Health Rights in Kenya

Following the Second Annual Right to Health Conference, my colleague Amanda Cary and I have been on the ground searching for innovative approaches to comprehensive women’s health care; models for service provision that move away from the “vertical approach” and integrate critical services such as family planning and HIV&AIDS counseling and testing.  This integration helps to break down the many barriers women face when accessing health care.  It’s a new way of thinking about health and about the systems that are designed to promote it — imagining every patient as a holistic person, with legitimate demands upon the health system and fundamental rights within it that must be respected, protected and promoted.

In order to examine these models further, we’re visiting NGO outreach sites in rural areas, government facilities in the heart of Nairobi, faith-based organizations in the capital’s slum areas and holding interviews with a wide array of service providers.  Here’s a brief glimpse into what we’ve discovered… so far:  the story of Emma and Eunice.

——

Eunice lives on the outskirts of Nairobi, along the dusty, crowded industrial road linking Kenya’s capital to the coastal port of Mombasa.  Every six weeks she goes with her newborn daughter, Stella, to the health center for their regular check-ups.  It isn’t easy to access health care in Kenya – health facilities are often far away and transport is expensive.  Even when a woman does manage to reach the facility, the medicines, services and even health workers may not be there.  Eunice is one of the lucky ones – she lives nearby to a government health facility in the Industrial Area.  But she chooses another facility for her care.  She chooses to pay extra fare, to take extra time and to travel into the heart of Nairobi to visit Nurse Emma Kariuki at Loco Health Center.

Loco Health Center is at the very end of a tarmac road falling slowly into disrepair.  The pavement eventually turns into dust, and cars become fewer and fewer as the road narrows towards a small footbridge leading over the railway tracks.  Under this footbridge, next to the old railway supplies warehouse is Loco Health Center.  The facility is made up of only a few buildings – one larger concrete building for general consultations, and several smaller trailers housing the child welfare clinic, antenatal care clinic and tuberculosis clinic and laboratory, as well as space for a support group for people living with HIV&AIDS.

Emma Kariuki has been a nurse at this small, bare bones facility for years.  And it was Emma who pioneered the integration of services for women who visited the facility – matching up the services she offered with her own, holistic view of the clients who came to seek her advice and support.  In Emma’s words, “I asked myself, if I’m genuine about HIV, the women who are coming for family planning are telling me they’re sexually active, and if they’re sexually active, then I’m denying them an opportunity to get to know their status.” One of her first clients was a woman whom she had tested for HIV as part of prevention of mother-to-child transmission.  The client was HIV negative.  The next time she was tested, three years later, she was HIV positive.  According to Emma, “That gave me the energy to continue.”  Emma was determined to take advantage of future opportunities for all her clients, no matter what services or needs brought them to the health center.

So Emma sought out training on HIV counseling and testing, and began to integrate it into her own family planning services.  Initially, her colleagues felt that offering HIV testing to people in the family planning clinic would deteriorate the demand for family planning services.  But Emma persisted, and proved them wrong.  “It was the opposite.  Clients began to come to us from other clinics.  Those that I tested would go and tell others in the community, and they’d come to me and tell me ‘Sister, I hear you’re offering VCT and family planning.  I’m not your family planning client, but I’ve come for VCT.’  Instead of the numbers going down, they started to go up.”

This is why Eunice comes to Loco, instead of her own, closer health facility.  When she arrives here with Stella, she can get a full package of care.  She has her reproductive health needs met, and she can feel confident that her other needs, such as HIV counseling and testing, will be met.  Another client at Loco, Felista, feels the same way.  She tells other women to come to Loco because “here they can be free, just as I am free.”  At Loco, women are viewed holistically – they are viewed as rights holders and as partners in health service provision, not simply as beneficiaries.  Both Eunice and Felista, through regular visits for family planning, have been counseled and receive regular HIV tests.  Now, they both want to bring their husbands to be tested at the facility as well.  This type of comprehensive care has ripple effects – by skipping a small stone across the pond, the waves have eventually reached the farthest shores.

