participants, as well as photos—providing challenges, opportunities for collaboration and ideas for action.
Health workers worldwide are standing up for health and human rights: be part of this movement.
Sarah Kalloch is Senior Coordinator for the Health Action AIDS Africa Program, Physicians for Human Rights
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