Sexual Minority in Kenya # IDAHO 2017 (International Day against Homophobia, Transphobia and Biphobia)

As the world marks International Day Against Homophobia (IDAHO), there is need to ponder on the uptake of health services especially for key populations in Kenya with regards to Article 43 of the Constitution of Kenya 2010 which states that “Every person has the right to the highest attainable standard of health, which includes the right to health care services including reproductive health care”.

Health care for sexual minorities requires access to both competent health care providers and sensitive prevention, treatment, care and support services. However, sexual minorities in Kenya continue to encounter numerous social (non-conformant sexual behaviors), legal (criminalization) and health barriers. The main issues include unfriendly health and HIV&AIDS programmes, stigma and discrimination at the health care facilities, and insufficient numbers of health care workers competent in dealing with health issues of sexual minorities. Denial ranges from non-availability of services or refusal of health workers to treat them that may lead to outright violence, abuse and even death.

Health care workers in Kenya fail to recognize and consider the diversity of the sexual minorities’ special health care needs. Most of them only provide limited safer sex education and health services related to STI/HIV/AIDS prevention and treatment. As a result, many sexual minorities such as MSMs and lesbians shy away from testing for HIV due to the fear of being identified without informed consent. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia, biphobia, transphobia, and discrimination by health care providers and institutions. Besides, continued stigmatization and discrimination at heath care facilities, lack of confidentiality and capacity to accept the sexual minorities by health care workers (HCWs) deny them their right to the highest attainable standard of health as a fundamental human right. Health care providers can take positive steps to promote the health of their LGBT patients by examining their practices, offices, policies and staff training for ways to improve access to quality health care for LGBT people.

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THE PLACE OF TRADITIONAL BIRTH ATTENDANTS (TBAS) AS MOTHER COMPANIONS.

According to the World Health Organization (WHO), a traditional birth attendant (TBA) is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs. Throughout history, in most rural setting, TBAs have been the main health care providers for women during childbirth in Africa attending to the majority of deliveries. Contrary to the thinking that TBA services are utilized by women only, men too, actively seek the services of TBAs and utilize them for their wives’ healthcare within the community, especially in patriarchal systems that place men as key decision makers and custodians of health. The use of TBAs has seen a rise in maternal and neonatal mortality rates due to lack of equipment and skills to successfully attend to these women. As a result of this, WHO in 1992 issued a directive dismissing the inclusion of TBAs within the formal maternity care system. According to this directive; they were to be tolerated only as an interim measure and replaced by midwives or nurse practitioners with suitably acquired ‘skills’ on the grounds that TBAs were not ‘trained birth attendants. In 2005, Kenya’s Ministry of Health banned traditional midwifery practices, saying TBAs had adopted increasingly risky methods of delivery citing that they focused their investment instead on training and equipment.

Despite the two directives being in place; the services of TBAs are still being sought and this engagement reverses the gains and milestones recorded in maternal health due to practices involved in the process such as the old age massage given to expectant mothers to soothe pain. This can lead to internal injury and hemorrhage which may see fluids being transferred from mother to unborn child and in the event of a HIV positive woman then there can be transmission to the unborn child. Since these TBAs have no protective gear there could be cross contamination; putting both self and the client at risk. Another likely process to occur is the sharing of apparatus which can act as a vehicle for transferring the infection from one client to the next depending on the duration of birth and the availability and knowledge of sterilization.

To avert such scenario, it is important to implement interventions that focus on sensitizing the TBAs to understand the dangers that are involved in such arrangements and the need for referrals since they have inadequate training and are therefore ill prepared to handle emergencies or complications. The TBAs can be used as mother companions thereby ensuring that they are still involved in the life of expectants mothers only that this time they are accompanying them for their ANC clinics and during delivery where skilled help is sought. These mothers are identified, trained and linked to the health facility for ease of referral to discourage them from conducting home deliveries. To achieve this, it is important to explain in depth to the TBAs how they will be engaged, and clarifying their new role; this is essential for fostering their willingness to participate and ensure sustainability of such initiatives. Some of the benefits that is associated with their use as mother companions include; an increase in women opting for skilled deliveries, shift in social norms surrounding skilled delivery and increased awareness of health risks and the benefits of hospital deliveries since the TBAs will be sensitized on the dangers of home deliveries they will work as advocates of skilled deliveries and will be able to accompany mothers to facilities, this will ensure that more women will be delivering in hospitals. They will also help shape the norms since they will still be giving advice on issues around delivery.

