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05May

Wash your hands, Keep Covid-19 at bay, But where is the water?

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Every year on the 22nd March, the World commemorates the World Water Day with focus on the importance of access to freshwater. This day raises awareness about billion people living without access to safe water. It is about taking action to tackle the global water crisis. A core focus of World Water Day is to support the achievement of Sustainable Development Goal 6: water and sanitation for all by 2030.

In 2020, the day could not have come at a better time, when the focus is on COVID 19 and the spirited campaigns on hand washing and personal hygiene. One of the surest ways of keeping this pandemic at bay, is washing hands with clean water and soap for a duration of 20 seconds. However, the question is how many families can afford the luxury of washing hands these many times a day to keep the virus away? According to Water.org1 about 20.5 Million Kenyans lack access to safe water; this means that this group of people is twice more exposed to the virus. As the hand washing campaigns continue, various institutions have come up with strategies to establish hand washing points in shopping malls and entrance to business premises. But those that live in the informal settlements are a forgotten lot, this is a group whose priority is to access water for every day use and your guess is as good as mine, hand washing is not in this list. Have we stopped for a minute to imagine what would happen if the pandemic got its way into these settlements?

The other ignored institutions are our primary health care facilities; over the years, these facilities have run on a shoe string budget to the extent that hand washing points are inexistence. In our budget lines, we have always tied WASH facilities under the administration costs which mean that the WASH facilities literally get swallowed up. As we run our campaigns around washing hands, have we figured out these facilities? With COVID-19, prevention is the way to go, without hand washing areas and reliable water in our facilities can we still talk about prevention of COVID-19, is this still possible if clients that walk into our facilities on a daily basis cannot access clean water and soap for regular hand washing? As we talk about preparedness at the county level to tackle the pandemic, have we ensured that facilities have adequate water and soap to encourage hand washing as a preventive measure? As funds are being released to mitigate the impact of the disease, could this be an area for prioritization?

As we look at the #SAFEHANDSCHALLENGE it is important to remember that washing hands is not only excellent but safe in the face of the pandemic but only if we have access to clean water and soap.

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03Dec

UHC Mass registration in Nyeri County marred by low numbers

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Nyeri County is among the four counties that have been chosen as a pilot county for UHC implementation, this follows recorded high incidences of non-communicable diseases such as diabetes, cancer and heart conditions among others; the other counties include Isiolo, Machakos and Kisumu. It is hoped that the lessons that will be picked from these counties will be important in influencing the decision on UHC implementation across the other 43 counties.
Despite the registration exercise being launched by Health Cabinet Secretary Hon. Sicily Kariuki, in Nyeri County on the 12th November 2018, and calling on every resident and every household to be registered, the county has witnessed low numbers. During a community dialogue meeting on UHC organized by Health Rights Advocacy Forum (HERAF) between 21st – 23rd November, residents of Mukurwe-ini Sub-County expressed their frustration on the slow pace at which the exercise was going on and the limited days before the event comes to a close on the 30th November 2018.
Some of the challenges cited during this forum included a reported go slow by the Community Health Volunteers (CHVs) who are being used as enumerators due to payment promises which were not honored. There were also complaints of poor mobilization by the county government; some of the households were neither aware of the ongoing exercise nor the requirements for registration.

There was a scenario where a child could not be registered because she is living with the adoptive father whose name was not on the child’s birth certificate and the mother was long dead. The area chief was asked to look into the matter, in as much as this could be an isolated case, there could be other similar cases which needs to be addressed to ensure that they are not left behind.The County needs to train the enumerators on how to deal with such scenarios when they arise.
The participants urged the county to make use of local administration and religious leaders to reach out to the masses. Poor network was not spared the blame, some households complained of having to move too far off areas (where there is network) to have the exercise conducted. Some also complained of having to wait for up to 40 minutes for an individual to be registered before the exercise proceeds. To beat the 30th November deadline, it is important for the county to bring all stakeholders on board to ensure that the exercise achieves the target of 100% registration. In the meantime, the county has developed a fact sheet on the FAQs about UHC and a UHC Communication plan which they hope will help in reaching out to the citizens.

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25Jun

Lack of awareness; the biggest challenge to the realization of the Linda Mama programme

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It’s been over year since the government, through the ministry of health launched the expanded free maternity programme dubbed “Linda mama – Boresha Jamii” programme. The programme meant to improve access and quality of Maternal, Newborn and Child Health services in the country, provides a package of basic health services accessed by all in the targeted population on the basis of need and not ability to pay. Linda mama’s main goal is to achieve universal cases to maternal and child health services and contributes to the country’s progress towards Universal Health Coverage.