In the eyes of providers such as Emma and women such as Eunice and Felista, providing comprehensive services for women is by no means impossible.  Women want to receive the services, health providers want to give them, and yet the system just simply isn’t designed for it.  Major challenges exist: health workers must be trained in counseling and testing for HIV, and there must be enough health workers in the facility to handle the influx of clients that will follow and spend the necessary time with each. Furthermore, health facilities must have enough commodities to instill faith in clients that when they do manage to make a visit, they won’t go home empty-handed and uninformed, and there must be enough space to ensure privacy and confidentiality.  Yes, there are major gaps and major needs; however, health workers such as Emma are changing the paradigm and demanding more from the system within which they work, looking for the simplest, most cost-effective way to provide the needed services.  Indeed, they are blazing a trail for the rest of us to follow.

Emma sought out extra training on HIV counseling and testing, as well as community and home-based care, and paid for it herself.  The Clinton Foundation provided Loco Health Center with the 2 extra trailers necessary to create the space needed for confidential counseling and testing.  With simple interventions such as this, Emma was finally able to provide the care that she felt respected the integrity of the women who sought her services.  Women do not simply receive information and services, they demand them as well.  We should all follow Emma’s lead, advocating for health systems that allow health workers to encourage, engage with, and respond to these demands.

Eunice, Felista and Emma have begun this process, and service integration is simply one method with which we can begin to meet the needs of both health workers and the communities they serve.  Let us support Emma and Eunice in this journey – let us recognize their challenges and acknowledge that they should not be fighting this battle on their own.  Let us follow Eunice’s lead, and seek out models that promote both women’s rights and women’s good health.  Let us look to the end of the road and under the bridge, to small, simple, unassuming models such as Loco Health Center.  Here, a woman is more than a body in need, a health worker is more than a stop along the way, and the right to health is looking more and more like a reality every day.

On a warm dusty Friday afternoon, members of the PHR delegation jumped in a VW-style bus and headed to a local hospital 2 hours outside of Nairobi. We settled in for the ride…, Boni, our skilled driver, three American health care workers (the US PHR delegates), PHR staff (Lissy and Amanda!), and two remarkable colleagues…Stephen Rulisa, a prominent Rwandan doctor and rising leader, and Margaret Byabakama-Muyinda, a seasoned and passionate nurse advocate based at Mulago Hospital in Uganda. As the city ebbed away, boisterous lorry trucks emblazoned with bright Swahili, English, Arabic, and Hindi phrases rumbled past us en route to Mombasa and occasional herds of camel and goats spotted the unfolding landscape. But inside our comfortable matatu, we were engrossed in conversation, collectively processing lessons from the Kenyan conference on health rights that had concluded the day before.

We attempted to make sense of statistics…like the estimated 40% of maternal deaths among women in Kenya attributable to complications of unsafe abortions, which contributes to Kenya’s adjusted maternal mortality rate (MMR) of 560 out of every 100,000 pregnant women. [by comparison, the US MMR is 15, (although it's 39.2 among black women in the US). Cuba 's MMR is 45].

We attempted to understand the structural barriers to equity and health…in Kenya, for instance, where a poorly funded public medical system often charges fees to patients in order to stay afloat, a woman who has suffered sexual assault or rape is charged 3000 Kenyan shillings (nearly $38 US dollars) to submit a paper form documenting the crime. Given that more than half the country lives on less than $2 a day and many less than that, it’s no surprise that the majority of sexual assault cases go unreported in Kenya. Along with other structural barriers, this powerful financial disincentive drives the rights and health of women into the shadows.

We attempted to process the stark consequences of missed opportunity. Unlike many countries in Africa that lack adequate numbers of qualified health care workers, Kenya produces a relative abundance of trained nurses. But the problem is that a lack of funding, clear policies, and effective implementation has prevented the public health sector (hospitals, clinics, dispensaries) from employing these nurses. So Kenya’s health infrastructure remains thirsty for workers in a sea of relative plenty, and patients continue to pay the ultimate price.