Since TBAs have been receiving payments for the services rendered, it important to offer incentives to ensure that they are motivated to do this work as well as to earn a living. It is also important to ensure that there are quality services and the facilities. These facilities should also be accessible to ensure that mothers do not face challenges when seeking services.

World Asthma Day 2017 “You Can Control Your Asthma”

World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. World Asthma Day takes place on the first Tuesday of May. The theme of 2012’s event was “You Can Control Your Asthma”

World Asthma Day is celebrated in every parts of the World to spread the knowledge about the Asthma. It is used to provide the awareness among every people to prevent and cure the people from the Asthma Disease. Asthma Day makes the people to come together to spread the knowledge about the prevention, causes and cure of the Asthma Disease. It is used to make the people to make every activity to be fulfilled in a great manner.

History of World Asthma Day

World Asthma Day was initially established in 1998 by the Global Initiative for Asthma (GINA). While almost all of us are familiar with the sound and visual of an inhaler for Asthma being used, not all of us are aware of the actual nature, cause, and that there are multiple types of asthma out there. The truth of the matter is asthma isn’t entirely understood, what is known is that there are multiple factors at play in the complex chemistry that creates an asthma sufferer. These include genetic interactions and elements in the environment that can change both the severity and how likely it is to respond to treatment.

The known aggravators of asthma are many and include everything from allergens, air pollution, and other chemicals that can appear in the environment that irritate the lungs. In high enough concentrations these factors can cause serious asthma attacks in sufferers and aggravate cases that are otherwise mild.

Asthma is incredibly prevalent in those areas that suffer from low air quality as a result, and those areas also tend to be those that house low-income and minority communities. As such these already disadvantaged individuals are the highest sufferers of this pernicious disease. An added factor is psychological stress, and again this element is particularly high in those living on the edge of poverty, increasing its occurrence there further.

Public Participation – The Kenyan Context.

Despite the constitution vesting sovereign power to the people of Kenya under Article 1(1-4), most Kenyans are ignorant and do not have enough information about the constitutional provisions on the county and national governments and how they can actively participate and benefit from the devolved dispensation. Those who are aware of their civic duty to publicly participate in county government processes and participate encounter different scenarios.. In some instances, the public’s proposals have been picked after prolonged budget advocacy initiatives and incorporated in to the budget; for instance the Community Health Volunteers (CHVs) allowance in the health sector budget. Since devolution, health CSOs in Nyeri County

have adamantly advocated for the allowances of CHVs to be included in the health budget and for the first time in the 2016/17 budget this was budgeted for. This is expected to appreciate the contributions of CHVs for the excellent services that they have dutifully rendered to the community at no pay.

In other instance, despite making people centered inputs during public participation, the views of the public are either ignored or rubbished. This has given credence to assumption that; the public is merely invited to agree on the projects already proposed for them in order to meet the Constitutional requirement on public participation. Public participation meetings are therefore slowly losing steam as citizens feel they are only engaged to rubber stamp on what the government officials have already decided on irrespective of citizen’s opinions. The public participation approach envisioned by the constitutuion was one where by the public’s views are sought and their proposals incorporated and not what is currently happening.

