Why COVID 19 should be a turning point for Health Care in Kenya.
In the year 2010, Kenyans voted in the new constitution that was signed into law by the then President, H.E. Mwai Kibaki. It introduced a devolved system of government whereby national government services were delegated to the designated 47 county governments. According to the constitution, these county governments are interdependent and undertake their relations through consultation and cooperation. Consequently, health care has been devolved to county governments and Kenya, through national, regional and global commitments committed to attain high standards of health with an all-inclusive and rights-based approach, in response to the needs of its citizens.
In the year 2018 H.E. President Uhuru Kenyatta launched the Universal Health Coverage (UHC) Pilot Program dubbed Afya Care – Wema Wa Mkenya that aimed to enable Kenyans access affordable healthcare without financial hardship under the auspices of the Big Four Agenda. This project was launched in Kisumu, Nyeri, Isiolo and Machakos counties and it is expected that critical lessons from these counties shall inform the rapid scale up to the rest of the country.
With the UHC card, Kenyans in the four pilot counties have been able to access health care services ranging from Emergency Services, Child Health Services, Maternal Health Services, Mental Health Services, Infectious Disease Management, Non-communicable Disease Management, Inpatient and Outpatient Services and Community Health Services across county public health facilities. This is well in line with Sustainable Development Goal (SDG) 3: Good Health and Well Being which among its targets aims to reduce global maternal mortality, end preventable deaths of newborns and children under 5 years of age, end communicable diseases and reduce non communicable deaths. Against this, the Kenya Government Voluntary National Review 2017 to the United Nations High Level Political Forum reported gains made in regards to maternal mortality with the ratio at 362 per 100,000 live births. Further, under-five mortality rate is 52 per 1000 live births and neonatal mortality is 22 per 1000 live births. Under communicable diseases, tuberculosis incidence per 1,000 population was 90 in 2015 while the number of new HIV infections per 1,000 uninfected is 240.
While this progress points to a healthier nation, in light of the current global crisis of COVID 19, Kenya’s health care system has begun to show cracks with concerns being raised over the country’s preparedness to handle critical patients – especially in devolved units. Before the COVID 19 global crisis, only 24 Counties had functional Intensive Care Unit (ICU) facilities, 14 Counties of these having benefited under the MES project. Further, the total number of ICU beds stood at 162 in the Counties with 22 Counties lacking ICU facilities. In total, Kenya had a total of 518 ICU beds in both private and public health centers of which if the numbers of critical COVID19 cases increased, hospitals would have been unable to effectively cope with the cases. Lastly, cumulatively, there were 161 ventilators in the County ICUs.
According to the 2019 Civil Society led Second Progress Report on SDGs Implementation in Kenya by the SDGs Kenya Forum and its implementing partners, Kenya’s human resource in the health sector has been characterized by a shortage of health workers and frequent industrial strikes. This is because the country has a proportion of 14 doctors per 100,000 population and 42 nurses per 100,000 population as at 2016. This is below the World Health Organization’s (WHO) recommendation of 21.7 doctors per 100,000 population and 228 nurses per 100,000 population.
Moreover, as we celebrate nurses and midwives on World Health Day, it is frightening that most of the Kenyan health care workers risking their lives to be at the front line to fight COVID19, have no protective gear to protect them from infection.
Additionally, the response mechanisms to COVID19 has fallen short of the Leave No One Behind approach. People living in informal settlements have no access to water and cannot practically practice social distance. Persons are unable to access COVID 19 preventative materials such as masks and hand washing liquid and sanitizers while women and girls are already experiencing heightened gender-based violence (GBV) as a result of the curfew, quarantine and other social restriction measures.
However, some of the solutions by the Kenya government to some of the challenges have been encouraging. For instance, it is in the process of increasing its capacity for mass testing for COVID19. It is also working in partnership with local manufacturers to support the production of sanitizers and protective gear such as, gloves and masks to in anticipation of a shortage. Additionally, the toll free GBV helpline has been announced to be open through out the pandemic to assist survivors of GBV. Lastly, the government has set aside funding to directly support COVID 19 response.
As everyone adjusts their lives, it is our hope that when Kenya overcomes the virus, stakeholders will rethink health funding, infrastructure and workforce not only for pandemic preparedness but for daily health care needs for all Kenyans, including those who are most vulnerable.
SDGs Kenya Forum Secretariat.