Public health projectKenya

PUBLIC HEALTH PROJECT KENYA

(I) General social economic characteristics of residential life in Kenya

Government structure and a political regimen

Administrative and territorial subdivisions

Climatic and geographic peculiarities General economic growth and the

types of production: industrial and agriculture

1. Government Structure and A Political Regime

The Republic of Kenya is a unitary State with a multi-party political system whose hallmark is parliamentary democracy.

The Parliament of Kenya is bicameral house consisting of the National Assembly and the Senate.

1. The National Assembly has in total 349 members plus the Speaker who is an ex-officio.

2. The Senate consists of 67 members plus the Speaker, who is an ex-officio member.

Government Structure and A Political Regime (Continued…)

Government Structure and A Political Regime (Continued…)

Under its old constitution, Kenya comprised 8 provinces each headed by a Provincial Commissioner (centrally appointed by the president).

Provinces were subdivided into 69 districts as of 1999 census, which were then subdivided into 497 divisions each with 2,427 locations (mtaa) and then 6,612 sub-locations (mtaa mdogo).

Under the Constitution of 2010, and subsequent integration of the Provincial Administration with a new system of Counties, provinces are to be scrapped.

2. Administrative and Territorial Subdivisions

The Eight Provinces of Kenya

3.Geography and climate peculiarities of Kenya

Kenya straddles the Equator, and is located on the eastern coast of Africa. Roughly one and half times the size of Japan, it covers a surface area of about 586,600 square kilometers. It is bordered by Somalia to the east, Ethiopia and Sudan to the north, Uganda to the west and Tanzania to the south. Kenya has a single time zone, GMT +3.

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. The climate of Kenya varies by location, from mostly cool every

day, to always warm/hot. The climate along the coast is tropical where air changes from cool to hot, almost every day. The further inside Kenya, the more arid the climate becomes. An arid climate is nearly devoid of rainfall, and temperature swings widely according to the general time of the day/night

On the high mountains, such as Mount Kenya, Mount Elgon and Kilimanjaro, the weather can become bitterly cold for most of the year. 

4.General economic growth and the types of production: industrial and agriculture

As at May 2010, economic prospects are positive with 4-5% GDP(gross domestic product) growth expected, largely because of expansions in tourism telecommunications, transport, construction and a recovery in agriculture

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(II) Organization of the health service system in the country

Model of a health service system (depending on the primary sources of financing)

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Public health facilities continue to be the major providers of health care services.

In 2009/10 they accounted for nearly half (47%) of THE, followed by private health facilities, which were responsible for 22%

Inpatient care took 22%of THE in 2009/10, Expenditures on public health programmes 23% in 2009/10

TOTAL HEALTH EXPENDITURE (THE) ON PRIORITY AREAS, 2009/10

How much do we spend on health

Private medical institutions.Paid medical services forms Kenya has an extensive network of private healthcare facilities,

from small local clinics, to large, high-class hospitals. Private health care is voluntarilly purchased by individuals who pay different amount depending on the type of health insurance and level of coverage. 

Other financing sources

•private,•profitable insurance organisations •non profitable organisations

They include:

.

They include:

AAR Jubilee Insurance

Alexander Forbes Healthcare

The non profitable organizations include: AMREF EQUINET APHRC FEMNET JAMII BORA and others

RELATIONS BETWEEN INTERNATIONAL ORGANISATIONS AND HEALTH SERVICE SYSTEM IN KENYA.

According to the World Health Organization (WHO), in 2007 the average life expectancy for both sexes in Kenya was 54 years, compared to a global average of 68 years.

The overall under-5 child mortality rate is approximately 121/1000 live births, or roughly double the global average.

However, this number drops significantly, to 91 per 1000, for the wealthiest 20% of the population, while it jumps to nearly 150 for the poorest 20%.

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The prevalence of communicable diseases in Kenya is a major factor in determining health outcomes.

HIV prevalence among urban adults is estimated at 10%, versus an estimated 5.6% for rural adults.

HIV prevalence is not evenly distributed throughout the country, with prevalence rates in Nyanza province nearly double the national average.

The WHO refers to Malaria as a “a major public health problem in Kenya.”The disease is in excess among adults living in malarial areas.

FINANCIAL PROBLEMS IN THE HEALTH SERVICE SYSTEM AND OTHER DISADVANTAGES

The two most significant barriers to entry in the Kenyan health system are the cost of care, and the availability of suitable care within a reasonable distance (i.e., geographic barriers) Access to a well-equipped health facility may actually be more important than the cost of services in determining whether an individual seeks care, in certain cases.

