Admiral Bill Fallon: Closing Reflections on Kenya
August 14, 2009
The CSIS Commission’s August 10-12 visit to Kenya has been a valuable experience, by introducing -- in real time and concrete detail -- many of the major issues surrounding the promotion of health in a developing country. We were able to engage with U.S. and Kenyan government officials at different levels, along with several U.S. implementing organizations and independent Kenyan groups. We could see U.S. funds at work in both urban and rural settings, in Nairobi, on the Mombasa coast, in western Nyanza, and in Eldoret in the Rift Valley. As co-chair of the CSIS Commission on Smart Global Health Policy, I am deeply grateful to the many individuals who generously gave of their time to make the visit a success. The trip will certainly help inform the Commission’s aim to formulate recommendations on a long-term U.S. strategic approach to global health.
A few observations that I take away from my brief time in Kenya:
First, security for the individual is an essential prerequisite for health interventions to be effective and have true, enduring impact on a person’s well-being. There need to be conditions of basic stability and predictability, freedom from fear, abuse and displacement. Human security requires we also pay close attention to the issues of basic nutrition and sanitation. Any U.S. long-term strategy of health engagement should be constructed on a sound concept of human security that begins with the individual.
Second, governance and host government policies are profoundly influential in shaping health outcomes. Major enduring challenges in Kenya are corruption and ineffective administration. These factors undermine confidence and accountability, impose high transaction costs, and constrain the determined efforts of the talented and committed Kenyan medical professionals who staff the various levels of the health infrastructure. We heard repeatedly, for instance, complaints of the malfunctioning of the procurement system for medical commodities.
Third, the quality of care delivered, we observed, is quite variable. Availability of essential services and commodities at affordable cost appears to be a key driver of outcomes. We saw quite a spectrum of operating conditions across several hospitals – from grim to quite good. The competency and commitment of staff were impressive, as were many grassroots outreach efforts.
Clearly, U.S. assistance has been a key factor in achieving major health gains. In the past several years, the U.S. government has leveraged the President’s Emergency Plan for AIDS Relief (PEPFAR) to improve treatment, prevention and care, to address related diseases such as malaria and tuberculosis, and increasingly, family planning and maternal health. The United States, in partnership with Kenya, has developed a very useful construct that could be elaborated in the future to meet evolving priority needs.