Annual Scientific conference of Kenya Association of Physicians DISPARITIES OF HEALTH CARE: CHALLENGE TO PHYSICIANS Dr. James Nyikal,MBS Director of Medical Services Disparities in health care in Kentya 1
Background Challenges to the health sector Finance and financial flows Rapid growth of infrastructure Human resource Emerging diseases Coordination Legal framework Poverty Disparities in health care in Kentya 2
Deteriorating indices Infant mortality rate Under five mortality rate Maternal mortality ratio Life expectancy Immunization coverage Disparities in health care in Kentya 3
National trends of infant and under five mortality source: CBS 25 2 184 219 19 15 1 5 126 119 157 14 113 IMR <5 MR 93 59 62 15 116 115 115 71 73 77 77 1948 1962 1969 1979 1889 1993 1998 2 23 24 25 Year Disparities in health care in Kentya 4
Trends in IMR by province 16 14 12 1 8 6 4 2 1989 1993 1998 1999 2 23 Year central coast eastern nyanza north eastern rift valley western nairobi national Disparities in health care in Kentya 5
Trends in IMR rural vs 9 8 7 6 5 4 3 2 1 urban (per 1, live births) rural urban national 1989 1993 1998 1999 2 23 Year Disparities in health care in Kentya 6
25 2 15 1 5 Trends in under five mortality by province 1979 1989 1993 1998 1999 2 23 Year central coast eastern nyanza north eastern rift valley western nairobi national Disparities in health care in Kentya 7
14 12 1 8 6 4 2 Trends in under five mortality rural vs urban (per 1, live births) rural urban national 1979 1989 1993 1998 1999 2 23 Year Disparities in health care in Kentya 8
HIV prevalence rate by 14 12 region 13.1 1 8 9 6 4 2 5.6 5.7 3.7 3 5 4.5 5.9 Central Coast Eastern Nairobi Nyanza North Eastern Rift Valley Western National average Disparities in health care in Kentya 9
National trends of maternal mortality ratio (per1,) 23 414 Year 1998 59 1994 365 1 2 3 4 5 6 7 Disparities in health care in Kentya 1
National trends of fertility rate 9 8 7 6 5 4 3 2 1 8.4 8.1 6.8 5 Urban Rural National 7 4.5 5.8 5.2 3.4 3.1 5.8 2.7 1978 1984 1989 1993 1998 1999 23 Year 5.4 3.3 Disparities in health care in Kentya 11
Trends of fertility rates by province 1 9 8 7 6 5 4 3 2 1 central coast eastern nyanza western north eastern nairobi rift valley national 1978 1984 1989 1993 1998 1999 23 Year Disparities in health care in Kentya 12
National trends of life expectancy at birth 7 6 5 4 3 35 44 49 54 59 57 2 1 1948 1962 1969 1979 1989 1999 Year Disparities in health care in Kentya 13
Immunization coverage by province 12 BCG Fully imm.(kdhs 23 Fully immun. (kepi) 26 % 1 8 6 91 58 98 98 71 9 89 74 85 7 76 57 9 87 64 63 4 3 2 2 western nairobi central coast eastern nyanza north eastern rift valley national Disparities in health care in Kentya 14
Health institutions distribution by province nairobi western Hospital rift valley north eastern Year nyanza health center eastern coast dispensary central 2 4 6 8 1 12 14 Disparities in health care in Kentya 15
Nurses/1, population Distribution of nurses by province 7 6 63 59 5 4 3 31 49 39 26 42 41 2 1 nairobi central coast eastern nyanza north eastern rift valley western Disparities in health care in Kentya 16
MO/1, population Distribution of medical officer by population (23) 15.35 15.3 15.25 15.2 15.15 15.1 15.5 15 15.1 15.3 22 23 Disparities in health care in Kentya 17
KES Trends in MoH actual per capita expenditure in Health 1 9.5 9.5 9 8.5 8 7.5 7.5 7 6 5 6 5.3 5.2 5.3 6.6 5.8 5.9 5.5 5 4.4 4.6 6.3 6.3 6.5 4 3 3 3.4 3.2 3 2 1 1979/8 1981/82 1983/84 1985/86 1987/88 1989/9 1991/92 1993/94 1995/96 1997/98 1998/2 2122 23/24 25/26 year Disparities in health care in Kentya 18
% population living below poverty line Regional poverty level 7 6 61 58 63 58 62 5 45 4 34 3 2 14 1 nairobi central coast eastern nyanza north eastern rift valley western Disparities in health care in Kentya 19
Health expenditure by source % 6 5 4 3 2 1 1994 22 GoK Household Private co. Donors NGOs others Disparities in health care in Kentya 2
Challenges to the physician Health reforms Leadership role and head of team Role model Cost of care and poverty Ethics in compromised social environment CPD Curative care/disease prevention and health promotion Perpetual dilemma Disparities in health care in Kentya 21
MOH response Paradigm shift in the NHSSPII Emphasis on disease prevention and health promotion Defining essential health package (KEPH) Focus on equity and access to affordable health care Building partnership with community Strengthen health care support delivery systems enhanced sector coordination and partnerships. Disparities in health care in Kentya 22
MOH response Actions taken Increased funding Employment of staff Purchase of equipment Rehabilitation of health facilities Strengthening of KEMSA to take over procurement functions Strengthening Regulatory Rapacity Disparities in health care in Kentya 23
MOH response Health sector reforms Decentralization Enhanced financial flows Procurement processes Human resource management Result based management Partner coordination Disparities in health care in Kentya 24
Way forward Physician leadership in the sector Advocacy for more funding of the sector Advocacy for reforms in the sector Disparities in health care in Kentya 25
Way forward Advocacy for better human management and development in the sector Institutionalization of CPD Promotion of accountability Promotion of ethics Disparities in health care in Kentya 26