Another major issue affecting access to care is the uneven distribution of health workers between urban and rural areas. In order for an individual to access health services, they must have both physical access to a health facility, and the health facility must also be able to provide service. Individuals in many communities also continue to seek traditional health services in addition to conventional medicine.  approximately 80% of Kenyans utilize traditional medicine as a primary form of healthcare

The Management of Kenyan Health

Service System

CARBINET SECRETARYPRINCIPAL SECRETARRY

PRIVENTIVE AND PROMOTIVE HEALTH SERVICES

NATIONAL QUALITY CONTROL LABORATORIES

HEALTH PLICY, PLANING AND FINANCE

CLINICAL SERVICES

HEALTH STANDARDS QUALITY ASSURANCE AND REGULATIONS

STRUCTURAL ORGANIZATION

MEDICAL HEALTHCARE UNITS

National

Provincial

District

Sub-distric

Dispensaries

Health centres

Nursing home

Private Clinics

Surveillance system

ROUTINE SURVEILLACE AND DATA FLOW

SYSTEM OF DISEASE ERRADICATION

Diseases marked for Eradication/eliminationLeprosy Poliomyelitis (AFP) DracunculiosisLeishmanniasis Neonatal tetanus

Diseases of Public Health ImportanceMalariaChildhood PneumoniaNew AIDS Cases Childhood DiarrhoeaTuberculosis STIsOther emerging infections like Pandemic Influenza A H1N1, HPAI

UTILIZATION OF HEALTH CARE SERVICES

MEDICAL CARRIER IN KENYA

Medical school

Internship

Medical officer (2yrs)

Registrer (Postgradute)

Supervised specialist (2years)

Consultant

Superspeciality

MEDICAL STAFF

Registered Renewed licensure

% active

Doctors 6306 4756 75.4

Dentists 780 590 75.6

Nurses & midwives

43970 28214 64.2

Clinical officers 8300 6300 75.9

Labtechnicians 4699 2092 44.5

total 64055 41952 65.5

YEARLY COMPARISON

ORGANISATION OF MEDICAL CARE TO RURAL

POPULATION

1)Types of medical institutions for outpatient and inpatient in rural areas

2)The main indices of provision with medical services and medical institutions activity

3)Disadvantages and principal problems

1)Types of medical institutions for outpatient and inpatient in rural areas-

a)level 1-dispensaries b)level 3 –health centres c)level 3-subdistrict hospitals A)DISPENSARIES The government runs dispensaries across the country and are the lowest point of

contact with the public. These are run and managed by enrolled and registered nurses who are supervised by the nursing officer at the respective health centre. They provide outpatient services for simple ailments such as common cold and flu, uncomplicated malaria and skin conditions. Those patients who cannot be managed by the nurse are referred to the health centres there

B)HEALTH CENTRES All government health centres have a clinical officer as the in-charge and provide

comprehensive primary care. Because of their heavy focus on preventive care such as childhood vaccination, rather than curative services, local council (municipal) and, do not have clinical officers but instead have a nurse as the in-charge.

Health centres are medium sized units which cater for a population of about 80,000 people. A typical health centre is staffed by:

At least one Clinical officer Nurses .Driver ,house keeper ,supporting stuff ,nutritionist ,public health officer ,health

information officer ,health administration officer , Health administration officer,medical technologist ,pharmaceutical technologist

All the health centre staff report to the Clinical officer in-charge except the public health officers and technicians who are deployed to a geographical area rather than to a health unit and report to the district public health officer even though they may have an office at the health centre.

The health centre has the following departments: 1. Administration block; where patients register and all correspondence and

resources are managed from. 2. Out-patientconsultation rooms where patients are seen and examined by

clinical officers. 3. In-patient (wards) where very sick patients can be admitted. The wards are

divided into male, female and paediatric with newborn units. 4. Laboratory where diagnostic tests are done. These laboratories can do the

following tests- bloodslides for malaria parasites, sputumAFB, urinalysis, full haemogram, stool ova and cysts, blood sugar, Elisa and CD4 counts in comprehensive care centres for HIV/AIDS patients

. 5. Pharmacy  6. Minor theatre where minor surgical procedures are done e.g. Circumcision,

stitching wounds and manual vacuum aspiration  7. Maternity  8. Maternal and child health  9. Kitchen and catering 10. Student hostels for rural health training centres where students go to get

rural experience.

