THE TRAGEDY OF HURRIED DEVOLVED HEALTHCARE IN KENYA

It is argued that it is in the times of turmoil when people reason prompted by the need to restore order. This approach has a sadistic angle since some disorders are preventable. The intended devolution is ultimately a great thing but the care givers have faulted the process being followed in doing so.

In this article I discuss the top most expected problems with hurried and unstructured devolution of public health care in Kenya. It Is worth noting that should the anticipated challenges affect the health sector negatively, it’s the poor who will bear the brunt. Public health sector provides care to 87% of Kenyan population. The middle class who are decision makers receive care from elsewhere; the private sector and overseas facilities.

What is at stake with hurried devolution of healthcare?

It is envisioned in the constitution that healthcare being essential its devolution must be systematic and guided by clear structures. In addition, the Devolution to County Act of 2012 sets presence of relevant laws as foremost prerequisite in assessing if a function is to be devolved or not.

The proposed Health Bill was introduced by the previous government but did not see the light of the day owing to fundamental flaws therein. Overally, this bill proposes certain changes to ensure that the health sector remains professionally managed and preserves its essential nature in spite of prevailing political circumstances of the day. The functions below will be irreparably negatively affected by devolution devoid of relevant structures and policies.

Training of health personnel

Kenya is credited with provision of impeccable training if healthcare workers in all cadres in the region. As a matter of fact the neighboring countries have viewed Kenya as a role model in this aspect. There is standardization of training for nurses, clinical officers, medical, dental and pharmacy officers. This has been entrenched in the well defined centrally supervised training.

In absence of centrally structured supervisory bodies to inspect and accredit training, the quality training received will be eroded. Even in the developed nations like USA, there is one central body to ensure the quality of training is safeguarded.  As a direct consequence of hurried devolution, we are likely to see mushrooming of dubious training institutions. Due to the sensitivity of services the health professionals will provide to the public, this must never be allowed to happen.  There must be defined and supervised training of all cadres. This is effectively rendered impossible by the hurried devolution of health sector.

Registration of health care providers

The health Bill recommends formation of centralized registration body to ensure only those duly trained and qualified are registered to offer health services in Kenya and indeed other nations where Kenyan credentials are recognized. It has been practice to ensure that persons trained outside the country are tested and approved before they can practice in the country. This also helps in authenticating the certificate presented. This function must never be taken to the 47 ill-equipped counties since the repercussions will be costly. In the proposed and hurried devolution, there is no clear indication as to who registers health workers.

Supervision of Health care providers

Like any function, supervision is vital to ensure accountability by all healthcare providers. In the devolved healthcare, much as the county administration argues they are capable of supervising healthcare workers, this must be distanced from political patronage and interference. The delicate nature of healthcare requires clearly defined and unambiguous separation of functions. What may appear as supervision by politicians may eventually cripple operations in public health facilities.

Specialization and sub-specialization training

A weak economy as Kenya must take heed to invest in human capital development. The role played by specialists and subspecialist in the public sector cannot be overemphasized. The determination of priority areas of training and who is to be trained must be preserved. The rationalization for this must not be subjected to the political whims of county government. Some counties have argued that they don’t even need doctors in the first place. Incidentally the proponents of this thinking are not care seekers in these facilities.

Similarly, the trained consultants must be equitably distributed in all the 47 counties to ensure that some Kenyans are not starved of these services while other places are overstaffed. The current system of identification of trainees and redistribution of qualified specialist has been variously faulted. But this is better than no system at all. There is need to involve all stakeholder in crafting policies to achieve adequate and equitable coverage by consultants.  It is anticipate that the unplanned devolution being fronted and not backed by any policy or legal guidelines will irreparably dent the attempts of attaining better coverage as enshrined in the Kenya Vision 2030

