Summary This report covers results and recommendation (referral) of all cases seen as part of the process of screening children in one of our programs Noted on the screening form is that it did not include the height column which is very important for general health evaluation. Weight in relation to height is key to determining the growth and development of the children which again is important for both short and long term physical and mental development. We evaluated all the children BMI (body mass index) based on their accurate weight and height. The average BMI for all children evaluated is 16.285, (A BMI of 20 to 25 may indicate expected weight, lower than 20 suggests the child is underweight while above 25 may indicate the child is overweight. The common health conditions included 1. Mild Respiratory infections (upper respiratory infections, Influenza and other colds) 26 (10%). Prescriptions were written for the specific cases identified 2. Gastro-intestinal conditions (including worms, amoebiasis and diarrhea) most of which are transmitted through fecal-oral routes were 36 (14%). Anti-worms were provided through the centre. 3. Musculoskeletal conditions including slight injuries, deformities and general aches included 5 (2%) cases. There were 2 cases which were referred to Kijabe and Kenyatta Hospital with deformity and follow-up will be done during the next screening. 4. Ear, Nose, and throat conditions were 7 (2.7%) 5. Dental cases 55(21.4%). These included mild to worse dental carries, discoloration probably due to high fluorine contents in water etc. There will be need to provide dental assessment, treatment for children in this centre to encourage proper dental hygiene. 6. There were water washed skin and hygiene related skin conditions amounting to 20 cases (7.8%). Health education was given individually but a lot of efforts on this and provision of water will be necessary in the future. 7. Malnutrition. There were just two cases noted of clear signs of malnutrition. It’s worth noting a BMI of 16.3 is outright underweight based on WHO classification. A follow-up is needed to ascertain what can be done as this is key to promoting general health of the children under the compassion international program 8. Immunization. It is worth noting that the only way to ascertain completed primary immunization is an immunization card. Based on BCG scar, confirming immunization against Tuberculosis, 40 (16%) children didn’t have the scar on the right outer aspect of left lower hand. It’s important to ensure they get immunized during this year medical screening. Hespa Ltd. 2011

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In this study, the researcher sought to investigate the driving and contributable factors that promote HIV and STIs inside the Kenyan prisons. In general, it is estimated that over 15% of Kenyan inmates are either living with HIV or have AIDS and other sexually transmitted infections. Using descriptive study method the researcher sought to find out prevalent sexual behaviors existing within the prison walls. Through guided interviews, the researcher was able to find from the inmates their sexual behaviors and through the questionnaires, the researcher collected information regarding their risk towards HIV infection. These questionnaires were distributed to 60 prisoners using systematic random sampling to ensure generalization of the results. The response to questions in the questionnaire was between 91 to 100%. Data was then analyzed using quantitive and qualitative methods and presented using tables, pie charts and graphs. Knowledge, skills and practice were analyzed using keywords defined in the operation definitions. This study conducted in 2008 reveals that overcrowding, long sentences, lack of adequate information on HIV and AIDS and prevention strategies contribute to the high HIV prevalence in Naivasha Maximum prison. Among the participants who participated in the study, 10% revealed that they are recycling used needles and are sharing the needles daily while using injectible drugs. Sexual relationship between men is rife in the prison facilities with over 20% revealing to be having unprotected sexual relation with male partners. Recommendations emphasizes on evaluation of policies and government in health care provision in the prisons in Kenya. Prisoners’ welfare needs to be addressed to cater for their sexual needs in a way that the risks are reduced. Strategic interventions needs to be put in place to avert the risks on inmates due to their vulnerability as far as HIV and other STIs are involved. This study will also help in development of ways of harm reduction so that those who will engage in sexual relations with fellow inmates will reduce the chance of being infected through safer sexual practices or treatment.

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Health System financing in Kenya