C)SUBDISTRICT HOSPITALS -These are similar to health centres with addition of a surgery

unit for Caeserian section and other procedures. Many are managed by clinical officers. A good number have a medical officer and a wider range of surgical services

-They send complicated patients or problems they encounter through public health officials or district medical officer of health to contact level 4(district hospital) or 5 (provincial hospital)

3) DISADVANTAGES AND PRINCIPLE PROBLEMS Such environments are characterized by 1)harsh weather conditions 2) sparsely distributed small settlements 3) poor road and other communication networks 3) low economic levels. 4)financial problems-most people cannot afford to pay for the

treatment 5)staff to population ratio is high 6)diagnostic problems-lack of adequate special equipment used to

diagnosis 7)distance from their homes to the health centre or dispensary is

long .most patients cannot make it 8)illiteracy –most of them prefer to get treated by witch doctors or

take herbal medicines 9)inavailability of drugs –lack of wide range of drugs.most drugs

are not available.so they have to go for the substitute . 10)electricity problems –these areas have power cut often

Organization of hospital care to

urban population in Kenya

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Kinds of hospital medical aids. 1. Administration block 2. Out-patient consultation rooms. 3. In-patient (wards. 4. Laboratory. 5. Pharmacy  6. Minor theatre   7. Maternity  8.Maternal and child health  9. Kitchen and catering 10. Student hostels for rural health training centres

where students go to get rural experience.

Provision of population with hospital Bed

The frequency of hospitalization

Average duration of patient stay in hospital

Hospital lethality

Population size

In July 2013, estimates are released and it was claimed that those numbers had risen to 44,037,656 which would make this the 33rd largest country in the world in terms of population numbers alone.

Figure 8.1 Population size in Kenya from 2004-2013

Population Density

Kenya has a surface area of 580,367 square kilometres which converts to 224,080

square miles and makes it the 47th largest country in the world in terms of pure land

mass.

Figure 8.2 Geographical Map of Kenya

Figure 8.3 Distribution of population in Kenya (2009)

There is an average of 67.2 people here (174.1 per square mile) and

this means that Kenya is the 140th most densely populated country on

earth.

National Languages

Kenya's various ethnic groups typically speak their mother tongues within their own communities.

Swahili and English are two official languages. SIL Ethnologue lists a total of 69 individual languages spoken

in Kenya.

Mechanical movements of the population: urbanization

Today, 30 percent of Kenyans live in cities. Migration flows to urban

centres accelerated in all parts of Kenya after independence, increasing

the proportion of the urban population from 8 per cent in 1970 to

21 per cent in 2004 and now to an estimated 24 per cent (CBS, 2011).

Morbidity and injuries

MORBIDITY AND INJURIES• General I.R of the populationI.R- number of new cases of disease among the population, during a given time period on estimated mid-interval population.No. of all cases of 1st time revealed Dis during current year x 1000 inhabitantsAverage annual number of inhabitants-cause specifici.) TB- 761ii.) HIV/AIDS- 51.9iii.) Malaria-29.7iv.) Injuries-72.9-age specific<5 years – 2115 (2115 cases/1000 children of the same age)5-15 yrs- 1420Adults >15yrs- 822• General P.R of the populationP.R- number of all cases of disease among the population during a given time period (usu./Yr) on estimated mid-interval population. No. of all cases of Dis during current year x 1000 inhabitantsAverage annual no. of inhabitants • Cause specifici.)TB- 1104 ii.) HIV/AIDS-1049 iii.) Malaria- 229 iv.) Injuries- 486• Age specific<5 years – 28205-15 yrs-2444Adults >15yrs-1870

Home, 18.5

Residential Street18%

Major Highway27%

Pub1%

Industrial3%

Com-mercial

4%

Coun-tryside

2%

Other2%

Unknown27%

SCENE OF INJURY

None30%

Alcohol28%

Other2%

Unknown41%

Substance Use

Suicide ideation risk factorsCurrent Alcohol UseProblem DrinkingBullyingVictimizationSadnessHunger

Prevalence of Suicidal IdeationAll Students-27.9%Boys-27.5%Girls-28.3%

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Prevalence of HIV infection among newly registered TB patients,* by province --- Kenya,

Cancer burden in kenya

men Oesophagus Prostate Stomach Liver Kaposis Leukemia Colorectal Nonhodgkin Lung pancrease

Women Breast Cervix Oesophagus Ovary Stomach Liver Colorectal Nonhogkin Corpus uteri Kaposis sarcoma

DISABILITY

CAUSE-SPECIFIC AND AGE SPECIFIC OF DISABILITY DISTRIBUTION OF DISABLED PERSON BY GROUP

The causes include congenital disability, which refers to conditions that one is eitherborn with or that are genetic in nature; accidents (road traffic crashes, falls, domestic or general burns, etc.);environmental pollutants; diseases; lack of immunization; lack of breast feeding; fighting or domestic violence; conditions that started gradually (idiopathic); and other causes (family planning, wrong medication, etc.).

