Tag Archives: Kenya

Africa: Does Democracy Improve Your Health?

18 Nov 2013

Back in the 1990s, the Nobel-prize winning economist Amartya Sen famously wrote that “no famine has ever taken place in a functioning democracy”, coining an argument has shaped thinking across countless sectors – and none more so than healthcare.

If governments face open criticism and are under pressure to win elections, we assume, they are incentivised to improve the health of their populations. Dictators are not.

“Democracy is correlated with improved health and healthcare access … Democracies have lower infant mortality rates than non-democracies, and the same holds true for life expectancy and maternal mortality,” Karen Grépin, assistant professor of global health policy at New York University, wrote in a 2013 paper. “Dictatorship, on the other hand, depresses public health provision.”

She argues that democracies entrench longer-term reforms than their dictatorial counterparts – often involving universal healthcare or health insurance schemes.

“The effects of democracy are more than a short-term initiative, such as an immunisation programme, which don’t always have lasting effects,” she said in a telephone interview. “Democracy can bring larger-scale reforms that create new things or radically transform institutions.”

But does that theory hold water in Africa?

Ghana, one of the continent’s deepest democracies, is doing well. According to Gallup data, 75 percent of its population consider its elections to be honest, compared to a median of 41 percent over 19 sub-Saharan countries. Correspondingly, it was also one of the first countries in Africa to enact universal health coverage laws.

In 2003, roughly a decade after entering a multi-party democratic system, the west African country hiked VAT by 2.5 percent to fund a national health insurance programme.

Voters who had been overstretched by the previous ‘cash-and-carry’ system happily swallowed the tax increases, and the scheme was so popular that when the government unexpectedly changed in 2008, it survived the transition.

The country still has a way to go to attain universal coverage. According to the National Health Insurance Authority, by the end of 2010 34 percent of the Ghanaian population actively subscribed to the scheme. But the institutions are now in place, laying the foundations for the future.

Similar schemes are being rolled out in other democracies like South Africa. But this isn’t a simple equation. There are plenty more multi-party systems which have failed to enact meaningful reform – think of the pitiful performance in Kenya, where the government changed earlier this year – while some more autocratic regimes are performing well.

“Several of the countries that are seen as the big success stories in public health are not very democratic,” argued Peter Berman, a health economist at the Harvard School of Public Health.

Take Rwanda. Led by Paul-Kagame’s decidedly authoritarian Rwandan Patriotic Front, the country is considered “not free” by Freedom House. In the run up to 2010 presidential elections Human Rights Watch alleged political repression and intimidation of opposition party members against the leadership.

Yet the government has a strong developmental track record. “Rwanda started out with somebody who is autocratic, but who genuinely wants to see these indicators change,” Grépin said.

Over the last decade, Rwanda has registered some of the world’s steepest healthcare improvements. After the 1994 genocide – when national health facilities were destroyed and disease was running rampant – life expectancy stood at 30 years.

Today, citizens live to an average of almost double that. Deaths from HIV, tuberculosis and malaria have each dropped by roughly 80 percent over the last 10 years, while maternal and child mortality rates have fallen by around 60 percent.

Part of its success stems from the fact that its healthcare services reach rural citizens. The leadership hands responsibility to local government and authorities and holds them accountable for their efficiency; and almost 50,000 community health workers have been trained to deploy services to marginal populations.

Like Ghana, Rwanda runs a universal health insurance scheme, though it has fared better in its roll out. Upwards of 90 percent of the population is covered by the community-based Mutuelles de Santé programme, which has more than halved average annual out-of-pocket health spending.

“By decreasing the impact of catastrophic expenditure for health care we increase the access,” explained Agnes Binagwaho, minister of health, from her Kigali office.

The benefits of that programme are clear to see at the bustling Kimironko Health Centre, which is a 20-minute drive from central Kigali and deals with most of the suburb’s non-life threatening medical complaints.

