Tag Archives: health as a priority

We salute the Initiative by Kenya’s First Lady towards improved maternal and child health outcomes in Kenya. Japheth Mati MD

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The “Beyond Zero Campaign” launched on 24 January 2014 under the stewardship of Kenya’s First Lady, Margaret Kenyatta, seeks to improve maternal and child health outcomes in Kenya. Her enthusiasm and commitment to the success of the Initiative, including the pledge to raise funds for it through participation in the forthcoming London Marathon, is completely unprecedented in Kenya’s history. We salute this initiative by the First Lady of Kenya.

The Strategic Framework for the engagement of the First Lady in HIV control and promotion of maternal, newborn and child health in Kenya, which was unveiled on World AIDS Day 2013 focuses on the following five key areas: (i) Accelerating HIV programmes, (ii) Influencing investment in high impact activities to promote maternal and child health and HIV control, (iii) Mobilizing men as clients, partners and agents of change, (iv) Involving communities to address barriers to accessing HIV, maternal and child health services and (v) Providing leadership, accountability and recognition to accelerate the attainment of HIV, maternal and child health targets.

In an earlier post under the title “What’s in the way of achieving improved maternal health in Kenya” it was observed that there is sufficient knowledge of the causes of maternal deaths, and how they can be prevented. It is known which interventions work and which do not. What appears to be the main barrier is the lack of commitment to act; to prioritize reduction of maternal mortality, and to reflect this in resource allocations to the health sector, and to maternal health services, in particular.

The health budgets in most African countries, Kenya included, do not demonstrate that health is rated as a high priority among other national needs. This is often the result of failure by governments to recognise the importance of health in development, so that expenditure on health is not perceived as a critical economic investment alongside spending on education, agriculture or industries. Yet, health is a critical resource, without which investment in all other sectors would go to waste. Further, poor health creates critical barriers to economic production.

Within the health sector, lack of equity in planning and distribution of resources for health results in inequitable access to health care services: Physical access (e.g. distance to the nearest health facility); Affordability (when fees charged for services are unaffordable); Acceptability (where people lack confidence in the services provided and decide not to utilise them). People who are denied access through the above barriers often turn to out-of-pocket expenditures on their health care. Ironically, evidence reveals that the poor bear the heaviest burden of out-of-pocket health expenditures, irrespective of where they seek health care.

From available evidence it is obvious that local and international health goals cannot be achieved without emphasis on equitable expansion of access to basic services for all. Policy makers and planners must begin to accept the existence of, and to act on, the vast inter- and intra-regional health disparities in Kenya. It was the expectation that devolution would create opportunities for better prioritization of needs at the grassroots, and, through better knowledge of community needs, formulate more focused interventions. 

Engaging with communities as envisaged in key area (iv) of the proposed Strategic Framework is indeed a critical focus, considering that proximity to health facilities and services, is no guarantee they will be utilised. For example, there are several areas in Kenya, both rural and urban, where communities will prefer traditional medicine as their first line of health care before modern drugs are sought. There is evidence to show that within certain communities in Kenya, majority of pregnant women will have consulted a mganga (traditional healer) who administered to them herbal preparations and potions to ward off evil spirits, before making their first antenatal clinic visit[1]. These women perceive antenatal care services available at health facilities- dispensaries and health centres, and those provided by TBAs and herbalists, to be complementary, and generally, they seek both types of care interchangeably. This may have negative effects, for example, due to delays in early diagnosis and management of antenatal complications, resulting in poor pregnancy outcomes.

https://africahealth.wordpress.com/2010/10/27/what%E2%80%99s-in-the-way-of-achieving-improved-maternal-health-in-kenya/

Family Care International: Care-Seeking During Pregnancy, Delivery, and the Postpartum Period: A Study in Homabay and Migori Districts, Kenya, September 2003 http://www.familycareintl.org/UserFiles/File/SCI%20Kenya%20qualitative%20report.pdf


[1]Family Care International: Care-Seeking During Pregnancy, Delivery, and the Postpartum Period: A Study in Homabay and Migori Districts, Kenya, September 2003 http://www.familycareintl.org/UserFiles/File/SCI%20Kenya%20qualitative%20report.pdf

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It Makes Good Sense To Prioritise Health In Development

Many governments in Africa have not yet recognised the importance of health in the overall national development; consequently, they have not allocated commensurate resources to the health sector. The levels of health budgets in many of these countries do not demonstrate that health is rated as a high priority among other national needs. Despite the fact that in 2001 African countries pledged at Abuja, to increase health sector budgetary allocation to 15% of government expenditure, and although they repeated this pledge in Kampala in July 2010, in most of these countries national budgetary allocations for health remain far below this target. For example, for the fiscal year 2010-11 Kenya allocated just about 5.5 percent of the total Government expenditure to the ministries of Medical Services and Public Health and Sanitation. As a result, out-of-pocket health expenditures in sub-Saharan African countries are generally high ranging from 6% in Namibia to 62% in Chad, and nearly 45% in Kenya. The implication of this is that ill health contributes significantly to, and perpetuates, poverty because health related costs result in the depletion of people’s meagre resources. Irrespective of where sick people seek treatment, be it in public or private health facilities, or private pharmacies and dukas, or even the herbalist, this is to a large extent dependent on their access to cash or household assets that can be sold in order to pay for the out-of-pocket health expenses.

Expenditure on health is not adequately perceived as a critical economic investment in the same way as is spending on education, agriculture or industries. In Africa, the biggest chunk of government expenditure is believed to go to security related expenses (military and civil defence), even in those countries that have not fought a serious war since independence. Despite the lack of absolute and valid correlation (whether positive or negative), between levels of defence spending and socio-economic indices, savings in defence expenditure can be one way of boosting the very low health budgets existing in sub-Saharan Africa. Even though generally, military spending is not recorded in the Public Expenditure Reviews, it has been estimated that in 2011 Kenya spent 2.8% of the GDP on military expenditure alone. Yet it should be common perception that health is a critical resource for development, without which investment in all the other sectors would go to waste. Poor health impacts negatively on economic productivity, through loss of labour, and under-performance due to illness.

Since the advent of the HIV epidemic there has been greater appreciation of the role of health on development. In the highly affected regions of the world the epidemic has negatively impacted on agricultural and industrial output, thereby perpetuating the cycle of poverty. Other diseases that have significantly influenced productivity are malaria and tuberculosis, as well as the so called neglected tropical diseases (NTDs), which even though they kill fewer people compared with HIV and AIDS, TB and malaria, they nevertheless are responsible for the crippling health and socioeconomic burden on the world’s poorest people in Africa, Asia, and the Americas.

The implications from the above are that African governments must recognise the pivotal role that the health sector should play in national social and economic development, and to urgently ensure commensurate allocations of resources. In addition, governments should recognise the critical barriers that poor health poses to any measures intended to uplift the social-economic status of poor and disadvantaged communities.

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