Are Kenyans really ready to ask their leaders critical questions regarding the decisions they make for the public without the public’s input? Kenyans are ready to ask their leaders this question, but there are grave challenges to ensuring this happens. The socioeconomic and cultural environments do not facilitate Kenyans to adequately reach out to their leaders and demand for their accountability.  Culturally, Kenya is a country that has brought up generations on the concept of respecting the elders, although these cultural barriers are breaking down, it will take some time before Kenyans can fully put their leaders to account without fear of repercussions that may arise. On the socioeconomic environments, most Kenyans who participate in these public participation meetings are not economically empowered and at times tend to feel intimidated to even ask questions when things are not going right during public participation meetings. We need to focus on ensuring the citizens understand that sovereign power belongs to them as stipulated in the constitution and that without their consent no government project can be implemented.

Solution to effective public participation may emerge once the proposed Public Participation Bill 2016, which seeks to provide a general framework for effective public participation is passed by National Assembly and the Senate. Sponsored by Senator Amos Wako, Chairperson, of the standing committee on Legal affairs and Human rights The Bill is expected  to give effect to the constitutional principles of democracy and participation of the people. .  The Bill has given the mandate in section (6) for each responsible authority to develop specific guidelines for undertaking public participation in the institution for which it is the responsible authority. For public participation to be effective it needs to follow uniform guidelines that put into consideration the Rights based approach.

There needs to be amplified sensitization for the public to understand what public participation really means and that they can stand up and oppose their leaders’ propositions or decisions. The government officials also need to be sensitized on the fact that public participation ensures that they work for the people and not implementing agendas that in the long run may not have tangible benefits to the public hence ensuring that they do their work well.

Community theater groups; Increasing awareness on the Right to health in Kenya

Kenya faces disparities in the quality of health care which is common in contemporary world more so in developing countries. It is evident that urban areas are generally better endowed with the widely accepted indicators of quality health care while the rural areas tend to be relatively deprived. Most health care facilities are concentrated in the urban areas and have more health care workers while in rural areas there are fewer health care facilities with inadequate human resources. Additionally, the qualities of services offered in the urban health facilities are better as compared to the ones in rural areas. However, through devolution of the health sector, many attempts have been made to improve the standard of health care in the rural areas. In the recent past, there was the introduction of community strategy that aimed at empowering communities to take charge of their health before devolution took center stage. Community theatre groups have been very instrumental in reaching out to a wider audience in the community through dramatized skits and role plays.

 
Community theatre is defined broadly as the work communities of people commit to improving their individual and collective circumstances through creative expression. Community theatre is made by and intended for, members of a community. However, this may differ in the way it has been designed and the ways the community have their input depending on the context and performance.. Most of these performances have the Uniqueness in entertaining and creating community awareness through role plays dramatized skits, information and experience sharing with regards to public health advocacy. Community artists have demonstrated a commendable ability to inform, educate and promote public health participation in relation to health promotion and preventive activities.  However, it is believed that some of these performances by community theatre groups can be supportive in shunning stigmatization on HIV/AIDs, condemning discrimination on clients seeking medical services at given health facilities, Upholding and respecting human rights and the right to health, demystifying myths especially on family Planning commodities, embracing male involvement on family planning services, imparting knowledge through health education especially on HIV/AIDs and prevention measures, shunning medical negligence among health care workers. Demystifying harmful cultural practices for instance Female Genital Mutilation (FGM) and ovulatory amongst practicing communities, emphasizing on the importance of community ownership at given health facilities to enable increased workload hence improved service provision dramatized performances are useful in the progressive realization of the right to health in Kenya since it uses clear illustrations, simple and easy to understand language that appeals to the consent of the communities in question. In this case, our theatre groups use participatory education theatre as an education-entertainment (edutainment) model. They infuse folk media and role-play to come up with a socially relevant theatre that is accessible to people and communities. The model draws on community’s pool of knowledge, issue-based and can be used as lobbying or mobilization tool. Theatre groups’ performances are important because learning in a theatrical setting makes learning fun. It teaches the communities about health care workers and medical ethics, health facilities management and services provision and finally emerging trends in the health sector.

