Social Determinants on Health The Kenyan Situation
Outline Introduction Poverty Education Food security Women empowerment Disease burden Conclusion 2
Introduction Demographic Profile The population is estimated to be 30 million 51% of this is less than 18 years old 52% of the population lives below the poverty line High Unemployment rates Infant mortality is 115 per 1,000 Maternal mortality is 414 per 100,000 Disease burden in Kenya has been markedly increased by Malaria, TB and HIV/AIDS Given these conditions, the challenges that Kenya therefore faces are not unique Government response in addressing health problems arising from these conditions Government has increased health budget by 30%, making it 3 rd highest after security and education 3
Introduction continued The government in an endeavour to achieve the MDGs is keen in making significant gains in the following: Poverty reduction Food security Education Women empowerment Improved living conditions in slums Disease burden reduction 4
Poverty contributing factors Poverty and ill health form a vicious circle Unemployment has been attributed as one of the key causes of poverty It also predisposes the youth to violence, suicide, alcohol, drug abuse and crime Urbanization plays a key role in predisposing to the poverty Ill health 5
Poverty - Response The Government and other partners has been addressing each of the above as applying multi-sectoral approach as follows: Replace the slums with decent cheap and affordable housing with better sanitary conditions Feeding programmes have been introduced in the schools in the slums Meal programs have also been started for Children s homes for orphans and other vulnerable groups. Alcohol and drug abuse in and out of school adolescents is being addressed through education and enhancement of various bills e.g. the Tobacco bill and the formation of organizations like NACADA Sanitation is being addressed by privatizing garbage collection and provision of proper sewerage system. Provision of safe water has been privatized to make it more available to all households 6
Education Situation Enrollment in schools had drastically gone down before 2003 with some schools having empty classes. The implications of this on health included having fewer mothers with basic education to take care of the family. Response The introduction of free primary education for the first basic eight (8) years in school. The Government is also going to construct 12,800 new schools to be able to accommodate the increasing number of enrolments 7
Food Security Situation Hunger a problem experienced all over Sub Saharan Africa leads to under nutrition or malnutrition which affects a measurable percentage of our children leading to stunted growth. Malnutrition leads to suppression of immune function with decreased resistance against infection as well as reducing the learning capacity of the individual which leads to less productivity and poor quality of life. Response The promotion of improved high yield agricultural methods by the government and development partners in which community involvement is of crucial importance to increase a sense of ownership. Growth and monitoring programs for under 5s have been serving as early warning signs The pastoral community is also being supported in rearing animals which can withstand drought situations and which also raise their economic status. 8
Women Empowerment Situation In most communities the woman has no say whatsoever in deciding whether to use a Family Planning method or even how many children and these are factors which will affect her health including decisions around Female Genital Mutilation. Response Education promotion and the formation of women s group Formation of community based cooperatives to empower themselves economically. Safe Motherhood Initiative introduction Affordability of the medical services have been enhanced with the introduction of affordable user fees which has lead to an increase in utilization. Accessibility and referral system has also been improved in the marginalized areas with the introduction of ambulances and radio calls where there is no telephone system. In the pastoral community the introduction of Manyattas (Health Camps) near the health facilities has also contributed in the reduction of maternal mortality. In collaboration with the Ministry of Transport the roads are being graded to improve the transportation system which enables vehicle to reach those remote areas reducing the delay in reaching the hospital. The involvement of the Community Health workers in the IMCI Strategy has also played a key role in the reduction of Infant Mortality. 9
Disease burden reduction Situation The disease burden in Kenya has been markedly increased by Malaria, TB and HIV/AIDS, the bed occupancy due to these diseases in most of the public hospitals is above 50%. Acute shortage of human resource Response Abolition of user fees at community level Free laboratory testing and treatment for the Malaria and TB. Soon free ARV treatment for the patients who qualify. The Government has increased the number of nurses 10
Conclusion In conclusion the Government aims to achieve its focus on having a health nation by addressing the issues on social determinants of Health through a Multi Sectoral Approach These planned activities will be within the Economic Strategy Paper, the Poverty Reduction strategy paper targets. In addition the government has developed the National Health Sector Strategic Plan (2005-10) The approach in the plan opens up for intersectoral collaboration which covers the whole span and scope of life from birth through adolescence to adulthood with all the indicators considered 11