President Uhuru Kenyatta greets a one-day-old baby when he commissioned medical equipment at the Mwingi Level 4 Hospital in Kitui. Kenya. Credit: State House

By Werner Schultink and Rudi Eggers & Siddharth Chatterjee
NAIROBI, Kenya, Mar 27 2018 (IPS)

The Government of Kenya has prioritized universal health coverage (UHC) in its Big 4 agenda over the next 5 years.

This is a significant and perhaps the most important strategic priority. Why? Every year over a million Kenyans get trapped into poverty because of a catastrophic out of pocket payments due to health reasons.

In 1978, health campaigners worldwide achieved a major breakthrough at the UN Alma-Ata Conference on Primary Health Care. This conference statement signaled a new approach to health care, often described as the ‘primary health care approach’ or the ‘Alma-Ata principles’ – deeply rooted in the social and structural determinants of health (such as poverty eradication), and emphasising the importance of health care being accountable and accessible to the people it serves. A global target of achieving “Health for All” by the year 2000 was established.

How do we ensure that Universal Health Coverage is possible in Kenya by 2022?

The answer is simple. The focus has to be on preventable and primary health care as emphasized in the Alma-Ata principles. The centrality of reproductive, maternal, neonatal, child and adolescent health will be critical to achieving UHC.

Kenya has made considerable but slow progress in reducing maternal, newborn and child mortality, but missing its 2015 Millennium Development Goal targets implies there is still a lot of pending work to give women and children the most basic of rights – the right to life and well being. As the First Lady of Kenya Ms Margaret Kenyatta has often said, “No woman should die giving life” which led to the launch of her signature Beyond Zero campaign and the Government declared a free maternal health care policy in 2013.

There are two reasons for seeing maternal and child health as a forerunner for UHC. First, it is clear that the mother’s overall state of health has a lifetime impact on an individual child’s health. Second, there is now evidence that households with maternal health complications spend considerably more of their savings to cover medical expenses. This is particularly key in rural settings where women play major economic roles.

The loss of women’s contributions combined with the spending shock they face can force households, particularly those already vulnerable, into deeply-entrenched poverty.

Reduction of out-of-pocket expenditure is central to achievement of UHC. One approach towards this reduction must be promotive and prevention-based intervention. We already have several proven, low cost-high impact interventions for significantly reducing the number of women dying during childbirth and shrinking new-born and childhood mortality.

About 74,000 Kenyan children under the age of five died in 2016, including 33,000 aged below the age of one month. At the same time, about Kenyan 6,000 women die every year from giving life, many from treatable infections. Many of these deaths could have been averted with relatively simple interventions.

Kenya has done very well in developing relevant national guidelines and policies creating a framework that can efficiently deliver these high-impact maternal, newborn and child health interventions. Devolution of health services must now include cascading the policies to local health services, but more importantly, ensuring the guidelines are fully implemented.

Another concern is the variations in mortality, with differences between rural and urban communities, rich and poor and between developed and under-developed counties.

Even though Nairobi is the most developed county, it has the highest annual absolute number of maternal, newborn and child deaths compared to all other counties. This will only increase as the city population rapidly expands. Conversely, maternal and newborn mortality rates are highest in counties such as Marsabit, Turkana, Kitui, and Kilifi.

The recently-released UNICEF report on the power of investing in the poor indicate that for every US$ 1,000 invested in health for the poorest children, nearly twice as many lives are saved compared to investing in areas where richer people live.

The attainment of UHC must not be seen as a purely technical objective, but must be accompanied by purposeful redistribution of resources for equitable gains.

The following low cost high-impact interventions will leapfrog UHC. These interventions should be included in the essential health service package that should be available to all Kenyans at no further cost: 1. 100% immunization coverage. 2. Scaling up maternal and child health by ensuring exclusive breastfeeding, hand-washing to prevent transfer of infectious diseases, chlorhexidine as an antiseptic for umbilical cord, newborn resuscitation, ‘Kangaroo’ mother care, family planning, antenatal and postnatal care and skilled delivery. 3. Prevention of water borne, vector borne, TB and HIV and sexually transmitted diseases. 4. Prevention of non-communicable diseases, particularly diabetes and hypertension. 5. Improving nutrition of women who conceive and follow this through to the first 5 years of a child’s life.

These 5 actions will not only help achieve universal primary health coverage within 5 years, but reduce the number of patients going into the referral systems. It will reinforce the famous adage, “prevention is better than cure.”

Innovative approaches are needed to address weaknesses and shortages of human resources and focus more on improving performance of the existing workforce. Already, the government is emphasizing the role of community health volunteers in implementing some of these interventions.

With over 70% of Kenya’s population under 30 years of age, the government of Kenya’s focus on UHC is critical for Kenya to reap a demographic dividend.