The World Health Day

[1]The World Health Day is a global health awareness day celebrated every year on 7 April, under the sponsorship of the World Health Organization (WHO). In 1948, the WHO held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. The World Health Day is held to mark WHO’s founding, and is seen as an opportunity by the organization to draw worldwide attention to a subject of major importance to global health each year.

 

This year’s theme is “Depression; Let’s Talk”.  The day aims to mobilize action on depression. This condition affects people of all ages, from all walks of life, in all countries. It impacts on people’s ability to carry out everyday tasks, with consequences for families, friends, and even communities, workplaces, and health care systems. At worst, depression can lead to self-inflicted injury and suicide. A better understanding of depression – which can be prevented and treated – will help reduce the stigma associated with the illness, and lead to more people seeking help.

 

WHO has identified strong links between depression and other [2]non- communicable disorders and diseases. Depression increases the risk of substance use disorders and diseases such as diabetes and heart disease; the opposite is also true, meaning that people with these other conditions have a higher risk of depression. Depression is also an important risk factor for suicide, which claims hundreds of thousands of lives each year. [3]On 30th March, 2017 in Geneva, it was brought forth that depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma; prevent many from accessing the treatment they need to live healthy, productive lives.

 

In Kenya, sometime back, health experts warned that at least one in every four Kenyans will suffer from mental illnesses at one point in their lives. In this case examples of mental illnesses include; Depression, Anxiety disorders, Schizophrenia and addictive behaviors.  Mental disorders include those affecting mood, thinking and behavior.  It was further noted that quite a good number of patients seeking out- patient services in Kenyan hospitals have mental disorders and a huge number suffer from depression yet the country has only 88 psychiatrists and 427 nurses qualified to handle the illnesses in the 14 mental health hospitals which have a bed capacity of between 15 and 25. [4]Globally nurses represent the most prevalent professional group working in the mental sector. The median rate of nurses in this sector is (5.8 per 100,000 population) is greater than the rate of all other human resources groups combined. A majority of the Kenyan population is unable to access mental health care services due to various factors including prohibitive cost and inaccessibility of the facilities. [5]It is worth noting that there has been progress with regards to mental illnesses in Kenya. Recently, the country’s first Mental Health Policy 2015 – 2030 was launched. The new policy is meant to streamline mental health laws and help in drafting more guidelines to outline the kind of care patients are supposed to receive at the given level of health care. [6]Mental health legislation may cover a broad array of issues including access to mental health care and other services, quality of mental health care, admission to mental health facilities, consent to treatment, freedom from cruel inhuman and degrading treatment, freedom from discrimination, the enjoyment of a full range of Civil, Cultural, Economic, Political and Social Rights and provisions for legal mechanisms to promote and protect human rights. However, there is an urgent need to train mental health experts besides increasing the number of hospitals offering mental health services in Kenya. Furthermore, a sustained scale-up of mental health services accessible to everyone, even the most remote populations not only in Kenya, but the entire world is paramount.

[1] WHO, April 2017, Bulleting of the World Health Organization

http://www.who.int/campaigns/world-health-day/2017/en/ World Health Organization

 

[2] WHO, 2010 Global Status Report on Non-communicable Diseases, World Health Organization

 

[3] WHO, World Health Day, April 2017 http://www.who.int/mediacentre/news/releases/2017/world-health-day/en/  World Health Organization

 

[4] WHO, 2011 Mental Health Atlas, World Health Organization

http://apps.who.int/iris/bitstream/10665/44697/1/9799241564359_eng.pdf, World Health Organization

 

[5] Daily Nation, Wednesday May 18, 2016, Health experts warn of mental illness crisis, Page 10, National News, Medical Care, Nation Media Group.

