Comprehensive Primary Health Care in Kenya
Kenya is a country in East African region and is part of the developing countries cluster. Primary Health Care (PHC) as a part of the larger health system in Kenya is not well developed. It is inaccessible and very expensive to a population where majority live below a dollar per day (Hecht 2002).Generally speaking, the health system is crippled and lacks the institutional capacity to raise it on its feet.
Kenya faces a double edged crisis: its healthcare workforce is rapidly depleting, and its health systems are weak, fragile, and hanging on a precipice (Ehiri & Prowse 199). A direct consequence of this is that the indicators for health development in the continent are dismal. About one in six Kenyan children die before their fifth birthday, with half of these dying from diseases preventable by vaccines; and one woman dies every two minutes from complications of pregnancy and delivery (UNICEF 2005). International experience has shown that a comprehensive approach can help bring about real improvements in health in a developing country like Kenya.
Role and relevance
Comprehensive Primary Health Care (CPHC) is abroad based approach to health care. It includes clinical care administered by doctors, nurses and health workers. It also includes prevention programs, health promotion, rehabilitation, public health measures and advocacy on health related matters (Hecht 2002).Prevention programs can include immunization, antenatal care, screening and early intervention, preventing complications of chronic diseases, and other measures (Hecht 2002).
CPHC is more cost-effective
About half of the total national expenditure on indigenous health is spent on hospital care (NEPAD 2003). This reflects not only their poorer health, but a significant lack of access to primary health care services. Kenyan do not receiving health care early enough to prevent serious ill health. They carry a heavy burden of illness that takes a huge toll on communities and families, physically, emotionally, and financially (Sanders 2003). The financial consequences of this burden of illness impact on all Kenyans because public health budgets must cover the high cost of hospital care for people who are ill from diseases that could have been prevented. CPHC which advocates for prevention programmes will help to eradicate such unnecessary financial burdens.
CPHC Save lives
This all inclusive approach to health care will save the lives of many Kenyans who are wallowing in the valley of preventable and curable diseases. For instance, Malaria is probably Kenya’s most widely spread disease which caused the death of many people (Andrea 2004). This would not have been so if a CPHC was in place since communities living in prone areas would have taken precautionary measure. Other diseases that have caused substantial deaths due to lack of a CPHC are typhoid, cholera, dysenteries among others.
Appropriate and accessible
CPHC promotes accessibility of basic health care to all communities especially those that are marginalized and vulnerable. This approach would help save the lives of millions of people who have no access to health services. These are people in the rural areas, the urban poor, slum dwellers and populations in marginal lands especially in the North Eastern region (UNICEF 2004). This people cannot access the health services because they are too costly, inadequate or they are non existence. It is on this sad note that I strongly believe that this approach will serve the health needs of this country most appropriately.
During the implementation of prevention programmes, the community members are trained and sensitized on various health issues. This amounts to empowerment of such a community in that they can handle other related diseases to prevent fatal cases (Askew 1991). In the case of Malaria for instance, a community will be sensitized on preventative measures such as use of mosquito net, clearing bushes near the homestead, draining stagnant water and using repellants (Andrea 2004). They will be taught and advised on early detection of malaria and the treatment options available. Much attention will be given to pregnant women and children. In this way the community acquires knowledge on the disease and can educate others.
Integration of health care programs
The health care systems of many developing countries emerged from colonial medical services that emphasized costly high-technology; urban-based, curative care (NEPAD 2003). Public health programs of international development agencies during this period were also largely targeted at eradicating specific diseases such as smallpox, yaws, and malaria (Andrea 2004). Each disease eradication program operated autonomously, with its own administration and budget and very little integration into the larger health system. CPHC will help to merge these programmes so as to achieve integration.
Communities will be in a position to bring together preventative and other health related concepts which is of more importance than comprehending each article in isolation (NEPAD 2003). For instance, it is more rational to teach communities to seek immunization for their children at an early stage than to tell them to immunize their children against small pox in the ninth month and hope someone else will tell them about polio and tetanus. There may be some successes during this period for example, eradication of smallpox. However, these short-term interventions do not address poor populations’ overall disease burden (Commission for Africa 2005). Integration of such programmes also helps to reduce the cost of implementation due to shared facilities such as hospitals, health workers among other things.
Future potential of CPHC in Kenya
Development of integrated health management system
The government has appreciated the fact that health does not occur in isolation, the various sectors, including those within a national government and among aid agencies, need to work together at every level of practice (UNICEF 2008). The ministry of health is not the sole agency charged with production of health; departments of agriculture, housing, sanitation, and education, along with food distribution, are all involved in achieving health.
Integration efforts are clearly evident in inter ministerial committees established to develop health policies (GOK 2007). The existing ministries have been charged with the responsibility of safeguarding the health of Kenyans. Health workers have been seconded to these ministries to facilitate the implementation of health policies (GOK 2007). A good illustration is when the minister for environment closed down a slaughter housed in Nairobi citing health related risks.
Decentralized approach in community development
The Alma Ata declaration requires that interventions come from the needs of the community, expressed and subsequently led by community members (WHO 2004). Global health problems cannot be solved by distant policymakers and planners. Involvement of individuals and communities mobilizes local resources to deal with health problems. Being a signatory to the declaration, Kenya is adopting the concept of decentralized participation (UNDP 2004).
Programs need to be founded and researched in the locality in which they will be applied. The government in the recent past has been developing the health care system through civil societies based in the target area since they can identify with the prevailing health problems. The Alma Ata declaration also recognizes that the issue of accessibility to health services and resources has historically been a barrier to effective care and that placing emphasis on curative, tertiary care hospitals located in urban centers often precludes access for a mostly rural population (Sanders 2004).