Under the programme all pregnant women can access antenatal, delivery and postnatal care free of charge in all public, some faith based and private healthcare facilities national wide. The redesigned initiative expands the network of healthcare providers to include faith based facilities through direct re-imbursement mechanism that pays for number of deliveries reported by the facility to a health insurance plan to be administered by NHIF.

Although the programme is set to position Kenya on the pathway to Universal Health Coverage, lack of awareness about the programme is the biggest challenge that will negatively affect its realization in Kenya especially in the rural areas. Most of the health care workers do not know about the programme and those that do have very limited knowledge of how and when to start implementing the program. In Kilfi County for instance, most of the health care workers have no knowledge of the programme especially in dispensaries where even the facility in-charges have no knowledge of it. If Kenya is to realize Universal Health Coverage, awareness of the government initiative should be made not only to the health care workers in rural areas but also the communities. When the free maternity program was launched in 2013 by president Uhuru Kenyatta, 35% increase in the number of deliveries in public health facilities was registered this means, more than 2,000 women and 30,000 maternal and child deaths were averted by the year 2016. The Linda mama programme if well implemented is set to be a great step towards improving access and quality of maternal, newborn and child health care services in the country as well as attainment of health goals  as outlined in the vision 2030 which is to attain the highest possible health standards in a manner responsive to the population needs.

The beneficiaries should be aware of the programme for them to benefit from it. Awareness on what the programme is about, the benefits and how to register should be done especially in the rural areas through public barazas, community and opinion leaders, community dialogues and through health meetings for the programme to be successful.

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07Feb

The County budget and Economic Forum in the wake of the upcoming government

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As a group of new leaders take the leadership positions in the counties, what should come to mind is how these leaders will engage the public in ensuring public participation in the budget making process. The County Government Act and the Public Finance Management Act, require public participation in matters of public finance. While there are numerous references to public participation in these laws, most are vague and contain no further guidance. However, there is one major exception to this, which is the very specific requirement that every county set up a County Budget and Economic Forum (CBEF).

The first devolved government took advantage of the public’s naivety and some county governments went on to constitute a CBEF that only had the governors cronies as members, while others did not constitute one at all. It is upon the CSOs in each county to put the government to task in constituting functional CBEFs that have the citizens’ interests. The PFM Act 2012 clearly outlines under article 137 that the County Budget and Economic Forum shall consist of the Governor of the county who shall be the chairperson; other members of the county executive committee; and a number of representatives, not being county public officers, equal to the number of executive committee members appointed by the Governor from persons nominated by organizations representing professionals, business, labor issues, women, persons with disabilities, the elderly and faith based groups at the county level.  The persons need to have been nominated by the said groups and not just appointed directly. This is so as to ensure that the citizens in the CBEF represent the citizens’ views and not their own interests.

The purpose of the Forum is to provide a means for consultation by the county government on preparation of county plans, the County Fiscal Strategy Paper and the Budget Review and Outlook Paper for the county; and matters relating to budgeting the economy and financial management at the county level. In addition to the above, consultations shall be in accordance with the consultation process provided in the law relating to county governments.

Despite this requirement in law, most of the counties have not been adhering to it. According to a research study by the Centre for International Private Enterprise (CIPE) which sort to establish the extent to which citizens have been engaged in the budget making process in Kenya through the CBEF structures in eleven counties, only one County – Kwale reported having an active and operational CBEF, there was also a mention of the existence of CBEF in 3 other counties namely, Elgeyo Markwet, Makueni and Migori Counties. Some counties have attempted to enact legislations on public participation; these include in addition to the three with CBEFs Kakamega, Nairobi, Nyeri and Busia County thus the extents to which these structures have been operationalized still remain low. Despite the Counties reporting to have CBEFs, the manner in which the structures are working is still in question. As reported in nearly all the counties, the manner in which CBEF officials operate and the interests they represent are questionable as they do not represent interest of any constituents. It also came out that most CBEFs exist on paper but do not do any work or play any role in the budget making process.

Article 1 of the Constitution states that all sovereign power belongs to the people of Kenya. It further states that the people may exercise this sovereign power either directly or indirectly through their democratically elected representatives. The objects of devolution enshrined in the Constitution give powers of self-governance to the people and enhance the participation of the people in the exercise of the powers of the state and in making decisions affecting them; and to recognize the right of communities to manage their own affairs and to further their development. It is time, we as constituents rise and take up our role as enshrined in our constitution and other devolved policies. The CBEF is a good place to start with and with the backing of the law, the citizens ought to ensure that the operation CBEFs is as per the standards they require as the government officials appointed work for the people and not the other way round.