 

[6] WHO, 2011 Mental Health Atlas, World Health Organization

http://apps.who.int/iris/bitstream/10665/44697/1/9799241564359_eng.pdf, World Health Organization

 

On doctors’ strike and devolution of the health sector

 

As the world commemorates the International Human Rights Day 10th December, 2016 Kenyans should have a look at the milestones we have achieved over 50 years since independence. This has been quite an experience specifically with the promulgation of the 2010 constitution, which has seen the sovereignty power exercised in two levels. Besides, chapter 11 of the constitution provides for a devolved government and therefore, establishes county governments to work in tandem with the national government. As we ponder on the constitutional rights stipulated in chapter four of our constitution, among others, the right to health with regards to devolution of the health sector will have to be fast tracked with the recommendations in line with the ministerial task force including automation, supply chain reforms and organizational restructuring. This will definitely compel the need to engage with the county governments on the plans for county health strategies and services. However, the main challenge is on how to galvanize the minds of Kenyans especially those in authority to appreciate the re-organization of the state in line with devolution. Health Service Commission (HSC) has to fully pronounce its mandate since there already exists disparities in the level of professionals and this is quite evident on how health is termed to be difficult under devolution. On Human Resources for Health, there is a gap in some of the core mandates for instance on employment and deployment, staff welfare and equipment for the given facilities. From the on-going doctors strike, among the demands is county governments to address disparities in human resources management.

There has been anticipation on the gazettement of the same from the national government. This will give clarity on the roles and responsibilities to be assigned at the county level. It will equally create adequate information on the health plans as dictated by the county governments. Also, it will increase awareness on devolution in the health sector through capacity building for proper planning and implementation. In the recent past, there have been concerns that the funds required in managing health institutions have not been devolved yet. Sometime back, as highlighted in the newspapers, the Council of Governors (CoG) was on the war path with the national government over Sh. 2 billion free maternal health care arrears and yet the national government was said to be planning to take the free maternal health care from counties to the National Health Insurance Fund. (NHIF)

At the county assembly, health committees need to be involved in the budget making process that will see full participation to enhance accountability and transparency. This will be geared towards monitoring the progress on HSSF funds for improved health services at the county level. Besides, issue- based advocacy and the mechanisms therein has to be emphasized in the health sector devolution. It will include proper communication to be disseminated at the county level on the functions that have been devolved, that is; schedule (iv) on the functions between the national government and the county government. Among the areas of concern for advocacy will be to focus on; policy i.e. what has been drafted with regards to the law abiding relevant issues, finance i.e. is the cash flow adequate or inadequate to enable the implementation in  certain areas of interest, and lastly on the capacity and the need for better working apparatus.

Besides, on capacity at the county level, there’s need to be the involvement of some relevant dockets for instance Transitional Authority, to assist in looking into the county functions and advice accordingly on the capacity therein at the given counties. The CRA needs also to define its role in participation on health and devolution to the counties. On the other hand the CSOs need not to be left out, since they have always been very instrumental in spearheading some of these processes by strengthening people’s capacity and work in tandem with the government through research and dissemination of their policy briefs as key stakeholders.

The persistent strikes by health workforce is disheartening to health services a healthy workforce also means a better labor market. The government should stop spending indiscriminately and show the striking doctors commitment to solving the endless doctors’ strikes as they come up with new ways of dealing with boycotts and work stoppages in essential services.  There ought to be protection of third parties (citizenry) who suffer in the process since the greatest obligation is ensuring they enjoy their rights. The state ought to respect the public’s right to health; protect and take steps to ensure third parties do not interfere with the enjoyment of the right to health and to fulfill in taking steps to progressively realize the right to health.