Kenya continues to rely on vertical programs, with less emphasis on people’s involvement and development of systems and infrastructures to sustain those programs (Werner et al. 1997). For example, although the current initiative on vaccines and immunization designed to help countries incorporate new vaccines into their national health systems has benefits for addressing specific communicable diseases, their fullest potential will be difficult to achieve in the absence of effective health systems and supporting infrastructures.
Maintaining the cost of expensive new vaccines after donor support ceases also poses a serious challenge to sustainability (UNICEF 2008). As with most vertical programs, analysts have expressed concern that raising poor countries’ awareness of new vaccines and immunization programs without support in implementing such programs could end up creating markets for these vaccines while doing little to tackle major health problems.
Chronic underinvestment, interventions by global partnerships that focus only on single diseases, and sporadic financing by both the governments and their partners have left health systems prostrate (Braveman &Tarimo 2002). They are unable to deliver drugs, tools, and other interventions of proved effectiveness against the leading causes of early death and illness (WHO 2006). Developing countries’ governments like Kenya must be committed to funding and budgets for sustaining community involvement in CPHC. This can be achieved through, for example, private-sector involvement and through hosting village, district, or regional people’s health assemblies so that the voices and opinions of the people can be represented in the design and implementation of health policies (Braveman &Tarimo 2002).
Trained health personnel
Most importantly, to achieve a CPHC, reform of the health sector should include coherent human resource development plans at the village, district, regional, and national levels and strategies for retention of trained personnel in remote and rural areas (ILO 2000). Primary health care systems in developing countries provide interventions that are already known to be effective. This means that achievement of quality in primary health care facilities requires the proper performance of these interventions according to prescribed standards to reduce mortality, morbidity, and disability. However, the most common challenge is that often these interventions are not properly executed (Brugha et al. 2002). Thus, quality improvement in this context is not simply a matter of providing infrastructural resources but, rather, one of paying attention to improvement in process, especially through training and supervision.
Long-term social interventions
Short-term measures do not necessarily undermine the contributions of vertical therapeutic interventions to public health, it is apparent, as this paper has shown, that they are not sufficient to greatly alleviate the overall burden of disease in developing countries unless the socioeconomic, political, and health system factors that underpin health and disease in these countries are challenged (McIntyre & Gilson 2000). The remedy to a CPHC, as we have argued, lies in a fundamental shift in emphasis from vertical, short-term measures to a revitalization of Alma Ata’s primary health care, with emphasis on poverty alleviation, community participation, and the development of health systems and infrastructures to create and sustain health (WHO 2004).
Similarly, in reviewing factors that contributed to improvements in health in England, Thomas McKeown demonstrated that population health improved more because of investments in “environmental public health,” political, economic, and social measures than from specific medical or therapeutic interventions(McIntyre & Gilson 2000). Decline in deaths from tuberculosis and from respiratory and water- and food borne diseases had already occurred before any effective immunizations or treatments were available (McIntyre & Gilson 2000).
Concrete strategies and processes
Thus, to improve the health status of people in Kenya and to ensure sustainability, a revitalization of the tenets of Alma Ata’s primary health care is needed (UNICEF 2008). Of critical importance is the need to establish concrete strategies and processes, with clear targets, to reduce inequities in the allocation of resources for primary health care, and with a focus on both horizontal and vertical equity (Sanders 2004). The value of this proposal is illustrated by the striking success that has been achieved in CPHC by a few poor countries, notably Sri Lanka, Costa Rica, Cuba, China, and Kerala state in India (UNICEF 2008).
Mortality and malnutrition rates are much lower and life expectancy much higher in these countries than in other countries with similar economic characteristics and indeed some wealthier countries. In this regard, it is important to stress that the nature of the political system, its values, and its processes for participation define the frontiers of opportunity for CPHC. Systems characterized by the absence of democracy and by pervasive corruption, violence, and sex discrimination are breeding grounds for inequities in health and in other social spheres (African Union 2003).
Health policymakers should be aware that macroeconomic, labor, and social policies have the potential to limit or enhance health opportunities for different groups in the population (GOK 2007). International aid agencies and governments in Kenya should be aware that the pursuit of liberal macroeconomic pro growth policies has the tendency to provide better opportunities to those with resources and high levels of education while large segments of the population without these assets are unlikely to benefit and may in fact become casualties of economic transition (African Union 2003). Thus, it is the duty of health policymakers to signal when other policies may undermine efforts to promote a CPHC.
There is strong evidence that Kenya has risen to this challenge. The health strategy of the New Partnership for Africa’s Development (NEPAD), to which Kenya is part, outlines actions that are to be taken by African countries in the renewed spirit of partnership and collaboration (NEPAD 2003). The strategy identifies key actions to strengthen health systems, improve partnership and communication with communities, and focus local action on the leading burdens in Africa such as malaria, HIV/AIDS, and obstetric emergencies. Kenya has signed up to the NEPAD health strategy, and is increasingly allocating at least 15% of its total budgets to health care in compliance with the Abuja target agreed in 2003 (UNICEF 2008).
The implementation of this commitment by African governments is being monitored closely by the African Union, and the union has called on the international community to fill the $19bn gap in health financing that the World Health Organization has determined that Africa is unable to self finance (African Union 2005). In the area of workforce, several groups have called on the G8 to invest in Africa’s efforts to stem the brain drain and to produce the right multidisciplinary workforce to improve the performance of health systems and meet regional and global targets for health (African Union 2005).
Having discussed the above issues, I am of the opinion that there is hope for the development of a sustainable CPHC. However one thing is clear, to sustain any initial gains and reverse the country’s poor record on health and development, Kenyan institutions will need global support to track achievements; learn lessons; document success; produce and manage knowledge; and share vision and experiences.
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