Better plan needed in Kenya’s health sector

NAIROBI: The year 2014 was challenging for most Kenyans although there were flashes of good news such as decreasing deaths due to road accidents and the reduction in electricity and fuel costs. Security was the outstanding challenge despite a lot of effort.

But how did the health sector perform?

Overall, it was unclear where the health sector stood in 2014. It moved forward in implementing devolution of health services in the counties and continued well in offering free maternity services, but fumbled in the Ebola and Tetanus communication.

Despite many doubts, most counties held on and were able to deliver health services comparable or better to the time before devolution. Even then, many counties experienced serious planning problems in human resource management, causing delays in salaries and creating uncertainties and low staff morale.

The potential for counties to be a game changer in health services delivery is high. Counties need good strategic plans based on the their characteristics, alternative funding sources to complement the exchequer and to implement good monitoring systems that track the overall health system including service delivery, staffing, essential medicines, disease reporting and financing and accountability in the management of services.

Experiences from the UK, Kerala State in India, the Philippines and North East Brazil show that devolution of health services does not just happen, it has to be made to work.

The 2010 constitutional arrangement required the participation of the Transitional Authority and the national and county governments to achieve this objective.

Apparently, this has not been the case, at least from the public's perspective, because health appears to be a county affair. Even as the counties work to improve health, the national government should allocate more resources.

The five per cent allocation of total Government expenditure is meagre, the lowest in the region and three times lower than the 15 per cent African Union benchmark.

It is worrying that Kenya still depends largely on donor funding for health services, and steps to fill this gap are not that feasible.

The World Health Organisation (WHO) estimates Kenya to have one of the highest maternal deaths in the region. The free maternity presidential directive was a good move, but financial rebates alone are insufficient.

Structural problems such a far-flung maternity units, low staff motivation, poor road networks or inadequate ambulance services may frustrate such initiatives.

It will therefore, be important for this initiative to be supported for it to work smoothly, with initiatives such as the ambulance services arrangement that Bomet County entered into with the Kenya Red Cross.

Such arrangements are not unique to Bomet, but have been revolutionary in countries like Zimbabwe and Zambia, which have similar arrangements with an organisation called Riders for Health.

Communication on Ebola preparedness and the safety of the tetanus vaccine was a challenge for the national government. It is not that what they said was inaccurate, but the way it played out in the public eye was disastrous.

Many may have thought that something was being hidden.

Ebola not only kills quickly and painfully, but also causes social disruptions and huge economic losses and most people figured this out as the epidemic in West Africa was unfolding.

People needed fast action and proof that the country was ahead of the game. They wanted honesty on how to calibrate their level of risk, how to protect themselves and what the Government was doing to help them.

Doubts started as the media reported various lapses and even established that some of the assurances were not accurate. This was to be followed by WHO’s assessment that Kenya had weaknesses.

Tetanus is often a fatal disease caused by bacteria that are abundant in our environment. In newborns and mothers, it is generally the result of unsanitary delivery conditions.

In 2012, only 40 per cent of Kenyan babies were born in health facilities leaving 60 per cent at risk of contracting tetanus.

Indeed by June 2014, UNICEF classified Kenya to be among the bottom 24 countries in the world in maternal and newborn tetanus control.

The writer is a Public Health Specialist