Health Rights in Kenya

After HERAF came to an end our work continued with visits to a couple of very exciting agencies and then we toured an outlying district hospital.

The first agency visit was with the Population Council where we learned about their work for more than fifty years in reproductive health, including women’s rights to safe pregnancy. This is where issues related to women’s rights really hit the ground. Some of the topics they have taken up include gender-based violence which is an issue not only within families, but is often culturally sanctioned such as female genital cutting (female “circumcision”.) They have also developed innovative approaches to care, including the integration of HIV testing and counseling into family planning visits.

We traveled a bit further to meet with representatives of Marie Stopes, Kenya. Not a person, this is a British agency that offers significant family planning and health services, including post-abortion care. It is estimated that up to 40% of maternal deaths are associated with abortions and MSK is one of the few agencies that provides medical care for these women, particularly in rural areas.

Marie Stopes doctors have perfected a ten minute tubal ligation procedure done under local anesthetic which has provided voluntary permanent sterility to many women. The staff discussed an example of a woman who had 18 babies, but was not able to insist on condoms or to use other birth control with her husband. The agency also offer safe circumcision which has been shown to reduce HIV transmission, and vasectomies. MSK provides 80% of the tubal ligations performed in Kenya and has advanced a number of other innovations, particularly in marketing of vasectomies, etc. An example is the special condoms which they market under the name “pleasure”.

Shockingly, considering the level of work that is done by the Marie Stopes agency and the fact that this is the only health care provider in many rural areas (they have 25 active clinics), the US government has recently announced stoppage of all support for MSK. Invoking the 1985 Kemp-Kasten Ammendment allowing the President to deny funds to organizations that support coercive abortion or involuntary sterilization, the Bush administration has added MSK to the exclusion from support. This is based on a determination that like the United Nations Population Fund (UNPF) which provides some services in China, Marie Stopes International also provides support to people in China. This is the connection which the US cites to cut funds and in fact to ban funds for any agency that might peripherally work with MSK. It is the first time the amendment has been used to deny funding to any group other than the UNPF.

It is not possible to really comprehend the loss of life this apparently small yet outrageous decision by the US administration will cause. Fewer condoms, especially in rural areas will equal more deaths due to HIV, as well as the certain increase in abortions due to unwanted pregnancies with all the resulting infections and deaths. Studies indicate that MS prevented over 12 million unintended pregnancies in Africa in 2007.

The people we met with are hopeful for real change in these policies with the new administration coming in January.

Our final visit was to a district hospital. We drove for a couple of hours over a very busy and extremely “washboard” road. We were so jostled my jaw ached from holding my teeth tight so they did not clatter. The hospital was large and included outpatient as well as inpatient services. Near the check in desk was a sign: “Huduma Bora Ni Haki Yako” (Good Service is Your Right) – the goal we all hold for patients in Kenya and at home.

I am delighted to have attended this conference on right to health, where it was reported that high numbers of people who cannot afford to access health in Kenya where 56% of people live under $2 per day and 30% live under absolute poverty. This conference has forced me to think about where the real answers lie for this problem.

I think while advocating for the right to health, the control of population growth should also be considered. Most health problems proportionally rise as the ratio of dependents for each breadwinner in the community increases. Poverty related diseases such as HIV, TB & Malaria are the major causes of morbidity and mortality in most developing countries. Control of these diseases should be from where they are (at the community level), and not from the top. Communities should be educated on basic disease mechanisms and control.  This is where the strong role of leadership comes in mobilizing and equipping people with the knowledge and skills to combat these diseases.

A good example of this is the empowerment of women since at the community level as women bear the biggest burden of working and feeding the family.  If women are empowered and educated, they could help in fighting these diseases and hence foster development. Community health insurance, like the system that we have initiated in Rwanda, is one of the basic tool for which we must advocate. Once people are insured it increases health seeking behavior.  People do not have to fear for the charges once they go for treatment, and this alone serves in poverty alleviation and disease control.

Take an example of malaria -  early diagnosis and treatment are major tools in combating malaria for it enables the patient to get cured early and faster and go back to their jobs. It also shortens the period of transmission of the disease to other members of the family, which can help the control of the disease leading to increased productivity and a healthy workforce. Poverty can be combated if more hours are spent working rather than in the hospital sick or caring for a family member who is sick. For this to be effective there must be a strong leadership from above to empower those below to participate in their own affairs of disease control and prevention.

I enjoyed meeting my colleagues in Kenya who are also interested in promoting health rights, and I look forward to working with them in the future.

Hi all…for my first blog entry from the second annual Kenya Health Rights conference I’m beginning at the end..in other words, the best way to start to synthesize the vast amount of data and the number of powerful stories of health rights violations and opportunities presented over the last two days is to look back from the finish line…particularly because we ended with the most salient rationale for a rights-based approach to health…simply put, it works.

Anand Grover, the new UN Special Rapporteur on the Right to Health and a prominent lawyer and health rights leader in India, ended the conference by walking attendees through this results-based rationale for health rights. As Grover laid it out, whether you’re a health worker and/or citizen of Kenya or India (or, for that matter, the US), it turns out that we’ve already got waves of evidence that reveal the ineffectiveness and inefficiencies of non-rights based health systems.