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06Feb

Healthcare system in Kenya and the milestones

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While access to quality health care is a constitutional right, millions of Kenyans are denied access to quality health care due to various reasons such as, affordability, geographical barriers, shortage of health care providers among others. The structure of the Kenyan Health Care system can be divided into three sub-sectors namely; (a) the public sector which includes government health facilities, medical schools and the public pharmaceutical chain called KEMSA, (b) the non-commercial private sector; FBOs, NGOs which include mission health facilities, medical schools and MEDs and (c) the private commercial (“for-profit”) include health care facilities, medical distributors / supplies, ICT in health, health management advisory and training institutions.

A major concern in the health sector is the infant and under-five mortality rates. According to the World Health Organization, the infant mortality rate stands at 48%, a number that is very high considering the changes that have taken place in medicine’s history. The number is experienced due to several causes including; malaria, which is the main cause, respiratory infection, malnutrition due to high levels of poverty, diarrhea diseases, HIV/AIDS, and TB. To reduce the under-five mortality rates, sensitization programs have been done by private companies and other organisations such as the Kenya Red Cross to sensitize people on the importance of hand washing in the prevention of diseases, and also raising funds to help those that have a chance of recovering (Help a child reach five campaign). Additionally, there has been enhanced sensitization on the need to sleep under insecticides treated mosquito nets and improved treatment on malaria infected cases to help reduce cases of infant deaths.

Besides infant mortality, several cases of maternal mortality are also on the rise where women lose their lives during child birth. This is highly associated with the fact that most women especially in the rural areas still make use of traditional birth attendants mainly due to inaccessibility to medical services or preference on traditional birth attendants as compared to skilled birth attendants. Some myths and religious beliefs are no exception. Hospitals and clinics are located far as per the recommended 5 km radius within reach from their homes forcing most of them to skip clinic days as required, therefore, relying on midwives. Lack of skilled attendance at birth, delayed treatment, and high costs incurred at hospitals are also key contributors to maternity mortality.

The government of Kenya has however put in place measures that will greatly reduce the maternity mortality cases. Such measures include; the presidential directive on free maternity services to women giving birth in public hospitals since June 2013, mobile clinics specifically designed to reach women in areas where clinics are hard to access (beyond zero), campaigns that aim in educating women on the importance of prenatal care, improved infrastructure and equipment in hospitals and increased number of health care givers. The government abolished user fees in public sector at the dispensaries and health centers levels for specific groups i.e. children less than five years of age, pregnant women and orphans and vulnerable children. The government has also provided funding to compensate the facilities for the revenue loss from the limited user fee income.

Health care workers from various cadres have been expressing their grievances and demands in form of nationwide strikes, as witnessed in the recent past. Among these demands include; improved working conditions, poor working environment due to lack of equipment, inadequate health care workers with increased workload, poor remuneration, acute shortage of drugs and inadequate supplies which leads to poor service delivery. Recruitment and deployment of health care workers is another point of focus since the rural areas are lagging behind in terms of health care development and yet it is the goal of the government to change this since the Constitution of Kenya was promulgated paving way for devolution. It is evident therefore, that geographical disparities in health care access in Kenya are very high.

In conclusion, there has been tremendous improvement in the health sector where for instance, most people have taken up insurance covers after several campaigns and introduction of affordable rates across all classes of people, mostly convenient is the NHIF medical cover. The rate of HIV/AIDS infections has also gone down to 6.7% as compared to 10% in the 1990s. This was made possible due to awareness on how to prevent acquiring the virus, provision of free condoms and behavior change communication amongst the youth, availability of medical care to those who are prone to getting infected, and sensitization on the importance of living positively amongst PLWHIV. Besides, there has been an increase in numbers of dispensing clinics to prevent congestion in referral hospitals. The government has also increased its total expenditure on the health sector to up to 30%. More workers and medicine has been acquired. The government has also cut more deals with foreign countries like Japan, European countries, and USA on bringing the state of art.

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10Jan

Kenya Citizens’ Health Manifesto

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2 versions of the Kenya Citizens’ Health Manifesto (10 pager and 1 pager). The Manifestos were presented to the Political Parties before they launched their national manifestos last month. One on one meetings can be held with the manifesto for the candidates to understand why they need to support its implementation.

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