Digital Media and healthcare

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Courtesy of: Digital Trends

You wake up feeling ticklish in your throat, you try to shake it off and drink lots of warm water or the honey and lemon concoction. After a day, it’s still there, instead of seeking a doctor’s appointment, you head to the internet. Today, anyone with a digital device with connection to the internet can access a variety of health information on-line ranging from a simple sour throat to the more serious like bronchitis and Asthma.
Everybody consumes and talks of e-health but not many people have come up with a clear definition of the term. In this digital era, it’s used to describe essentially everything related to computers and medicine. E-health was initially coined and used by business leaders and marketing teams rather than scholars. The private sector devised the term e-health with reference to other e-words” such as, e-business and e-commerce in an attempt to compress the viewed merger of electronic commerce to the health sector, and provide a possible identify that the internet was opening up in the health sector. For instance, to Intel e-health was a concerted effort embarked on by leaders in health care and hi-tech businesses to fully harness the benefits available through convergence of the internet and health care.” (Eysenbach, 2001)
In the early 1990s, the internet had brought new opportunities and challenges to the traditional health care information technology industry; and the coining of e-health to address these issues seemed appropriate. In the academic environment, G Eysenbach defined e-health as “an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the internet and related technologies. He added that in a broader sense the term characterizes not only technical development but also a state of mind, a way of thinking, an attitude and a commitment for networked, global thinking to improve health care locally, regionally, and world-wide by using information and communication technology.” (Eysenbach, 2001)
With the digital era, where most individuals have a digital device, health information is often said to be one of the most searched content online. (Eysenbach, 2007)These claims have been mostly based on survey data, for instance the Pew Internet & American Life Report, which found that “80% of adult Internet users have searched for at least one of sixteen major health topics online. With such an online demand for heath information, medical practitioners have had to adapt to the changing times; social media is being embraced by more medical practitioners who use it to share health information and providing patient care.
Health information in relation to online platforms has seen drastic improvements with the recent advances in digital media where we have 4G, motion gaming, digital TV and smart phones.

This information has progressed with the changing Cyberculture which is the electronic environment where various technologies and media forms converge: the Internet and email, personal homepages, online chats, personal communications technologies, mobile entertainment and information technologies, bioinformatics and biomedical technologies.

Health information on social media has improved with regards to the features of Cyberculture (Convergence, Remediation, Consumption, and Interactivity) where by health information can be accessed on various digital device, it also contains videos and not only content, it is highly sought by various individuals and has enabled patients communicate with their doctors while online.
Despite the switch by medical practitioners in embracing the changing digital era, the participatory nature of social media entails an open forum for information exchange, therefore increasing the possibility of wide dissemination of non-credible, and potentially erroneous, health information. (Chou, 2009). In accessing health information online, most individuals may not consider other Internet tools such as e-mail, chat, instant messenger, or social networking sites, which may actually help them to identify credible information on the Web (Eysenbach, 2008).

The fact is that there is a great deal of high-quality information on the Web that is published by trusted organizations. It is important for these organizations to appear credible enough to initiate a behavior change in consumers.
The world we leave in ensures that almost every individual is able to find and provide medical solace online, but, just because we can, it doesn’t mean we must. Without the knowledge on where to access legitimate e-health, it is not a good idea to consider social media as a source of healthcare since this cannot be subsituted with health personnel.

Adolescent sexual and health reproductive health in Kenya

On 28th of July 2015 we were represented at a dissemination meeting of the fact sheet on Adolescents Secxual and Reproductive Health in Kenya organized by Center for the Study of Adolence (CSA). Adolescent sexual and reproductive health (ASRH) is a crucial component of lifelong health and well-being of individuals, which contributes to the health of future generations. Among the key areas of concern were; the ASRH policy directions for instance, how to ensure young people get information so that they can make informed decision, programming and how to make good use of celebrities in conveying positive messages since they are role models, how to contextualize certain issues in terms of reference since the approaches may vary due to geographical locations in Kenya, service provision and  HIV testing, communication strategies, youth friendly services and how to factor in financial barriers that hinder quite a good number of adolescents from accessing various services.

It was concluded that there is need to advocate for ASRH policy at the county level through the elected leaders, and have a clear access to information, meaningful involvement of adolescents. On programming, issue of coordination should be enhanced through multi-sectoral e.g. Ministry of Health, Ministry of Education and Ministry of Agriculture. More emphasis should be placed on resource mobilization and allocation as well as the interpretation of the policy statements by both the media and the general public.