Answers to Your Questions About Kenya

August 11, 2009

You've been reading on this blog about the Commission's trip to Kenya. As you've probably seen, we have asked all of our dedicated readers to submit suggestions on what the Commission should focus on, who they should talk to, and any other comments you might have.

We weren't disappointed. As expected, we have received many thoughtful insights into the health challenges facing Kenya - with some interesting ideas on how to address them.

Here are some of the best of what we've already received. Stephen Morrison, Director of the CSIS Global Health Policy Center, answered  them while en route to Kenya. Thanks to everyone who has submitted -- and keep sending us your thoughts! (Use the submission form over to the right) Tomorrow we'll post a few more.

Question: It is heart-warming to find maternal, newborn and child health on the agenda of the Commission. It is important to point out that we know how much it will cost us to scale-up high-impact interventions - both moderate and rapid scale-up modes. What we need to ask is: HOW DO WE UNBLOCK/REMOVE THE HINDERANCES/BOTTLENECKS TO SCALE-UP OF THESE INTERVENTIONS? The answer may vary from country to country but there will be some common threads across all the countries. - Doyin Oluwole

Response: Doyin: Many thanks for your critical question and comment. There is a rising consensus on the need to address the alarming problem in many places of high maternal mortality and illness, along with continued challenges to improve newborn and child health. Progress in improving maternal health especially has been limited. We should come away from this brief visit to Kenya with a better idea of obstacles and solutions. It is fair to argue that many different health interventions are needed, especially in dealing with birth emergencies. These interventions are very reliant on having functioning health systems and will require a long-term investment and strong country ownership.

Question: PEPFAR is spending billions on AIDS, and some share goes to Kenya. How can those dollars be used to strengthen the health system rather than taking a 'silo' approach? The systems need to be strengthened (a) to deliver the AIDS treatments, but (b) to provide family planning. Is the United States partnering with other countries or organizations in addressing the health needs of Africa? -Hazel Denton

Response: Hazel: Thank you for your thoughtful note. PEPFAR is spending over $6 billion per year on HIV/AIDS worldwide and of that more than $.5 billion per year in Kenya. The United States in earlier decades achieved much in Kenya in the area of family planning. One issue we will be examining is indeed how the major new PEPFAR platform can be extended to benefit other areas that are important and under-resourced. There is a consciousness about the need for greater balance and integration. The trick is figuring out concretely how to do that, and how to measure the impacts. I also want to draw your attention to an excellent paper on family planning written by Janet Fleischman and Allen Moore. It focuses on the great need to do more. It also highlights both the political difficulties and the resurgent interest in this area led by the Obama administration.

Question: Efficiency and accountability: How can the U.S. and non-governmental organizations better integrate their efforts effectively and accountably? This is an important issue. Without checks and balances, many good intentions end up as failed projects. Also, it is important for us to access what the key areas are related to overall public health that lead to resilience, or a countries ability to bounce back after a large scale disaster or civil war. Once we have identified those key indicators, we should then focus capacity development efforts toward helping countries achieve them.

Long-term sustainability: How can the United States guarantee that its investments create continuing long-term benefits for needy people around the world? This is an important issue. Often, many efforts are done in isolation that are unable to produce long term effects. We need to continue to develop humanitarian aid missions that focus on training and education. We need to impart the skills to the local community so they can provide the services to their people. Better to teach them how to procure medicines than to simply provide donated medicines. Also, need to work at central governmental level to ensure they can and will provide the logistic support for any efforts done locally. If we teach a local doctor how to do laparoscopic surgery, need to ensure that he will have access to the needed equipment and supplies that will support him performing the procedure in his local community. If not, he or she may leave the country and travel to a country that will allow him or her to utilize their new skill set. - Bruno Himmler

Response: Thank you for your two communications. I think one key to long-term sustainability is better impact measurement, focused not just on the health status of individuals but also on the impact of investments on key government practices. We also need stronger compacts with partner governments that result in higher sustained political and financial commitments, delivery of services, and building of key systems -- procurement, management/training, and data collection. It will be a long-term enterprise to achieve that level of ownership.