Example: health system financing…During the conference, for instance, we learned that more than half of all Kenyans pay for health care out-of- pocket. In a country where 56% of Kenyans live on less than $2 a day, the lack of a health financing system based on principles of equity, access, and affordability has direct visceral consequences for a population that already live on the margin. Got asthma?…cough up the money for your life-saving preventive and curative treatments. Break your leg? Expect a crippling assault on your life’s savings and your kids’ chances to eat. Without a rational health financing system, the default is a out-of-pocket system that penalizes the poor and helps to exacerbate rather than address illness and inequity. The absence of rights, speaker after speaker powerfully voiced, equals the absence of health .

What’s the alternative? In Kenya, it turns out the problem is not the absence of alternative health financing tools.. in fact, we heard a variety of local NGO leaders and health care workers debate the merits and drawbacks of several health financing options that exist in some form in Kenya already. We learned of the tax-financed supply-side system largely used to staff public facilities…we learned of a demand-side insurance schemes, including one known as the National Hospital Insurance Fund…we learned of innovative community-based health financing models tied to micro-credit enterprises (which, in its largest example, covers 200,000 people in one of Kenya’s provinces). we learned of the private for-profit insurance programs that differentially select (or cherry-pick) the healthiest patients by excluding others with pre-existing conditions (like HIV)…in fact, like in the US, Kenya has a dizzying fragmented collection of health financing options. and, like in the US, Kenyan patients, especially the most vulnerable, continue to fall through the cracks.

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The Conference day opened with an overview of the current Kenyan health financing system by three speakers, Burkard Koemm, Julia Ouko and Peter Nyarango. Mr. Koemm included a description of the various types of insurance financing available and noted a system must provide a method of collecting funding as well as a method for distributing payments.

Ms. Ouko reviewed the current National Hospital Insurance Fund which has provided hospitalization coverage (not outpatient services) for forty years. The NHIF functions similarly to the US Medicare system in some ways. For example, this agency establishes the payment for services and contracts with hospitals to provide services. Recognized issues include high costs (NHIF administrative costs run as much as 57%, leaving less than half for payment of services) and There are discussions about expanding the NHIF to include coverage for outpatient services and to expand the fund to cover all Kenyans by 2014.

Mr. Nyarango was a bit more critical of the current system and the need to consider complete change. He pointed out that although the NHIF covers 80% of the formally employed through employer/employee contributions, only about 10% of the Kenyan population are formally employed. More than 56% of the population lives at or below the poverty level of $2 daily. The indigent are not covered by NHIF, and only 25% of the self-employed voluntarily purchase the insurance.

The rest of the morning was spent reviewing issues related to health care workers resources. Patrick Mbindyo presented some research noting the over-emphasis on ethnicity and political affiliation resulted in problems during the post-election violence. He and others called for more professionalism in order to build more respect and recognition for the health care workers as professionals to transcend the tribal differences. There were also calls for help for health care workers who were traumatized during the terrible aftermath of the post-election violence and the need for better preparation for future disasters.

Emily Bancroft of PHR reviewed methods that have been used by others to leverage the Global Fund monies to strengthen overall health systems, including increasing health care worker resources through salary support and skills building. Chris Rakuom reviewed the importance of nurses and the challenges of training and certifying nurses. Nurses are the basis of care, providing 80-90% of healthcare services, according to the World Health Organization. He noted that nurses are often among the only public servants in many rural areas (alongside teachers and security personnel.) WHO recommends 200/100,000, yet in Kenya there are only 49/100,000, a shortfall of about 47,000 nurses. Yet, Kenya actually exports trained nurses abroad. Mr. Rakuom explained that the government is working on methods to improve nursing retention in the nation and in specific rural areas.

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“In every adversity there is an hidden seed of advantage.”

Early this morning I was up and resumed my early morning ritual of watching news programming as I prepare for the day. Unlike my first 2 days in Kenya my anxiety level was such that I felt relaxed enough to explore a bit. I decided to get the Kenyan perspective on the news. I found the above quote on TV K-24 (all Kenyan all the time). My time is Kenya has quickly taught me that the Kenyan people espouse to the philosophy inherent in the quote. They are can do sort of people who don’t let the barriers (limited supplies, shortage of health workers, etc. ) create obstacles.

For example, earlier this week we visited the Liverpool VCT. I sat in awe as the staff discussed their scope of service provision including hotlines for youth, post-rape care, programs for MSMs and prisoners, and most noteworthy: services for disabled persons. The staff were engaged, committed, and innovative in their approach. They talked of being committed to the goal of testing 80% of the Kenya population for HIV by 2010. The rate is 37% up from 14% just 2 years ago. Yeah! They spoke passionately about their services for the disabled making it clear why disabled persons may be more vulnerable to HIV. Some may say that it’s no surprise VCT has a large staff and a rather sizable budget. But I say the key is in the people. The staff’s commitment to upholding human rights principles—principles such as accessibility, respect for autonomy, justice, etc. They have invested human capital in upholding these principles.