CAUSE OFcongenital

accident

burn envi

disease lack lack

fighting/ idiophatic

other

don’t % no

DIASABILITY      pollutant  

immune

breastfeeding

violence

(start gradual)  

lnow    

AGE                          

0-14 27.4 5.50.7 0.1 19.1 2 0.4 0.2 9.2 9.7

25.7

100 699

15-24 21.6 8.80.2 11 17.4 4.1 0 0.3 12.5 10.7

23.4

100 473

25-34 15.4 10.80.4 11 18.5 3.7 0 1.7 12.9 10

25.3

100 356

35-54 7.4 15.50.9 2 16.3 3.1 0 2.2 14.8 15

22.6

100 678

55+ 5.7 18.70.2 0.6 22.1 1.9 0 0.9 10.2 19.2

20.5

100 676

                           SEX                          

male 15 15.20.5 0.6 18.6 3.5 0.1 1.5 8.9 14.5

21.7

100

1501

female 13.5 9.80.4 1.2 19.1 1.9 0.1 0.7 14.3 14.7

24.2

100

1594

TYPE OF DISABILITY

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The various causes were categorized as follows: hearing impairment, speech impairment, visual impairment, mental disability, physical disability, self-care difficulties and other disabilities.

TYPE OF DISABILITY (IMPAIRMENTS)

characteristic none hearing speech visual mental physical

self-care other total

AGE 0-14 97.6 0.5 0.2 0.4 0.1 0.6 0.3 0.2 100 15-24 96.4 0.4 0.2 1.1 0.2 1.1 0.3 0.3 100 25-34 96 0.4 0.1 1.1 0.5 1.3 0.3 0.3 100 35-54 93.5 0.4 0.1 2.8 0.4 2.3 0.3 0.2 100 55+ 85.3 1.1 0.2 5.1 0.6 6.2 1 0.4 100 SEX male 95.5 0.6 0.2 1.2 0.3 1.6 0.4 0.2 100 female 95.4 0.5 0.2 1.5 0.2 1.6 0.4 0.3 100 RESIDENCE rural 95.5 0.6 0.2 1.2 0.3 1.6 0.4 0.2 100 urban 95.4 0.3 0.2 1.9 0.3 1.3 0.4 0.3 100

ASSISTIVE DEVICE AND SUPPORTIVE

SERVICE.

-Assistive devices and support services consist of equipment and appliances used to complement diminished or absence of certain physical functions. -Support services are services that disabled person need or receive for their disability in relation to health, rehabilitation and welfare including but not limited to services from a personal assistant or aid.-Such devices and services enhance the ability of a disabled person to participate in day-to-day activities-These include those related to information (hearing aids, magnifying glasses,Braille) and communication (sign language interpreter, portable writer), as well as to personal mobility (wheelchairs, crutches, walking sticks/ frames guide). Others are household items (flashing light on doorbell, amplified telephone); personal care and protection (special fasteners, bath and shower seats, toilet seat raiser); handling goods & products (gripping tongs, aids for opening containers) 

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characteristic

assistive

support

information

communication

personal mobility

house hold

personal care

handling product

  % no device device deviceitem device

& protection

&good device

AGE                0-14 20.4 5 0 0 20.4 0 0 015-24 15 467 12.3 0.3 2.6 0.3 0.3 025-34 20.4 356 13.7 0.4 6.5 0 0 055+ 37.6 676 15.9 0 22.8 0.2 0.8 0                 SEX                male 33.1 1120 16.1 0.4 17.6 0.2 0.5 0.1female 25.6 1271 14.4 0.1 11.3 0.1 0.3 0.1                 RESIDENCE                rural 25.9 1891 11.2 0.1 15.1 0.1 0.3 0.1urban 41.2 500 30.3 0.6 11 0.3 0.7 0

SUMMARY OF DISABILITY

4.6% of Kenyans experience some form of disability.

More disabled persons reside in rural than in urban areas.

Leading cause of disabilities in Kenya is diseases (19%), followed by congenital (14%) and accidents (12%), but nearly a quarter of disabled person did not know the causes of their disabilities

A quarter of disabled person work in family businesses, but a third do not work at all.

16% women with disability aged 12–49 years use some form of family planning.

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