Experiences from Kenya

Sammy Ole Oinyiaku

Regional Representative

The Presentation

• Personal Introduction

• Kenya Health Care System

• Health[e]Foundation in Kenya

• Experiences

• Way Forward

Sammy Ole Oinyiaku

• BA in Psychology, United States International University (USIU); Nairobi

• MPH in Epidemiology and Health Communication, Columbia University (Mailman School of Public Health); NYC

Employment

• World Bank

• USAID

• AMREF

• Health[e]Foundation

The Kenyan Health Care

System

Health Care Delivery in Kenya

• The Second National Health Strategic Plan (NHSSP II)

• Community Unit Strategy

– Populations divided into six cohorts

– Health facilities divided into six levels

LIFE CYCLE SERVICES NEEDED

COHORT PREVENTIVE CURATIVE

Pregnancy and the New-Born (up to 2

weeks of age)ANC and nutritional care; PNC; Use of skilled births attendants, clean

delivery; Breast feeding; supplementary feeding;

FP Services; TT2

ITN promotion and use; IPT and Indoor spraying;

Micronutrients / supplements (Iron)

Hygiene, water and sanitation.

Adequate and timely referral system, Partograph, transport (ambulance)

system. Basic and Emergency

Obstetric Care.New born resuscitation,

PMTCT / Nevirapine;Rapid case detection of childhood

diseases

Early Childhood (2 weeks – 5 yrs) Community IMCI + ITNAppropriate nutrition, EBF; EPI and

Vitamin A / Zn.Psychological stimulation; physical /

cognitive development;

Clinical IMCI; ORS for treatment

Diarrhoea, antibiotics and anti-

malarial drugs. ARV

Late Childhood (6-12 years) Health programme;

Adequate nutritional care; ITN promotion and use.

Overall treatment and care;Appropriate feeding, timely treatment

of infectious and parasitic diseases.

Youth and Adolescence (13-24 years) RH (FP & Post Abortion Care)

HIV/AIDS/STI counselling,Adequate nutritional care;

Accident prevention

Overall treatment and care,DOTS, STI and opportunistic

infections

Adult (25-59 yrs) Annual screening and medical

examinations; RH services, accident

prevention. Exercices.

Overall treatment and care,

ART and palliative care,

DOTS

The elderly person (60 yrs ++) Annual screening and medical

examinations. Exercise.

Access to drugs for degenerative

illnesses;

Service Delivery Levels

• Level 1: Community /Household Level

• Level 2: Dispensary

• Level 3: Health Center

• Level 4: District Hospital

• Level 5: Provincial Hospital

• Level 6: National Referral Hospital

Health Care Situation

• Kenya health care system faced by a myriad of Human Resources challenges

– Overall lack of personnel in key areas

– Immigration of trained personal

– Inequitable distribution between rural and

urban health facilities

– Traditional health care approaches e.g.

TBAs and medicine men/women

HIV/AIDS Situation in Kenya

• Comparison was done between the KDHS 2003

and KAIS 2007

• Comparisons restricted to men and women 15-

49

• National prevalence of 7.4%

HIV Prevalence in Kenya

AGE TOTAL FEMALES MALE

15-64 7.4 8.7 4.6

15-49 7.8 9.2 5.8

Health Care Workers: The Numbers

No. of Grauating Nurses, COs and Physicians 2002 - 2006

Staff Cadres 2002 2003 2004 2005 2006Registered Nurses 1,094 1,256 1,253 1,412 1,304

Enrolled Nurses 428 524 536 576 497Registered Clinical Officers 256 293 237 449 489

Laboratory Technicians 164 245 208 228 160

Physicians 210 290 406 363 464

Pharmaceutical Technologists 70 57 66 121 92

Physiotherapists 34 29 32 47 34

Consequences

• High turnover of staff in government health

facilities to NGO, Mission and other facilities

• Emigration to other countries for better

opportunities

• Higher education studies in and out of the

country

• Change of profession including going into

private practice

Emigration Rate (%) 2005

Physicians Nurses

Kenya 51 8.3

South Africa 21.1 5.1

Africa 19 8.4

Educational Options

• Kenya Medical Training College (KMTC)

• Universities offering medical/health-related

courses – Moi, Kenyatta, KEMU

• Upcoming middle-level colleges affiliated to

KMTC or public universities

• Distance learning

Health Workers Challenges

• Minimal information on emerging issues and

trends

• Lack of computer skills

• Lack of CME – “outdated” skills and

knowledge

• Lack of access to trainings and training

information

• Few health workers with little or no time to be

away from their patients

Health[e]Foundation in Kenya

Activities since 2008

• Raising awareness among organizations, professionals and government ministries on HeF –meetings, exhibitions, presentations

• More than 50 organizations reached so far

• High interest on the training programs

• Innovative approach to training “out of the ordinary”

Trainings

• International Child Support (ICS) in Busia – 39

participants from the Ministry of Health – February

2009

– Most of them are from rural health facilities

• Kenya AIDS NGOs Consortium (KANCO) – 27

participants from facilities around Nairobi

- most of them are from resource poor settings

including slums

• Upcoming workshop in July

Participant Support

• Participants supported, monitored through

– Phone

– Emails

– On-site – personal visit for support

– HeF Website – “Lost

My Stick” feature

Training, Trainee Evaluation

• Trainings and trainees are evaluated through:

– TNA questionnaires

– Pre-tests and post-tests in the training modules

– End-day evaluations during KO/Workshops

– Facilitators’ evaluations

– One-on-one discussions

– Email feedbacks/comments

Experiences

• There is great demand for the training programs by health workers

• There is great interest in the “innovative”training approach

• There is great interest for collaboration by organizations including the Ministry of Health, academic institutions and individual professionals

•

Experiences

• There is great demand for the training programs by health workers

• There is great interest in the “innovative”training approach

• There is great interest for collaboration by organizations including the Ministry of Health, academic institutions and individual professionals

•

Way Forward

• Kenya is a “ripe market” with high potential!

• Continuous follow up on contacted organizations, past and present trainees

sammy@healthefoundation.eu

HEALTH[e]FOUNDATION

WWW.HEALTHEFOUNDATION.EU