Retention of workforce in the Public health sector

The jitters seen among the health workers owing to the anticipated political interferences, proposed reduction of pay and allowances is likely to push health workers out of employment. As it is, there a reports of resignations daily, stretching the already understaffed workforce in the lower units of healthcare system. It is worth noting that this may be viewed differently depending on which side one considers. To the Salaries and Remuneration Commission (SRC), they may laud this since they have constantly complained that the wage bill is bloated. But should they jubilate while an essential sector is crumbling? My opinion is no. To the employees, this is a very worrying development.  As with all other professions, it’s the hope of majority to have conducive and supportive environment to ensure services are discharged efficiently. A very thing workforce, de-motivated souls and poorly remunerated personnel inevitably affects their output. The public health sector is better improved through reduced exodus of staff to private sector, abroad and other unrelated engagements. The question is, does the devolved structure promote retention of staff in the public health sector? Simply no

What must be done to ensure smooth transition?

It is foolhardiness to presuppose that coercion and intimidation shall achieve results. If truly the relevance of devolution is to improve service provision, then dialogue must prevail. The Fourth Schedule of the constitution of Kenya has set the transitional period to three years to give room for adequate preparation before functions are handed over to the counties. But the usual practice of shifting goal posts has culminated to the standoff between the central government, the county governments on one hand and the healthcare providers of the other hand.

It must not be forgotten that no single group desires and longs for improved healthcare than the the healthcare providers themselves. The citizens must not allow other consideration but political class such as control of procurement, tendering and rewarding of cronies and sycophants to mar the process of devolved healthcare. Finally, in the event that the public health sector collapses, it is the poor citizens who will suffer and the elites continue enjoying uninterrupted services in private facilities and overseas institutions.

It is collective suicide to devolve healthcare in Kenya

In the recent past, there has been heated argument for and against devolved healthcare in Kenya. The process has received support and condemnation in somewhat equal measure. While this process in anchored on the constitution of Kenya, it must be noted that there have been issues raised that need consideration.

The medical fraternity has come out to unequivocally fault the haphazard and hasty manner in which health care is being proposed. The constant unheeded caution by the deliverers of healthcare has resulted into the current standoff and imminent strike that will erode gains made so far in restoring the image of public health sector in Kenya.

What are the issues?

The Transition to County government act of 2012 stipulates that the most important aspect before devolution is presence of relevant law(s) to spell out roles, responsibilities, obligations, and processes. As we speak today. The Health Bill has not been passed. This is the bill that will govern healthcare and the relationship between national and county government in matters of healthcare. In the absence of this bill, devolved health will cause confusion, anarchy, endless tussles and politicization of health sector.

The bill speaks of regulation of training, standards, quality, recruitment and licensing of health care workers to guarantee Kenyans quality of care. The bill envisages reorganization of administration of health sector, proposes centralized recruitment, posting and development of healthcare workers to ensure that all the 47 counties are equitably served.

The rushed devolution portends to cause undue political interference at the county level. It must be noted that county governments have now officially entrenched tribalism going by the composition of officers serving at the County Public Service Boards. These boards are composed of tribe mates and cronies and as expected, there will be little objectivity in their judgments.

Immediate effects of devolution in absence of legal framework

The process will affect the entire spectrum of health care. Supervision of training at both undergraduate and postgraduate levels remains in jeopardy. Kenyans must be assured that the worker churned out are properly trained and equipped to attend to them. Equally important, those trained must be absorbed into the already strained system. In Kenya today, there are 4000 doctors serving a population of 42million Kenyans (1:10500); very few dentists and even fewer pharmacists. There is a deficit of 40,000 nurses in the Kenya. This will only be worse with expected resignations.  Training of consultants also remains uncertain. With a country pegging the Vision 2030 on a health workforce and improved health indicators, training of specialist must never be relegated. There must be a clear structure to determine training needs, numbers and streamline the processes

Healthcare is a highly technical aspect of development. Some quarters have termed it as essential service. There must be clear depoliticization of healthcare processes. With creation of small empires in the counties and impunity exhibited by the county authorities, it is clear that the sector is headed for total collapse unless urgent measures are put in place

What is the proposed course of action?

