Kenya
Kenyan health sector reform finds support

afrol.com, 14 December - Kenya is facing a health crisis and decline in health services since the late 1980s, and the need of reform has long been known. Government efforts to decentralize health services to provide quality and effective care to the most vulnerable population now find donors and World Bank support.

In response to the Government efforts, the World Bank this week approved a US$50 million credit to support the ongoing decentralisation of the health sector. Earlier this year, the Kenyan Government received financial support from international donors, such as the Swedish development cooperation, SIDA.

By the 1970s Kenya had built a health system which performed relatively well compared to neighboring countries and some of the country's health indicators were among the best in sub-Saharan Africa, with an Infant Mortality Rate of 62 in 1985. However, the health sector has been in decline since the late 1980s, both in terms of the services provided and the health of the Kenyan population. 

Since then, Kenya has witnessed an economic stagnation. Health services have been shortened, population keeps growing fast and the costs of the spreading AIDS epidemic has a significant effect on the limited health resources available in the country. Today, government spends some US$ 6 on health care per capita, while this number was US$ 10 per capita twenty years ago. Other statistics show that infant and mother mortality has increased, while the life expectancy of a Kenyan has fallen during the last five years. 

Kenyan social statistics are in general disturbing lecture: Seven of thousand mothers die while giving birth in Kenya. Nine of a hundred children die within a year after birth. There is only one doctor for every 7000 persons in Kenya.

The HIV/AIDS pandemic has turned the health crisis into a more general development crisis. In 1990, the adult (15-49 years) HIV prevalence was estimated at 5.8 percent. This prevalence rate has been growing at an average of 11 percent per year, reaching 13.9 percent in 1999, according to statistics made available by the World Bank.

The straw has been the ongoing drought and desertification, further enhancing the health crisis. Under normal conditions, some 47% of Kenyans do not have access to potable water, and this rate has increased significantly during the drought. The drought also causes severe and acute problems of malnutrition. In August, the World Food Organisation reported that 25 to 30 per cent of children in some Kenyan districts suffered from malnutrition, which is two to three times the average rate of malnutrition compared to other developing countries. The Kenyan health sector was not at all ready to meet the extra burden of a drought.

The solution to the crisis in the Kenyan health sector has been sought in decentralisation. "There is a great need to bring the decision making process out to a local level, with a local participation," Ylva Sörman Nath from SIDA said commenting the Swedish contribution of US$ 9 million given to regional projects in September. 

With very limited resources, there is a need to use them in a more efficient way. "Local and regional institutions need more competence in managing their own units and build on the institutions they have," according to an analysis by SIDA. "The legal framework must be more flexible and give more authority to local units." It is hoped that these ongoing reforms will channel more of the resources directly to where they are needed.

The World Bank this week decided to fund the Decentralised Reproductive Health and HIV/AIDS project, which will support strategies to better target public subsidies to the poor and vulnerable. Through the project, the Kenyan Government will receive support in "implementing its decentralization policy by improving mechanisms for fiscal decentralization, building capacity at district level for results-oriented planning and financial management while promoting transparency, technical and financial accountability," according to a statement from the World Bank. 

The decentralised projects that have gained special attention from donors include HIV/AIDS programmes, reproductive health, medical counseling, institution building, children's health care, vaccinations and the prevention of malaria. 

Source: Based on afrol archives and World Bank

© afrol.com. Texts and graphics may be reproduced freely, under the condition that their origin is clearly referred to, see Conditions.    You can contact us at mail@afrol.com