Answers to Your Questions About Kenya, Continued

August 12, 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.

Earlier, Stephen Morrison, Director of the CSIS Global Health Policy Center, answered a few of them while en route to Kenya. Today, the staff of the CSIS Global Health Policy Center responded to more of your Kenya-related questions. 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: Health Action International Africa in Nairobi issued a report that reported there is an essential medical crisis looming in Kenya, Malawi, Uganda and Zambia. The url is www.haiafrica.org. Why is there such a crisis and what can be done? One other question I have is what role do donations of medical supplies and medicines play in the health environment in Kenya? - Mike Lane

Response: Thank you for your comment. Issues of procurement of medical supplies and essential medicines have impeded healthcare in Kenya for some time. Groups such as GAVI and the Global Fund to Fight AIDS, TB and Malaria have been looking into creative means to assure the steady provision of supplies and medicines. To learn more, I would suggest reading this recent OECD report.

Question: I would be interested in learning about public-private partnerships to support healthcare in Kenya. - Aden Huda

Response: Thank you for your comment. Public-private partnerships play an important role in the Kenyan health system. Joe Rospars commented on his blog today that "the Kenyan government oversees 41% of health centers, the private sector operates 43%, and NGOs run the remaining 16%." While in Kenya, two of the commissioners will visit the Kenya Medical Research Institute in Nairobi, a forty-year partnership between the Kenyan government, foundations and U.S. agencies. In addition, commissioners will visit a project that partners with Merck in Eldoret and HIV-Free Generation, a public-private partnership supported by Warner Brothers that uses video games to spread HIV prevention messages.

Question: Our Supercourse has 42 top level primarily academic collaborators in Kenya who you might want to as they know much about public health training in Kenya. Kenya has rapidly undergone the epidemiologic transition, there needs to be a major focus on NCDs as well as CDs. - Ronald LaPorte

Response: Thank you for your suggestion. The Supercourse looks like an excellent resource for public health students of all countries. While the group won't be able to take advantage of it in Kenya, they are visiting the Academic Model Providing Access to Healthcare (AMPATH) program in Eldoret. AMPATH is a PEPFAR-supported collaboration between Moi University and Indiana University, with additional partnerships with the ASANTE coalition of American universities. The Commission has been discussing the growing importance of a U.S. strategy for non-communicable diseases. While in Kenya, they will be studying the impact of infectious diseases, but also visiting facilities that address NCDs and mental health.

Question: What are the specific U.S. foreign policies that indirectly (and often unintentionally) impede global health successes and improvements? Let's identify them and work to renegotiate those U.S. policies so that health outcomes are not (unintentionally) collateral damage in relation to other U.S. interests and foreign policy concerns. - Susan L. Erikson

Response: Thank you for question and comment. We agree that the stovepiping of programs has unintentionally slowed, or at times reversed our global health successes. As we move forward, the Commission is looking for a greater integration of program, both within global health and with our large foreign policy goals. In Kenya, the Commission visited an AIDS, Population and Health Integrated Assistance (APHIA II) Project site. This 5-year project aims to integrate HIV/AIDS programming with reproductive health, family planning, maternal and child health, and malaria services.

Question: The Kenya Ministries of Health assessed the challenges the health managers are facing and the needs they have to succeed in their health management roles in 2008. I'm hoping you will be able to see the results of the assessment. This may be helpful as you draw your own conclusions on how improved preparation in leadership and management, that they identified as critical needs, can support all 4 of the areas you are assessing. - Joseph Dwyer

Response: Thank you for your suggestion. This document sounds like an important piece of reading for those interested in health management. Could you share it with us? While in Kenya, commissioners met with representatives of the Ministry of Health as well as representatives from local facilities to discuss health system issues like leadership and management.

Question: What are the unmet family planning needs, particularly for women living with HIV? How has the violence affected health care? Meet with Kilonzo on rape. - Jill Gay

Response: Thank you for your question and suggestion. Family planning and reproductive health have been a focus of both the Kenya trip and the Commission's work. Our colleagues Janet Fleischman and Alan Moore recently published a piece seeking common ground on family planning. Visits to groups such as Carolina for Kibera highlighted the impact of the post-election violence on primary care. While the group was unable to visit the Liverpool VCT center, they toured the gender violence unit at the Nairobi Women's Hospital to learn more about the treatment and support options available for survivors of rape and gender-based violence.

Question: A smart global health policy should address all health issues. In almost all African countries including Kenya, palliative care and pain management is not a priority, there are no national policies on palliative care and pain management. Over 90% of cancer patients present advanced illness, therefore, they will have moderate to severe pain among other problems. This pain is not controlled due to lack of policies and medication. - Dr. Zipporah Ali

Response: Thank you for your comments. We agree that NCDs are a significant issue that requires greater attention from both the Kenya government and donors. The commissioners in Kenya learned about the full spectrum of care, but unfortunately due to time constraints, were unable to visit facilities dedicated to palliative care and pain management. Please keep us informed about how Kenya is increasing its capacity to deal with this issue here.