A well thought out strategy must be worked out to retain professionalism and quality regardless of devolution. Stakeholder participation on defining processes is very critical to ensure success; the relevant legal and policy mechanisms must be put in place to govern the devolution process. Structures must be developed to foster accountability in this highly sensitive sector. Thus a complete reversal of devolution of healthcare providers and their personal emoluments will ameliorate the situation at the law makers are urged to debate and pass the pending Health Bill. The bill must entrench a (central) Health Service Commission (HSC), a licensing Board, and an organ to check on Quality of care.

In conclusion, the policy makers should remember it is very difficult if not impossible to force a process onto people (implementers) whether backed by constitution clause of not. Let sanity and reason prevail.

FORGET A SOUND ECONOMY, IT SERVES NO PURPOSE IF YOU ARE NOT HEALTHY

BY WOLFGANG FENGLER , WORLD BANK LEAD ECONOMIST FOR KENYA,RWANDA, ERITREA

The data is un-ambiguous: Kenya’s economy is starting to catch up with the rest of the globe. But many of us probably wonder if that is really true, judging by what we observe in the streets of Nairobi or in rural areas.
In other words, is economic catch-up translating into social progress? Will today’s children have a better life than their parents? Will everyone enjoy decent social and infrastructure services in the new Kenya? Let’s zoom in on the case of health.
How healthy is Kenya today? Simply said, it could do better. This is important from an economic standpoint because a population’s health is key foundation for development. Healthy populations are more productive.
They also save and invest more. On average, and all other things equal, one extra year of life-expectancy raises a country’s GDP by four per cent. Today Kenya is not reaping these “health dividends”. Life expectancy is still below what it was in the 1970s, and well below those of Asians and Latin Americans.
Sadly, most of the diseases affecting ordinary Kenyans can be avoided. About a quarter of a million Kenyans die from preventable diseases every year. HIV and Aids, diarrhoea, and respiratory infections are the country’s greatest killers.
In addition, nearly 40 Kenyan women die due to pregnancy-related causes daily. As in most other sub-Saharan African countries, maternal and child deaths mostly revolve around childbirth. Newborn deaths contribute to two-thirds of infant mortality.
There have been some achievements in the last 10 years though. One often overlooked fact is the foundations of a healthy life are laid extremely early and parents have a particular responsibility.
People tend to become health conscious once their muscles and bones begin to ache on a regular basis, typically around the age of 40 or 50. This is too late, drivers of health are determined much earlier, in fact even before birth.
Recent studies have shown the first 1,000 days of one’s life are very vital for their future well-being in comparison to the subsequent 10,000 days. These first 1,000 days include pregnancy and the first two years of one’s life.
Mothers can help their infants by giving them good food, especially by breast-feeding. Improved care during pregnancy and childbirth will be critical for making further progress in maternal and child health. Malnutrition is a critical cause of child mortality.
Over a third of Kenyan children are affected. The levels have remained more or less the same since the early 1990s. Even among the richest households, 25 per cent of children are stunted, suggesting a serious issue with child-caring.
The annual loss to Kenya’s economy as a result of stunting is estimated at US$2.8 billion.
In addition to these, Kenya also faces new health challenges that are a product of economic transition, such as diabetes, heart diseases, high blood pressure and cancer.
Combination of new and old health challenges creates a “dual burden” for Kenya. In future, Kenya’s high population growth will be driven by those living longer, and who on average suffer from these new diseases.
The country’s health system will need to respond to the dual burden with a new focus on prevention, including lifestyle changes and effective primary level management of chronic diseases while cementing gains made in the control of communicable diseases.
This would also mean focusing less public money on tertiary care to manage the complications associated with non-communicable diseases, because such care is prohibitively expensive. In the end, the best strategy is always prevention.
The writer is World Bank Lead Economist for Kenya, Rwanda and Eritrea. This article has been co-authored with Dr. Ramana, Lead Health Specialist, World Bank. Follow Wolfgang on twitter @wolfgangfengler