As dozens of men, women and children queue to hand over their health cards, a young nurse named Francine Nyiramugisha explains that “Ever since the Mutuelles de Santé was introduced, there has been a huge difference. You pay 3,000 RwF ($4.50) per year and then you get treatment.”

In the reception, thirty-year-old Margaret Yamuragiye, a slender sociology student who has been diagnosed with malaria, waits patiently for her prescription. “Before I got my Mutuelles card I would fear that I could not go to the clinic because it would be too expensive. Today if I have simple cough or flu, I come to the doctor, I don’t wait to see if it gets worse,” she said.

Nearby in Ethiopia, another autocratic regime registered by Freedom House as “not free” is also clocking significant health improvements. Like Rwanda, leaders in Addis Ababa have little time for political opposition, but are registering impressive developmental gains.

“They’re not very democratic but they have the power and authority to allocate resources towards population health needs,” Harvard’s Berman said.

There’s no universal coverage scheme in Ethiopia, but government has opted to focus on deploying basic healthcare services across hard-to-reach rural areas.

Starting from a pitifully low base, it has spent a decade training a network of around 40,000 extension workers to bring care to rural communities. Over ten years, the nation registered a more than 25 percent decline in HIV prevalence, according to a 2012 progress report. Under-five mortality has declined to 101 deaths per 1,000 live births in 2009/10, from 167 in 2001/2. Infant mortality halved in the same period.

Those examples should be evidence enough that the relationship between democracy and improved healthcare isn’t a simple one. “There are autocratic governments that care about the people and there are autocratic governments who don’t. There are democracies where politicians respond to a broad public demand, and then there are democracies where the politicians respond to narrower interest groups,” Berman said.

“There is no simple equation between democracy and caring about public health.”
[Courtesy of This is Africa]


Kenya: Technology Revolutionizes TB Management

NAIROBI, 18 April 2013: The use of technology is revolutionizing the way Kenya manages tuberculosis (TB). Through a computer- and mobile-phone based programme called TIBU, health facilities are able to request TB drugs in real-time and manage TB patient data more effectively, health officials say. They also use the platform to carry out health education.

“One of the challenges we have had with TB treatment is people defaulting [on treatment], but this will reduce significantly because through TIBU we will be able to track down patient treatment progress,” Joseph Sitienei, head of the Division of Leprosy, TB and Lung Disease at Kenya’s National AIDS Control Programme, told IRIN.

“By being able to track a patient, the health workers can send them reminders on their mobile phones when they fail to appear for drug refills,” Sitienei added.

Information sharing

In Kenya, a dearth of information on TB among patients and poor management of patient data have always been a challenge.

“People at times default not because they want to but because they lack information, and health facilities do not share patient data and history. Now the government is beginning to appreciate the relevance of technology in managing diseases such as TB,” said Vincent Munada, a clinical officer at the Kenyatta National Hospital in Nairobi.

Sitienei noted that TIBU – which is Swahili for “treat” – has also helped health facilities better manage drug supplies.

“Initially, health facilities used to request for TB drugs manually, but with this new system, they can ask for the same and the request is relayed to the ministry headquarters immediately. That way, drugs are supplied on time,” he said.

Kenya is ranked at 15 on the UN World Health Organization (WHO) list of 22 countries with the highest TB burden in the world, and it has the fifth-highest TB burden in Africa.

The government says an estimated 250 district hospitals, out of the country’s 290, are using the programme, which was launched in November 2012.

The government is also using the technology to support multi-drug-resistant tuberculosis (MDR-TB) patients living far from medical facilities, sending money to patients via the Mpesa mobile phone money-transfer system  to cover transport costs.

Enormous potential

Mobile phone platforms like TIBU could have even wider life-saving potential.

A recent report by multinational firm PricewaterhouseCoopers noted that mobile phone applications such as short text messages could, over the next five years, help African countries save over one million of the estimated three million lives lost annually across the continent to HIV/AIDS, TB, malaria and pregnancy-related conditions.