It is crucial that we further strengthen our partnership between county governments, UN agencies, international development partners, civil society and private sector to seek the quickest pathways towards realization of universal health coverage.

Kenya can lead the way in achieving universal health coverage.

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Credit: ©UNICEFKENYA/2011/MODOLA

By Rudi Eggers and Werner Schultink
NAIROBI, Jan 20 2017 (IPS)

For a long time, no person in Kenya suffered the devastating disability that is caused by polio. In fact, the only reminder in the early 2000s was the victims in the streets of Nairobi, many of whom had been paralyzed as children and adults. Their lives were ravaged by this terrible, vaccine-preventable disease.

A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in fifteen counties. Children in high-risk areas -- some of whom have never had access to immunization services before -- will have an opportunity to be vaccinated against polio.
Sadly, in 2013 a large outbreak of polio in Nigeria spread across the continent, affecting several countries on its way east. Kenya was not spared.  Fourteen new polio cases were confirmed. The polio virus struck those that were unvaccinated – the most vulnerable and the most excluded — children in areas with poor access to health services, refugees, and nomadic communities.  Fortunately, a rapid response by the Kenyan Government brought the polio outbreak under control, and the last case was reported in July 2013.  At that time, it seemed that the country was well on the road to being declared polio-free.

However, recently, concerned scientists have pointed to the increasing risk of polio, particularly the large numbers of children who remain unvaccinated, especially those in vulnerable populations in the northern part of the country and in the informal settlements of Nairobi and Mombasa.  Furthermore, the notion that the African continent was free from the polio virus was shattered when four new polio cases were reported in northern Nigeria. Given the previous experience, health experts and Ministries of Health recommended that the areas with low vaccination rates should be targeted with vaccination campaigns, specifically designed to reach those that missed out on the routine vaccinations.

Since the establishment of the Expanded Programme of Immunization (EPI) in 1980, Kenya deserves credit for reaching majority of the children with life-saving vaccines. But there is still a lot more work that needs to be done; progress in the country is very uneven and many children remain unvaccinated. It is estimated that 400,000 (3 out of 10) children still do not receive all the required scheduled doses of vaccines by their first birthday. This build-up of under-immunized children has previously contributed to outbreaks of polio. Most of these children come from poor families, the urban informal settlements and the hard-to-reach parts of the country, particularly arid and semi-arid (ASAL) regions where access to health services is limited.

A child receives vaccination against polio in a Mother and Child Health (MCH) Clinic at Mukuru Health Centre, in Nairobi, Kenya. Credit: ©UNICEFKENYA/2016/NOORANI

As long as there is a child out there who has contracted this disease, no matter where they live or who they are – all children everywhere are not safe. The four cases confirmed in October 2016 in the current polio outbreak in Nigeria place other African countries, including Kenya, at risk of importing the wild polio virus, due to the unaccounted number of unvaccinated children across the continent as well as the high population movement.

In the final push towards eradicating polio by 2018, Kenya with its strict monitoring system for the safety and quality assurance of vaccines, has already proved that it has the capacity to make the whole country polio-free. A five-day polio campaign that started on 18 January, 2017 targets more than 2.9 million children below the age of 5 years in the fifteen counties of Bungoma, Busia, Garissa, Isiolo, Lamu, Mandera, Marsabit, Nairobi, Samburu, Tana River, Trans Nzoia, Turkana, Wajir, West Pokot and Uasin Gishu. Children in high-risk areas — some of whom have never had access to immunization services before — will have an opportunity to be vaccinated against polio.

To ensure that all vulnerable children are reached, the exercise will be relying on the steadfast commitment of vaccination teams and the communities they serve. These heroic women and men in most cases walk long distances from house-to-house, often in the most dangerous of circumstances to reach all children. Communities where the polio campaign is backed and encouraged by religious and community leaders have much higher rates of protection than those that lack this support.

As part of the worldwide campaign to eradicate polio, there is need for everyone to rally behind this polio vaccination campaign, to reach each and every child regardless of their geographical location of their status in society. We have a responsibility to protect hundreds of thousands of children in Kenya from being paralyzed for life; from being excluded from their communities; and from being denied their right to a full and productive life.

In 2017 and beyond, no child in Kenya should suffer the consequences of a vaccine-preventable disease, for every child deserves to live in a polio-free world.

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Elected national Children’s Government of Kenya for 2016. Photo credit: UNICEF Kenya\2016\Gakuo.

By Siddharth Chatterjee and Werner Schultink
NAIROBI, Kenya, Aug 12 2016 (IPS)

Consider this: in 1956 Sweden and Kenya’s population was roughly at 7 million. Today Sweden has about 9.8 million, while there are about 44 million Kenyans.