The Fallacy Of Wasted Votes

I would like to go straight to the point.
In the build up to the Kenya's most competitive and most complicated elections in her 50yr history, there have been alliances and loyalties built over time.
What is shaping up is a conglomeration of tribal leaders desperate to be part of the next government.
A major confounding phenomenon unlike the past is opinion polling. These polls have deviated from the usual scientific techniques and seem heavily doctored with an intention to derail the undecided voters and mislead those already decided on  particular candidates.
It has been said that voting for Peter Kenneth, Ole Kiyiapi, Martha Karua and Mohamed Dida is wasting your votes. Allow me to radically disagree with this notion.

Why should you vote for Peter Kenneth and 'Others'
It is almost a forgone conclusion that there will be a run off since all indicators show not a single member will meet the threshold to win first round. for avoidance of any doubt, these are the requirments for one to be declared winner after round one:
(i) One must obtain a majority vote of 50% Plus 1
(ii) One must get at least 25% of the votes cast in more that 50% of the 47counties

With this tremendous threshhold, it is not possible to meet in the first round due to the following reasons:
- the tribal nature of Kenya votting patterns
- the multiplicity of presidential candidates whereby 8 persons have been cleared to vie either singularly or under different coalitions.

Implication is therefore that by going to the second round, the minor candidates christened by the Pollsters as other will play a critical role and will have a chance to still negotiate with leading candidates. Therefore opportunity will present once more for the two front runners to look for suppport from other candidates whose endosement they must secure in order to win.
If you have perused a particular manifesto and like it, then its imperative you go ahead and vote for the party that resonates well with your areas of interest may it be education policies, economy, agriculture, foreign policies, healthcare, governance and integrity.

Why should you vote for Peter Kenneth?
Since joining the parliament, Peter Kenneth popularly known as PK has redefined politics and politicking in Kenya. With the budgetary allocation to his constituency, he has turned around the lives of his constituents. Moreover, he has remained above board in his dealings always emphasizing integrity. It is on record of him having been one of the few (2 or 3) parliamentarians to pay taxes on their salaries.
In his manifesto, PK promises to focus more on social infrastructure of schools, security and health care.
By building a referral hospital in all the 47 counties of the country this will bring specialized care close to the population and in turn translate into reduced deaths of women and children, early disease diagnosis and timely treatment. It will also save on the scarce resources that will be channeled other areas of nation development.
Additionally, this candidate is hope personified. His brings new thinking and a deep sense of patriotism to the youths more so the first time voters and various disadvantaged sections of the populace. He will be the president for the old and young, rich and poor, large tribes and small tribes, learned and illiterates, able and those with disabilities.
Kenya needs to break from the sustained tradition of recycling leaders and repackaging that which cannot work and re-branding of usual faces. It must be clear break from bondage and tyranny of the few monied on the majority poor population.
It must be time to make that shocking decision. Vote PK.

Call to peaceful elections
Elections come and go but the nation and its citizens remain. It is therefore necessary not to spare any effort to safeguard the integrity of the Nation. Elections in democratic states are won through numbers. Therefore as you cast your ballots, remember that your candidate may win or lose and not win or win. We must prove the critics and skeptics wrong by upholding peace and brotherly love.
Lastly, to all people to believe in God, its high time we prayed earnestly for sanity to be upheld both during the electioneering period, at the time of voting and after voting.
God bless Kenya.

Understanding the Role of PSA in Cancer of Prostate Screening

SOURCE: WEBMD

Prostate-specific antigen (PSA) is a substance produced by the prostate gland. Elevated PSA levels may indicate prostate cancer, a noncancerous condition such as prostatitis, or an enlarged prostate.

Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cutoff for concern about the risk of prostate cancer. Men with prostate cancer often have PSA levels higher than four, although cancer is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate cancer. Those with a PSA between four and 10 have a 25% chance of having prostate cancer and if the PSA is higher than 10, the risk increases to 67%.

