health in Kenya

At Independence, Kenya vowed to fight three major ills facing the society then. They were to kick out illiteracy, poverty and poor health. 44 yrs on the fight is still on with little progress in the area of health. At least in education the government has been able to introduce universal education for primary going children. It is yet to implement a similar program fro health care with the last attempt being shot down in parliament due to its cost. In terms of poverty, many say it has got worse with some circles declaring its increase. Of the Millennium Development Goals (M.D.Gs), three of them are health related namely to reduce child mortality, to improve maternal health and to combat H.I.V/Aids malaria and other diseases. The other M.D.G.s are to eradicate extreme hunger and poverty, to ensure environmental sustainability, to achieve universal primary education, to promote gender equality and empowerment of women and to develop global partnership for development. Kenya still lugs behind in meeting its targets in relation to health care under the M.D.G goals except in the area of H.I.V/Aids management which some progress has been made The objective of this series of articles, is to an over view of health provision in Kenya starting with health institutions and later suggest ways in which health provision can be improved in the country. It is my hope that at the end, you shall have increased your understanding of health provision in Kenya and will be willing to share your inputs on ways to improve the system for a better life. Health provision in Kenya- institutional Health provision in Kenya is mainly concentrated in the urban centers with major differences in terms of service delivery between urban and rural health care centers. In Urban centers especially in Nairobi, Mombasa, Eldoret, Nakuru and Kisumu patients are able to find specialized services with the standards much higher in terms of hygiene, treatment and general patient attendance. Doctors are concentrated in urban centers leaving some rural areas including districts without even one doctor. In urban centers, the types of diseases found are much different with lifestyle diseases like cancer, high blood pressure, diabetes etc. taking the primary concern. It is also possible to find specialized hospitals in urban centers like the Gertrudes children’s hospital and the Karen hospital for heart patients. Other private hospitals also offer specialized care using some of the latest technology and are still developing their niche markets. One example is the M.P shah which is setting up a cancer center. Rural hospitals on the other hand, are sparsely populated with some district hospitals serving a radius of over 100km2. Their bed occupancy is mainly concentrated with women at one stage or another of the child bearing process with the maternity, pediatric and women wards being very busy. Other major activities in rural health are the treatment of tropical diseases, H.I.V management and public health with a strong focus on water, dust and hygiene related diseases. Kenya also has two referral hospitals located in Nairobi (the Kenyatta hospital) and in Eldoret ( the Moi teaching and referral hospital) The Spread of health institutions per province Below is a table that summarizes the various types of hospitals in Kenya per province. Hospitals in Kenya are classified under various levels with the highest health institution being the referral hospital, followed by the general hospital then followed by the health centre then finally the dispensary in descending order. Clinics are normally the smallest health facilities in Kenya and can be mobile or fixed premise in nature. Nairobi district hospital spread 1 referral hospital, 70 hospitals, 61 health centres and 395 sub health centres and dispensaries Coast district hospital spread 72 hospitals, 37 health centres and 344 sub health centres and dispensaries Central district hospital spread 69 hospitals, 95 health centres and 392 sub health centres and dispensaries Eastern district hospital spread 64 hospitals, 79 health centres and 695 sub health centres and dispensaries N/Eastern district hospital spread 13 hospitals, 14 health centres and 74 sub health centres and dispensaries Nyanza district hospital spread 102 hospitals, 118 health centres and 336 sub health centres and dispensaries R/Valley district hospital spread 98 hospitals, 196 health centres and 1080 sub health centres and dispensaries Western district hospital spread 73 hospitals, 91 health centres and 198 sub health centres and dispensaries (Source the statistical abstract 2007 by central bureau of statistics) Note: the table above shows a total of 4,767 health institutions in Kenya excluding clinics both private and public which gives an average ratio of 7551patients per institution. There are other institutions that must offer health to their members as they operate. They include schools especially boarding schools and universities, children homes, big industrial complexes and the military. The structure of health centers in Kenya Health centers in Kenya are mainly structured to cater for two main types of patients. The non critically ill and the critically ill who are served by the out patient facilities and the in patient facilities respectively. Most patients are normally assessed first at the out patient facilities and if found to need more medical attention they are then admitted into the in patient section of the health center. The out patient services are normally minimal with few basic departments that include the Consultancy room, the observation room, the pharmacy, the store and lavatory services. Most small health centers have this basic structure with some rooms serving multiple services like the pharmacy also doubling as the registration offices. Large health centers like hospitals also have the same services in the out patient wing in a very well coordinated manner with the in patient section that an outsider might not know the difference. The in patient services are normally divided by the wards within the hospital. Most hospitals normally have the following basic wards with varying names depending on their sizes. The general wards which are further divided into the male ward and the female ward, the maternity Unit, the pediatric ward catering for children, the theartre which can be for minor or major operations or surgery, the amenity ward which in many hospitals is referred to as the private wing which houses the more wealthy patients, a records department and reception area, a H.I.V wing and a pharmacy. Larger hospitals normally split the functions of the above wards to deal with medical conditions separately by curving out new wards from the general wards which sometimes are also referred to as the medical wards. The pediatric wing can also be further split to include a child welfare clinic and the maternity unit to include an anti natal/ family planning wing. All large health centers are also meant to have an incinerator which is a disposal unit for hazardous wastes and a mortuary. Unfortunately most rural hospitals do not have these two units thus raising serious concern on their management of ‘unwanted products’ from the medical system. Hospitals must also have ambulances and in some cases also host a medical training school and staff quarters. Most rural hospitals also host the public health department who undertake activities in the wider community that include disease surveillance, outbreak control and monitoring especially of diseases like cholera and tuberculosis. Functions of the hospital In the health care system, hospital is the basic facility from which a doctor, dentist and other specialized medical personnel operate from and practice their trade which is to diagnose and treat patients with various medical conditions. Hospitals are therefore meant to have all the necessary services and equipment including the right staff of nurses, lab technicians etc to allow a doctor to adequately treat a patient. This in essence means that doctors are never meant to be employees of any hospital and only hire out the facilities in order to serve the patients better. It therefore follows that hospitals should strive to have all the necessary equipment and staff to make the work of the doctor easier. This could explain why there is a high concentration of doctors in urban centers since urban hospitals are able to acquire equipment faster than their rural counterparts. This could also explain the referral status given to Kenyatta and Moi teaching and referral hospitals and other larger hospitals in respect to the smaller health facilities. Hospitals also act as storage facilities for meditation and drugs. This means that hospitals must have pharmacists to prescribe the right medicines to patents and those drugs must be in stock. Hospitals are the main co-ordination office for health provision especially in rural areas. They therefore may support other institutions that include blood transfusion units, research centers, medical training schools, health insurance units among others to ensure efficient health provision in a given location In conclusion, it is important that health centers especially in rural areas are equipped with adequate equipment for them to attract more doctors and to reduce the need to refer patients to urban centers and in some cases out of the country. Some of the recurrent equipment that hospital need include Basic Dressing and delivery packs, cheatle forceps and small containers, stainless steel trays, speculums, drip stands, trolleys, gauzes, strapping and general sets. Auto claves also make a huge difference in the theatre. It is also important to reduce the distance between various health centers especially in the rural areas. A way to do this is by organizing medical camps which bring the hospital to the people. These medical camps can be organized in various parts of the country and can be used as the primary tool to identify suitable locations to construct new health centers based on the health needs of the area. Other ideas to improve the service delivery in health centers include sourcing of additional funding to motivate the staff and improve hygiene standards in the hospitals and the setting up of mobile units.

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