But our discussion on the road to Kenya’s Eastern Province wasn’t centered on these statistics and stories. Instead, we kept returning to a few central themes…politics, leadership, governance, and power. These themes possessed a powerful gravity…we couldn’t help but discuss them. It was as if our ideas of health and equity and results revolved in tight orbit around the larger central sun of civic and political life. Empowerment and governance, fairness and transparency, participation and accountability…each of these concepts became the foundation of our free-flowing conversation of health and human rights.

As the asphalt road turned to bumpy gravel, Stephen told us of Rwanda’s governance reforms after the 1994 genocide. For instance, since evidence shows that women are often central agents of change in terms of health and civic life, he said, the Rwandan government focused on women’s participation…it’s a results-oriented approach to rights and health that too few countries around the world have employed. Now, Rwanda, a country that most Westerners associate with the horrors of genocide, leads the world with the highest percentage of women in elected office. (By comparison, as of 2002, the US ranked 52nd out of 179 countries with regards to women in national legislatures. Kenya’s percentage is 8%, one of the world’s lowest) Arguably, some of Rwanda’s post-genocide advancements in health and their emphasis on the role of women in governance and community engagement are not coincidental.

Fairness, accountability and the link to the right to health…like the ochre-hued dust from the road traffic, these concepts swirled around us. Over the past week, virtually every doctor, nurse and health advocate I spoke with brought up a major current news story about Kenyan ministers of parliament (MPs). And it captured our attention on the bus as well. In Kenya, apparently MPs are among the highest paid elected officials in the world earning more than $10,000 a month. But they’re only required to pay tax on their basic pay of $2500, and some don’t even pay that tax. In June, these leaders unanimously voted in rare cross-party unity AGAINST a proposal to require MPs to pay reasonable tax. Reports now suggest that many Kenyans view their leaders as unscrupulous, ineffective, and self-serving. And Kenyan health workers are adding their voice to the mix…if precious shillings paid by the public are disappearing into personal bank accounts or programs-to-nowhere, how can a struggling health care system hope to finance and mobilize needed programs? As our matatu jostled along, we asked…aren’t sustainable advances in health and human rights dependent upon and enabled by participation and transparency in governance?

We answered the question as soon as it was asked with an emphatic yes. As a middle-aged gentleman drove past us in a blue sedan, I noticed a picture of a beaming Obama plastered on his back window. It’s one of dozens of Obama stickers we’d seen in less than a week. In fact, so far, we’ve met more proud “cousins” of Pres-elect Obama than one would probably find in Hawaii or Kansas. I couldn’t help but wonder about the parallels in US and Kenyan civic life and these lessons of participation and governance for health care workers and human rights advocates. In the US, congressional leaders and President Bush have enjoyed historically low levels of public support…in part because of Americans’ frustration with a style of governance that had been relatively opaque and unresponsive. As President-elect Obama, who won by mobilizing and reshaping the American electorate, transitions to power, his attempts to increase transparency and community participation in US governance (see change.gov) hold interesting lessons and opportunities for health rights advocates. Isn’t participation of those who often feel powerless to change an opaque and unresponsive health system, particularly the most vulnerable of working families, the necessary means by which we achieve real progress in rights-based health reform?

In Kenya, where the public and health care workers lack faith in their parliamentary leaders, some advocates at the Kenyan health rights conference were calling for an Obamanian style of community engagement and civic advocacy around principles of participation, transparency and equity in health care. (for an excellent example of this kind of advocacy, check out a blog by Lukoye Atwoli, a prominent Kenyan doctor and mental health advocate). For example, one doctor mentioned that Kenyans should do more than just celebrate Obama’s victory in the US…they need to find and support their own Obamas.