HEALTH CARE financing in Kenya: effects of health care delivery

Frederick Kimemia, Bsc, KRCHN
Abstract
Majority of the population in the developing third world countries and to an extent middle income world countries are affected by the underfunding of health services. The inability for the citizen to, the government and institutions to finance health leaves that poor population paying from their pockets for the services they get form the health facilities.
Kenya being among the undeveloped countries with a huge disease burden and high mortality and mobility rates and currently recovering from absolute poverty has a mixed model of health financing. This model is largely reliant on out of the pocket mode of financing.
In comparison to Finland a first world country with the best health output indicators, this article compares how financing health care has a direct impact on the health of the population and looks at critical issues e.g. Life expectancy, mortality among women and children and health resource distribution and management.
This has greatly affected services delivery in most of the underdeveloped countries health care systems. The underfunding has had a cross cutting negative effect and continues to remain so. In Kenya the effects in a nutshell include reduction in life expectancy, high maternal and infant mortality, inadequate human resource for health and inadequate and stock outs of health commodities etc
Recommendation delves into the need of government to increase its efficiency and incorporate community involvement in financing health care, increase in financial allocation and equity
Key words
Health care, Health Systems, Output, Financing
Introduction
The methods used to finance health care services play a major significant role in shaping a country’s healthcare system. Personal health care includes services such as hospital care, physician care, dental care services, and drugs that are provided directly to individuals. How this care is financed influences how people access healthcare, the type of healthcare provided, and the mechanism used to allocate health care services. Since independence in 1963, Kenya has had a predominantly tax-funded health system, but gradually introduced a series of health financing policy changes. In 1989, user fees or cost-sharing, were introduced but later abolished in 1990 but later re-introduced in 1992. These fees have remained, with their impact on access to health care, until in June 2004,when user fees was significantly altered after the MOH stipulated that healthcare at dispensaries and health centers level be free for all citizens, except for a minimal registration fee in all government health facilities. Other healthcare financing methods are; The Social health insurance (SHI), whose purpose is to ensure access to outpatient and inpatient health care for all Kenyans and to significantly reduce the out -of –pocket healthcare expenditure of households. Community-Based and private-for profit insurance schemes, provide an additional cover to an individual based on risk related premiums. General revenue is another method of financing where by the government allocates a certain amount of money to the Ministry of Health so as to assist in financing health services in the country, usually done during annually budgetary allocations by the Ministry of finance. In view of this, the pros and cons of various financing mechanisms can be overcome by improving and linking the different approaches.
Methods
This Article is seeks to describe and discuss health care financing systems, effects of financing health care in service delivery and offer recommendation that will facilitate improvement and increase health outcomes in Kenya.
The author gathered information on the different heath care financing in Kenya through literature search and review on the different systems in the world. We compared the health care financing and indicators with Finland which is among the countries with acceptable health outputs in the world. The literature was analyzed and presented inform of discussion, graphs and tables and recommendations were offered for consideration.
Background of Health care financing in Kenya
Developing countries account for 84 percent of world population and 93 percent of the worldwide burden of disease; however, they account for only 18 percent of global income and 11 percent of global health spending. Limited resources and administrative capacity coupled with higher disease burdens, numerous competing critical priorities, and strong underlying needs for services pose serious challenges to governments in the developing world1.
Health care systems today account for about 9 percent of global production. While much of the debate on health spending and reform has focused on developed countries, these issues are of even greater importance to developing countries.
Kenya in comparison with Health care financing status in other countries
Global distribution of income, health spending, and population, 1994
Global spending on health totaled about US$ 2.3 trillion in 1994 (9% of total global income). Higher income countries spend just over US$ 2 trillion amounting to 89% of total health expenditure, while their population accounted for 16%, of the global population, with a Gross Domestic Product (GDP) of 82%. Developing countries with 84% of world’s population accounted only for 11% of all health spending, and a GDP of 18%. This disparity underscores the enormous difference between the developed and the developing countries in terms of capacities and health services that can be provided. This translates into large differences in health infrastructures and outcome

Distribution among low and middle income Countries GDP Health Spending Population

East Asia and Pacific
Europe and Central Asia
Latin America and Caribbean
Middle East and North Africa
South Asia
Sub-Saharan Africa
24
19
35
8
9
5
17
18
42
9
8
6
35
11
9
7
26
12