Fertility levels are declining gradually and Kenyans are living longer. It is estimated that there will be 85 million people in Kenya by 2050, with three quarters of these being below 35 years. While Kenya’s median age is 19, Sweden’s is 42.

Kenya’s mushrooming population presents an extraordinary opportunity and several challenges. The opportunity lies in the potential for a so-called demographic dividend of sustained rapid economic growth in the coming decades. There is reason for optimism that Kenya can benefit from a demographic dividend within 15 to 20 years. It is estimated that Kenya’s working age population will grow to 73 percent by year 2050, potentially bolstering the country’s GDP per capita 12 times higher than the present, with nearly 90 percent of the working age in employment. (NCPD Policy Brief: Demographic dividend opportunities for Kenya, July 2014.)

But Kenya’s demographic dividend is not guaranteed by its changing demographics alone. Key actions are required if children of today – who will be entering the labor force a decade’s time – are skilled, dynamic and entrepreneurial.

Unemployment among Kenya’s youth is now estimated to stand at 17.3 per cent compared to six per cent for both Uganda and Tanzania. A World Bank report says mass unemployment continues to deny Kenya the opportunity to put its growing labour force to productive use, thereby “denying the economy the demographic dividend from majority young population”.

Investment in children is Kenya’s best hope to set the right pre-conditions for this potentially transformative demographic dividend. Properly harnessed, the potential of the youth could propel the country forward as a dynamic and productive engine of growth in all the 17 Sustainable Development Goals (SDGs) set out last September.

At the beginning of this year, UN member states started the long journey to implement the SDGs and they all have 169 targets to achieve by end of December 2030. Some countries have already made good progress on the localization and mainstreaming of the SDGs in their development plans and budgeting processes. In fact, 22 of the 193 Member States that endorsed the SDGs voluntarily reported on their progress at the High-level Political Forum (HLPF) held last month in New York.

The Government Kenya played a very important role in the design of the global development agenda. About 20,000 Kenyans participated in the MyWorld Survey, in which they voted on the kind of world they wanted after the MDGs. Kenya was also one of many countries that commissioned consultations at national, regional and community levels to discuss the Post-2015 development agenda, and these culminated into a position paper that was presented for inclusion into the post-2015 development agenda.

The global development agenda dovetails with Kenya’s Vision 2030 in terms of timeline and key strategic focus and seeks as well to make Kenya globally competitive and prosperous for all citizens. Kenya Vision 2030 does capture the three dimensions of sustainable development including economic, social and environment. This makes it much easier to align the national development plan of Kenya to the SDGs.

However, as was evident with the millennium development goals (MDGs), the work of translating SDGs into results requires strategic actions. It requires that countries exploit fully the resources within in order to make the giant leaps needed to meet the targets.

Experts agree that for Kenya and the rest of Africa, these giant leaps will come through the youthful human resource, but only when the working age population becomes larger than people of non-working age.

In Kenya, there are about eight dependents for every working person, meaning that the state faces very high costs associated with economically unproductive populations. It means that Kenya must invest to create jobs, and invest in the young people with the skills to fill those jobs.

A society that wants to diversify its economy, achieve industrialization and socio-economic transformation and the SDGs must invest heavily in a strong, dynamic and empowered youth and women to drive this agenda. Kenya’s children will need quality learning that leads to educational attainment that is relevant to their lives, and gives them with the skills needed for the country’s changing labor market. Protection from ill health, malnutrition, violence, conflict, abuse and exploitation are also crucial for children – and their nation – to prosper.

In Kenya, the youth constitute an important segment of the country’s population, accounting for 35.4% of the total population and 66.7% of the adult population in 2009. The proportion of the youth category is expected to remain relatively high at 35.4% of the population in 2015, 34.8% in 2020, 34.6% in 2025 and 35.2% by 2030. This means that at least one in every three Kenyans will continue to be young.

Therefore, if Kenya and all other developing countries must successfully implement the SDGs, it is very important that young people, both boys and girls, no longer remain passive beneficiaries of development but must become equal and effective partners for development. This means that the problem of youth must be addressed as a policy and development issue, which must be mainstreamed in all planning and budgeting processes.

In addition, strong political commitment and leadership must be demonstrated at both national and local levels to address the problems of youth in Kenya. High growth rates must be translated into skills and jobs for the increasing young population and workforce in Kenya. Such actions will indeed help to keep young people away from being targets of youth radicalization and violent extremism.

Investing in youth is not only an investment in the future but also fundamental for the successful implementation of the SDGs.

Today 12 August 2016 is International Youth Day. Let’s commit to investing in youth. It is not only an investment in the future but also fundamental for the successful implementation of the SDGs.

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