We reached our destination and our delegation poured out of the matatu and onto the sprawling grounds of Machakos District Hospital, one of the highest level referral facilities in Kenya’s Eastern province. As we toured the colonial-era hospital and were greeted by patients and health workers, we started asking about the details…how many staff?, what patient care protocols existed? what’s the patient volume? what kinds of programs exist? and so on. We focused on important yet relatively technical topics that health workers are usually very comfortable discussing. I couldn’t help but think about how our conversation in the matatu about governance and leadership en route to the hospital was linked to our interest in health care services at our destination. The former discussion had highlighted the necessary means to achieve the ends we seek in our roles as health care workers. For our international group of health workers and rights advocates, our tour of Kenya reaffirmed this basic principle…if our destination is health and equity, we must lend our voice to others in civil society and travel down the road of participation, empowerment, and good governance.

I go back to Los Angeles now, slightly fatigued but enthusiastic. Through community-based tools like the South Los Angeles Declaration of Health and Human Rights or national efforts like the Rx Vote Campaign, I look forward to plugging back into our work and informing it with the powerful stories and lessons from our time in Kenya.

On Friday, the team had a great experience with several nurses and health professionals at a hospital in one of Nairobi’s neighboring districts 60 km away. After a 2 hour journey on a brain bogglingly bumping road, we arrived at the district hospital, comprised of several buildings surrounded by lush greenery. We were immediately greeted by nurses we had met at the HERAF conference the days before who offered to show us the facilities and answer our many questions about the work they do. This particular hospital has implemented many of the evidenced-based public health and human rights practices for which PHR advocates, including human rights education and integrated family planning and HIV/AIDS counseling and testing. In fact one of the first observations that struck me while visiting the hospital was the list of patients’ rights prominently displayed in most hallways and waiting areas, as well as a patients’ charter listing the appropriate wait times for various health needs.

I had a great conversation with 2 of the nurses about how patients’ rights are acknowledged, discussed and put into practice in the hospital facilities and in the community. One of the comprehensive HIV/AIDS care nurses explained how she discusses rights with the patients she sees , often providing them with their first introduction to their own rights. In response to my question about the impact of rights education, she simply said that when people know their rights, they come and seek care. When people do not know their rights, they do not seek care. This HIV/AIDS nurse further explained that her patients often reference the rights discussed and displayed throughout the hospital though feedback given at a “customer care” desk and suggestion box in the waiting areas. It is clear that the education provided in this hospital is a simple, but powerful way to promote better health outcomes.

The next observation that struck me at this district hospital was the way in which it integrated counseling and testing for HIV into the family planning services provided. We saw the counseling and testing rooms right in the maternal child health building and the youth reproductive health building where family planning services are provided. The nurses explained that the health professionals in this facility initiate a conversation about counseling and testing for HIV and provide the services to everyone who accepts. Since women are particularly vulnerable to HIV/AIDS due to conditions that make prevention, care and treatment inaccessible, the integration of services into a “one stop shop” is a critical intervention needed to ensure women’s right to health.

As an advocate, it was encouraging to see some of the rights-based strategies promoted by PHR currently in practice. While talking to the nurses we met, it became clear that many of the most powerful interventions to stem the AIDS epidemic are brilliantly simple, moreover they are already working. What is lacking is the political and financial support needed to implement these interventions systemically so that everyone can enjoy the same rights based care, prevention and treatment. Funding and strategies to support an educated and empowered workforce is essential to promote the education and empowerment of the entire community to access health systems. Furthermore, deliberate strategies to upscale integration of HIV/AIDS services with reproductive health and family planning services is critical to ensure that all women can access acceptable, rights-based health care. Key to this implementation is the immediate repeal of the global gag rule which, either directly through funding restrictions or indirectly through perceived limitations, hinders comprehensive family planning within US funded disease specific programs if the programs support safe abortion practices and policies.

Along that bumpy road, we found an amazing group of health professionals who demonstrated the feasibility and successes of a rights-based approach to health. Now it’s time for our US policymakers to learn from these Kenyan health professionals and support system wide improvements and expansions of rights-based programs.

“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.

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.

(more…)

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.

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]
(more…)

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?

(more…)

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]

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.

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.
(more…)

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.