Yet they are not alone. As I observed at the HERAF conference there are many Kenyans who remain committed to health as a right. The psychiatrist who continued to put forth the need to create access to available and quality health mental health services; he continued to put forth that all important agenda. The persons living with HIV/AIDS who gave voice to their concerns about addressing confidentiality and reducing stigma and discrimination. The program director who so eloquently made the case that advancing contraceptive technology for women is essential to adequately addressing the HIV/AIDS pandemic. One nurse spoke about her stance that quality care must be provided to rural persons despite any limitation that governmental regulations and limited resources may impose. “I have to do my best. That’s why I have to prepare myself to do my best and to be my skillset. The people in my rural community must have it.” These are just a few among many who have decided to advance a human rights agenda. These folks have made “walking the talk” a personal priority despite any structural and systemic barriers that may exist in the current health care system.

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.

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Today was full of interest. Nairobi is a fascinating city. It must be more than twenty times the size it was when I was last here (thirty years ago). At that time I recall the tallest building was about six stories, and downtown was only a few blocks–then the countryside started. No longer!! In fact the traffic is very difficult. It takes hours to go a few miles. When you consider that most vehicles are filled to overflowing with passengers, it is pretty amazing the number of people moving around the city! We have been traveling in a hired “matatu”–a minivan outfitted to carry about nine passengers (but often taking more) running mostly along set routes, like buses, but operated by individuals (I’ll try to upload a photo soon).

Our first meeting was with “Buck” Buckingham, the Kenyan Country Coordinator for the US President’s Emergency Plan for AIDS Relief (PEPFAR). His office is part of USAID, located in the US embassy. Just getting in was a bit of a trial, but Buck is very knowledgeable, experienced, and committed to the HIV work he has been doing for over twenty years. I was really impressed that the US government got it right this time with his placement in the position. Even with difficult questions, he seemed to really hone in the critical aspects of issues and was really quite forthright. For example, in the recently released Kenya AIDS Indicator Survey, there appears to be greater proportions of infected individuals than previously reported in PEPFAR documents (increased from about 5% to over 7%). Buck responded without defensiveness that the KAIS report had stronger data and would supplant the previous reported numbers. He is also very aware of the need for various funding streams to work together in order to decrease overlap, and the need to really focus on social concerns in order to help reduce the likelihood of transmission, particularly among women.

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When asked if I would be willing to be a delegate to the Health Rights Conference in Kenya, my first dialectic response was a bit like Teyve in “Fiddler on the Roof”–On the one hand…I should not go, that is a big expense, there should be better uses for the funds. Yet, on the other hand…perhaps I can be of some service to the cause. In the end, I chose to accompany the Physicians for Human Rights US group as a witness to what I believe are important changes in health rights for the people of Kenya.

My first visit to Kenya was almost forty years ago. It was before I committed to my life work, but what I saw then as a hitchhiking college student helped shape my choice to become a physician and to dedicate myself to providing health care services to those in need. Now I am a physician at a clinic for the poor in Kansas City, Kansas where I follow about 600 people with HIV.

My last visit to the continent of Africa was to the International AIDS Conference in 2000 in Durban. President Thabo Mbeki of South Africa publicly stated HIV does not cause AIDS and he forbade government doctors from offering prevention or treatment. Other nations in Africa recognized the growing threat of AIDS as the numbers of people infected by the deadly disease increased. At the time the biggest “boon” in Africa was the growth of the coffin industry.

It will be interesting to see how the people in Kenya view the importance of health rights and how they are finding ways to extend better health to more people. I look forward to the coming week.

PHR launched this blog a year ago, when we attended the First Annual Kenya Health Rights Conference. We’re attending again this year, and from December 2–5, PHR members and staff will be blogging from the Second Annual Conference. The conference is being held by PHR’s partner group, the Kenya Health Rights Advocacy Forum (HERAF), a network of health professionals committed to promoting health rights in Kenya.

Last year, PHR brought three of its US health professional members to the conference so that they could learn how health professionals in Kenya are working to address the human rights violations fueling the AIDS epidemic in East Africa. These PHR members visited clinics, met with NGOs, and participated in HERAF’s conference – leading them to become better advocates for health rights here in the US.

We are thrilled to be bringing a new group of health professionals with us to Kenya again this year to attend HERAF’s Second Annual Health Rights Conference. This year’s conference promises to be incredible. HERAF and the organizing committee have recruited a great group of presenters to bring to the attendees bold new ideas about policy reform, universal access to HIV treatment in Kenya, health financing, and advocacy. With lots of time for discussion and debate, it promises to be an exciting two days.

The three PHR members from the US will be joined by two health professionals from our partner groups in Uganda and Rwanda. Together, the group will visit clinics that are providing integrated services to women and children, meet with NGOs to explore the latest research on HIV, women’s health, and strong health systems, and share their own ideas and lessons learned about health professional advocacy in their communities.

Keep checking this site. We will have posts each day from conference participants, as well as photos and reflections from our members who are visiting Kenya. We will provide opportunities for learning and ideas for new ways to engage. Thanks for joining us.

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.

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

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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.

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.

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.

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.

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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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.