In the past, most experts viewed PSA levels less than 4 ng/mL as normal. Due to the findings from more recent studies, some recommend lowering the cutoff levels that determine if a PSA value is normal or elevated. Some researchers encourage using less than 2.5 or 3 ng/mL as a cutoff for normal values, particularly in younger patients. Younger patients tend to have smaller prostates and lower PSA values, so any elevation of the PSA in younger men above 2.5 ng/mL is a cause for concern.
Just as important as the PSA number is the trend of that number (whether it is going up, how quickly, and over what period of time). It is important to understand that the PSA test is not perfect. Most men with elevated PSA levels have noncancerous prostate enlargement, which is a normal part of aging. Conversely, low levels of PSA in the bloodstream do not rule out the possibility of prostate cancer. However, most cases of early prostate cancer are found by a PSA blood test.

The Murky Politics, Kenyan Edition And Appeal

In the recent past we have all been treated to the usual theatrics that characterise elective politics. There have been ups and downs for most people while for a few its been ups only on lows only.
The practice of elective politics comes with heightened emotions, lots of betrayal, shifting goal posts, and euphoria.

In the past 50yrs when Kenya has been in existence as in independent state, it has remained an envy of many nations owing to the prevailing peace. Indeed while all the neighbors have been busy fighting. The sad story of Somalia is common place, the turmoil in Sudan, perennial battles between Ethiopia and Djibouti, the numerous coups in Uganda, ever fighting Congolese, genocide in Rwanda, and long running war in Burundi are now news to any person today. This unusual phenomenon has helped the nation to become an economic hurb in the eastern Africa.

Until December 2007.....

In this period, the usual practice of high stake electioneering saw sustained polarization of the nation along sectarian and ideological divides initially and later along ethnic and economic divides. What began as an innocent chant during the first ever constitutional referendum turned out to be a factor to create ethnic bukanization of the nation. By the time of going to the polls, it was evident that all was not well.
Without dwelling too much on history, here we are again.

My I pose one question thus far: Did we learn a thing from the post-election violence of 2007/08?
I would hesitantly say Yes and No in the same breath. I would have been thrilled to resoundingly say YES we learnt. But unfortunately we did not! 

Why yes? As an aftermath of the chaos and kilings, the nation attracted alot of condemnation from the development partners and friends. For the first time, Kenya was in the news for wrong reasons. And consequently, the Rome statute that set up the ICC was invoked. To that extent, we learnt that the big brother is watching. No need to belabor that.

Why then do we say no? If the events of recent past are to go by, either we forgot the experiences or we have conveniently erased such memories to suit the moment.
For starters, these are the five reasons that strengthen such an observation.
1. The tone and pitch at political rallies are nothing different from what preceeded 2007 election. There has been heightened rate of hate mongering and hate speech. The speech that divides us Vs them, my people Vs others etc
2. There has been eveident disregard to the rule of law by both leaders and the citizens. The constant shifting of goal posts by political leaders has reinforced the quick tendency to anarchy and lawlessness to the extent that a slight provocation, would see tires burning on the roads and people pelting stones at motorists...Again!
3. The ugly scenes witnessed during political parties primaries have left citizens feeling betrayed. The characteristic vote rigging, violence, imposition of party preferred candidates among other evils has angered the voters
4. An unfortunate incident where some contenders storm the offices of the IEBC disregarding the laid down procedures of filing complaints. This rekindles the memories of scenes at the then ECK nerve centre at the Kenyatta National Conference Centre. Such actions must not escape uncondemned. At best such persons must be punished and this may set a precedence of similar acts (of hooliganism).
5. The proliferation of briefcase pollsters who have persistently portrayed the presidential race at pitting the two main alliances with attendant risk of supporting their refusal to concede should that happen. This if unchecked is a genuine recipe for chaos.

