Kenya lies in Eastern Africa and has a geographically diverse land area of 582,646 km2, 80% being arid or semi-arid. Some of Kenya's neighbors have experienced various forms of civil strife, with spill-over effects on various socioeconomic facets in the country. Agriculture, manufacturing, telecommunication and tourism are key economic drivers. Kenya has a Coalition Government with an Executive President and a Prime Minister. Constitutional, legal and broad institutional reform is a key Government agenda. The health sector is governed through two ministries, the Ministry of Medical Services and the Ministry of Public Health & Sanitation. The Kenya Health Policy Framework (1994-2010) is the overarching health policy and the National Health Sector Strategic Plan (2004-2010) elaborates strategic imperatives for the sector.
HEALTH & DEVELOPMENT
Development: Kenya's Human Development Index is 0.521, ranking the country 148th out of 177 countries. The economy grew steadily from 5.8 in 2002 to 7.0 in 2007, but declined to 4.5 in 2008 due to election-related political turbulence and the global economic crisis. Progress towards Kenya's attainment of the MDGs is slow and uncertain, with only education registering significant progress. Poor infrastructure, weak institutions and poor regulatory enforcement are key development challenges. Kenya Vision 2030 is the development blueprint by which the country aims to transform into a middle-income nation, through maintaining a stable macroeconomic environment supported by real time structural reforms.
Health status and indicators: Key health impact indicators suggest stagnation or decline in the health status. The rate of under-5 mortality has stagnated between 93 in 1993 and the current 92 per 1,000 live births. Maternal mortality ratio has worsened from 365 in 1994 to 414 in 2003, and maternal death is the leading cause of death in women of child bearing age (15%). This stagnation is attributable to the high disease burden due to existing, and new conditions, and an inadequate response to manage the disease burden. The health impact indicators also suggest wide disparities in health across the country, closely linked to underlying socio-economic, gender and geographical disparities. Low immunization coverage and cross-border social disturbances in the recent past have also seen the recurrence of measles and polio, conditions that had in the past been brought under control.
The burden of communicable diseases is high, with malaria as the leading cause of morbidity (30%) followed by respiratory diseases (24.5%). Recently, positive gains are emerging in malaria and HIV control, owing to availability of resources and improved coordination for scale-up of targeted interventions, and these need to be intensified to reach universal targets. Malaria prevalence is 14% and ITN coverage in pregnant women and children <5 years is 40% and 39% respectively. HIV prevalence is 7.4%, the rate being higher in women (8.5%) compared to men (5.6%). The large majority (83%) of those infected do not know their HIV status, and only 35% of those in need of ART are accessing treatment. TB control has been more challenging, with a high TB prevalence of 319 per 100,000, TB/HIV co-infection of 53% and a growing threat of MDR/XDRTB.
The noncommunicable disease burden is also on the rise with diabetes prevalence at 3.3%, a 3-fold increase over the last 10 years. Mental illnesses and road traffic injuries are on the increase, and 13% of school-age children aged 13-15 years are active cigarette smokers. Persistent poverty and low water and sanitation coverage have contributed to sanitation related illnesses like cholera. There are also pockets of neglected tropical diseases such as lymphatic filariasis.
Health system status and challenges: The sector has defined the Kenya Essential Package for Health (KEPH) based on a life cycle approach to delivery of a comprehensive healthcare package across 6 levels of care. Government is the main provider of health services, but the private for-profit and the privatenot-for-profit providers also serve a significant proportion of the population. Roll-out of KEPH is hampered by inadequate quantities and qualities of resources (human, infrastructure, financial), and still evolving institutional capacity to manage the available resources.