“SMS reminders to check for stock levels at the health centres have shown promising results in reducing stock-outs of key combination therapy medications for malaria, TB and HIV. For HIV patients, simple weekly text reminders have consistently shown higher adherence amongst the patients,” said the report.

According to the report, Kenya alone could save some 61,200 lives over the next five years by embracing mobile-based health information management.

On TB, PricewaterhouseCoopers said: “TB is a largely curable disease, but requires six months of diligent adherence to the medication regime. mHealth [mobile health] could help control TB mortalities by ensuring treatment compliance through simple SMS reminders.”

The report noted that mobile phone-based care for patients could reduce emergency visits to health facilities by up to “10 percent.”

“You know, at certain times, a patient doesn’t even need to come to a facility. You simply share what you have with them over the phone. It saves patients time and relieves the health worker to attend to other pressing issues,” Kenyatta National Hospital’s Munada said.

A 2012 study in Kenya found that the use of mobile phones between patients and health workers improved antiretroviral therapy adherence among people living with HIV.

In one mobile health project, community health workers were able to track their patients’ conditions through the use of text messages.

[Courtesy of IRIN]

KENYA: Poor Mental Healthcare


NAIROBI, 30 November 2011 (IRIN) – A shortage of mental health specialists and facilities, ignorance and stigma, are among the challenges facing the provision of quality psycho-social care in Kenya, say specialists. 
There is a huge treatment gap in Kenya, where there are currently 81 psychiatrists for a population of 41.6 million,”
” Monique Mucheru-Wang’ombe, a consultant psychiatrist at the Ministry of Medical Services, told IRIN. 

With most psychiatrists in private practice, only about 25 are in the public sector and then largely in the urban areas while the population was primarily rural, said Mucheru-Wang’ombe. 

According to the UN World Health Organization (WHO), in most countries, particularly low- and middle-income countries, mental health services are severely short of resources – both human and financial – with more being spent on the specialized treatment and care of people with mental illness and to a lesser extent on integrated mental health systems. 

Instead of providing care in large psychiatric hospitals, WHO urges countries to integrate mental health into primary healthcare in general hospitals and develop community-based mental health services. 

“Institutionalization is not the way to go,” echoes Mucheru-Wang’ombe, adding that community-based mental health services helped to make the provision of care more accessible and reduced stigma. 

She added that the integration of other health services such as dental or maternal and child services within the same institutions would also help to reduce stigma, as would awareness-raising on the importance of treatment and long-term management. 

Cases of families hiding away mentally-ill patients are common due to the negative perceptions associated with such illnesses. “Mental illnesses are thought to be a consequence of demon possession, evil spirits or curses. It therefore takes long for patients to seek help from the formal health sector,” she said. 

A general misconception in the coastal region where drug abuse is rife, for example, is that most of those suffering from mental illnesses have themselves to blame, exposing them to social ridicule. 

Some families therefore opt to hide their sick relatives to avoid embarrassment. 

The media has also been blamed for helping to perpetuate the stigma. “…It is a shame that coverage is almost always sensationalistic and further dehumanizes people who are already relegated to the fringes of society,” writes Judith E. Klein, the director of the Mental Health Initiative in a blog. 

“The stigmatization of people with mental disabilities runs very deep, and it is very difficult for them to shed it,” says Klein. “Sensationalist media coverage does everybody a disservice because it reinforces the message that disabled people are hopeless, pathetic burdens to society and that if only they received more charitable assistance, perhaps society could take a breath and forget about them – again – at least until the next scandalous story breaks.” 

According to Frank Njenga, a consultant psychiatrist, there is little psycho-social help available to those in acute need, such as survivors of frequent rapid onset disasters in the country, for example, the recent Sinai slum fire. 

Widespread poverty is also a factor, said Njenga. 

Mama Naima* told IRIN that a lack of money to take her 22-year-old son for specialized treatment had forced her to rely on traditional herbal concoctions. 

The provision of mental health services is a relatively new area in Kenya, says Adrienne Carter, a psychotherapist/trainer with the Independent Medico-Legal Unit (IMLU). 