That said, here are a few thoughts that people need the reflect on:

One, that elections come and go, people remain, a nation remain. Therefore its imprudent to allow destruction because of a one-off event namely elections

Two, the people who suffer most in cases of violence are the poor and the marginalised. This section cannot afford hired security, their habitat is highly prone to giong up in smoke. Additionally, they are unable to afford the cost of meeting the consequences of violence.

Three, the politicians will use idle youths to cause fracas then retreat to their leafy surbubs and discuss away from cameras on who have more fanatical following than the other. Similarly, they will share power and its trappings, keep off for five years and resurface after with new slogans and promises. This 'self reincarnation' behavior of politicians must be curtailed through the ballot.

Four, a progressive society should focus on ideals and issues and not party(isan) interests. That way one will determine what exactly is worth dying for.

Five, it takes long time to build a house and few hrs to pull it down.

Going forward...
The elites have been accused of being twitting voters, and facebook expinionists. Rightly so. It is disturbing that being refuse to take part in elections either as voters and/or candidates and instead resort to perpetual complaining and lamenting.
Each person must know there is always consequence for their (in)actions whether immediate or delayed. Its high time people devoted more time and developed some interest in shaping the national agenda. We are at a critical moment of making it or breaking it. Our actions will determine our future.

Final Appeal
Fellow countryment, whatever happens, lets never forget that there will be only one KENYA and our unity is one thing we must never miss. Where there is peace people prosper. Lets keep peace. And yes...there can only be one winner. If one all parties must win by hook or crook, then thats not democracy.
Lets guard what we have...PEACE.
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DEATH IN BAGAMOYO

Death in Bagamoyo

To most people, this was a normal trip like any other. With lots of planning and anticipation the day was come and indeed the faithful left for a journey. A journey whose what lay ahead no one could tell.

A group of 84 faithful had sought to go for a mission at the heart of Tanzania. For them, this would help them relax, and more importantly spread the good news to the ends of the world.

Due to unfamiliarity with other routes, they opted to use the longer route that would see them spend more time in Kenya. Thus they chose to pass through coast, Mombasa to be precise.

It is said that the two drivers were heroic enough to proceed at dawn without a rest. But this as it turned out became the beginning of the nightmare of these faithful.

As they drove the two buses, the one a head lost control and the driver lost concentration and veered off the road. Then they did signal the other driver who came back to help in rescuing these bus that was off the road with no injuries. Not suspecting anything or overlooking certain road use principles, this bus was parked on the road side and the occupants left in a huff to help push the first bus that  was clearly off the road. Its in this when an on-coming trailer rammed on the parked bus throwing it and causing it to land on the women where 12 of them died on the spot.

The most astonishing bit about this story is this: as soon as this happened, it is alleged that the police were on the scene and instead of helping the injured, they actually drove off! The passers-by and curious onlookers did not help either. Despite the wails and shouts from women beneath the bus, the residents looked at them with overwhelming indifference to the whole thing. Form About 6am to about 11am there were bodies beneath the bus.

It is needless to say, majority died from mechanical force exerted onto them by the weight of  the bus. Others died from bleedings.

There are three fundamental questions that remain unanswered to date:

i)                    Why didn’t the drivers take a break and why did they choose to travel continuously on roads new to them?

ii)                  Why did the Tanzanian officials treat the casualties with such indifference to a point hereby the Kenyan Authorities had to send rescue in military helicopters/

iii)                What triggers this level of hatred and animosity between these neighboring countries which have never been at war? How else would you explain the allegations that the villagers were actually asking for money in order to rescue our poor women?

While this death comes with lots of pain, we must learn lessons and decide to act. We must know that when traveling to other countries, we carry the risks and no one actually loves our presence.

This death in Bagamoyo exposes the deep rooted hatred that has simmered since the times of our grand fathers. We must choose to resolve these issues once and for all.

To all the dead faithfuls, may you rest in peace. And to the injured, quick recovery. To the bereaved, may you find solace at this time of loss. Poleni sana.