“The usefulness of counselling in the healing of mental health problems is not yet well known, especially in the area of torture and other traumatic events,” said Carter. “There are numerous communities within Kenya that suffered greatly during the post-election violence. Some… managed to get psychological assistance, but most of them continue to suffer, untreated.” 

An experience is considered traumatic if the person never experienced it before, it is overwhelming and it changes one’s life completely, it involves death or serious threat to one’s life. Witnessed events may include observing the serious injury or unnatural death of another person due to violent assault, accident, war or disaster or unexpectedly witnessing a dead body or body parts. 

The disorder developed as a result of traumatic events may be especially severe when the stressor is human (such as in torture, rape). 

With traumatized people often exhibiting various physical reactions such as body aches, sleeping problems, nightmares and numbness, they mostly go to medical doctors to try to ease their pain, she said, “but the medications prescribed by the physicians help only for a short time… unless the root causes are treated, the physical symptoms continue to persist. 

“It is necessary to process the trauma and assist in integrating it within the psyche of the traumatized individual. If the trauma is not integrated within the psyche, the traumatized individual is often found to suffer from Post-traumatic Stress Disorder [PTSD].” 

PTSD is characterized by re-experiencing of the traumatic event or persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness and symptoms of increased arousal. 

“Unfortunately, people experiencing these symptoms are frequently misdiagnosed with schizophrenia and other psychotic disorders… [and] may end up for many years in mental hospitals where they are ‘treated’ with heavy doses of medications that do not and never will cure their symptoms.” 

[Courtesy IRIN]

KENYA: Maternity Hospital Working Conditions ‘deplorable’

A go-slow by nurses at Pumwani Maternity Hospital in Nairobi’s Eastleigh area has exposed serious challenges at Kenya’s largest maternity hospital, with officials calling for urgent intervention to improve services.

“Working conditions at the hospital remain deplorable,” Festus Ngare, secretary-general of the Kenya Local Government Workers’ Union, which represents the nurses, told IRIN on 17 March. “Although we have reached agreement with the hospital’s management on some of the issues and others are still pending, the working environment at the hospital is a major concern for all.”

The 180 nurses at the hospital staged the go-slow on 16 March to protest at being overworked and the withholding of their uniform and other allowances by the hospital’s management.

Ngare said: “As a matter of urgency, the [Nairobi City] Council should have not less than 30 doctors and not less than 100 nurses posted to the hospital immediately to help ease the workload. At the moment, some nurses find that after working a 6pm to 8am shift, there is no one to relieve them. They find themselves working for many more hours and this is not only a danger to the mothers and their newborn babies but a danger to the nurse herself.”

Read More Here:


KENYA:HIV/Aids Stigma stops Maternal Health treatment

The stigma being seen attending HIV/Aids clinics stopped many HIV-positive pregnant women from accessing vital HIV treatment that could protect them and their unborn children.

However a programme to integrate maternal services and HIV/Aids treatment into a one-stop clinic has proved successful in the fourteen health facilities in Western Province so far been integrated through an initiative by the Kenyan government.

The Kenyan government estimates about 32,000 babies are infected with HIV at birth every year. Integration of maternal and child health is a major part of the country’s plan to reduce mother-to-child transmission to below 5 percent of the 100,000 mothers who test positive annually.

Read More Here

KENYA: HIV/Aids Forest Evictees Struggle for ARVs

Wesley Kipkoech, 21, may be illiterate and speak only his native Ndorobo tongue, but he understands all too well that if he does not have regular access to his HIV medication, he is likely to die.

Kipkoech is one of hundreds of internally displaced people living on the edges of the Mau Forest Complex in Kenya’s Rift Valley Province after the government began evicting them in 2009, in a bid to rehabilitate the forest after decades of farming, charcoal burning and other harmful activities.

An estimated 30,000 people have been affected, according to the UN Office for the Coordination of Humanitarian Affairs.

Read More Here