Source; World Bank Health Nutrition and Population Database 2004

Per Capita Income, Outcomes, and Health Inputs
Developing countries have much lower per capita incomes (GDP), much poorer health status indicators, and many fewer health-sector inputs than developed countries have. Per capita GDPs in developing countries are on average less than 10 percent of those in developed countries, where per capita GDPs averaged over $18,000 in 1994. Low-income developing countries have per capita GDPs that are only some three percent of those in developed countries. In terms of regional groupings, South Asia has the lowest (country-weighted) per capita GDP, while the Latin American/Caribbean region has the highest. Latin America/ Caribbean, Europe/Central Asia, Middle East/North Africa, and East Asia/Pacific are middle-income regions, while South Asia and Sub-Saharan Africa are low-income regions.
With respect to health outcomes, mortality under age five in developing countries is almost ten times the level found in developed countries. Under-five mortality in Sub-Saharan Africa is more than fifteen times higher than in developed countries. However, this is not strictly related to income among the middle-income regions, as shown by the higher levels in the Middle East and North Africa relative to East Asia and the Pacific, despite the higher income levels in the Middle East and North Africa. Worldwide there is an inverse relationship between per capita income and under-five mortality; a great deal of variability exists among countries, which indicates the strong influences of social and cultural factors as well as the differences in the availability and efficacy of targeted maternal and child health programs.
Since 1980, the number of African countries implementing cost recovery through user fee system has grown considerably. Governments have come to see user fees as a critically important alternative to tax based financing for government health services in Africa, even for countries such as Kenya and Tanzania, which had previously provided government care free at the point of service. Recent surveys show that most African countries have now introduced some form of fee system for government facilities. 14 out of 15 African countries that Russell and Gilson surveyed and 28 out of 37 Norlan and Turbat surveyed in 1995 have done so. Since recovery reforms rely on people’s willingness to pay fees for health services, they are most likely to succeed when they also give people improved quality, access, and equity they want.
Countries in Africa face an array of healthcare financing problems2 that leave their health systems far from achieving the objective of good health, equity, efficiency, acceptability and sustainability. The main problem is simply a shortage of government budgetary resources for healthcare in relation to increasing demand and need for care. In addition, patterns of spending in most countries reflect an inequitable of inputs and services. Government resources are concentrated in large urban hospitals. On the average, people who live in the urban areas have higher income than those who live in the rural areas, yet the urban bias in government health spending means that the cost of gaining access to quality care are higher for the most remote, and usually, poorest groups of the population. Evidence from several countries e.g. Indonesia (Ministry of Health 1995), Kenya and Tanzania, (Griffin and Shaw, 1995), indicate that non poor people tend to consume more publicly financed hospital care per capita than poor people. High levels of waste and other forms of technical inefficiencies also plaques health systems. These are a threat to any gains that reforms to improve cost-effectiveness by reallocating resources might achieve (World Bank 1994).
Comparison with Finland3
Both Kenya and Finland are democratic republics. The countries have social, historical, economic and cultural realities. As a sub-Saharan African developing country, Kenya’s social economic indicators are low and have overall worsened, particularly during the 1990s. The level of poverty reached its worst level in 2000 rising to 56% from about 44% in the early 1990s. A highly industrialized society Finland has among the leading social economic and health indicators. The GDPs per capita measure shows that while Kenya’s is US$306, in 1999, Finland’s was US$23,096 in 2001, ranked 5th in the world. Average Life expectancy in Kenya stood at 54.7yrs in 1999, while Finland’s was 77.4 in 2001. Further data on health expenditure as a percentage of the GDP indicate a favorable figure of 7.8%in Kenya and a slightly lower 6.9% for Finland during 1998 (World Bank 2001). Overall healthcare financing differs with the share of out of pocket payments estimated at 49% in 1994 in Kenya and 20% in Finland in 1999.
Effects of Health financing and health care delivery
The methods used in Health care services financing and amount of resources dedicated into this activities play a major role in shaping the level, quality of health services in a country. Health services financed includes preventive, curative, promotive and rehabilitative care. Under financing any of this aspect of health service i.e. care, research or training means that health service indicators will be tipped negatively for example if a country does not invest in training doctors then it means the citizen who can access the services of a trained physicians will be few (Tommaso,2005).
When you overfund certain aspect of health care services and discriminate against others then the balance will not be the same for example HIV and AIDS has been overfunded against other illness since the focus has been source for funds for HIV care forgetting other illnesses that are associated with it.
For government systems to assure effective health care delivery there has to be a clear and enough assessable modes of health financing (Wamai, 2004). As discovered earlier the out of pocket system of financing personal health is not dependable since the patients or citizens may lack the credit and health problems may not be predictable.
The third party system of financing health care is somewhat dependable with certain manageable illness as long as premiums provides for them. For certain illness the health insurance may not cover and the patient may have to pay again from the pocket. Certain aspects of health care delivery e.g. training and research may not be covered by the third party. The best health care financing is the one where there is a mix of all prayers of financiers e.g. Donors, Government through tax and insurance firms (Schieber and Maeda, 1999). This ensures that Health care, research; training is covered and financed adequately and is affordable to all.
As described in the table below there is a direct relationship with the socio-economic status and occurrence and management of health problems. Health indicators are worse in economically challenged countries than the developed countries. Again the people with little capacity to pay or finance their healthy need are the ones who get sicker quite often and probably develop complications when they get sick.
In the table Kenya has a higher highest disease burden compared to Finland. Mortality for women is 20 times high and underweight children are 9 times more in Kenya compared to Finland.
One major indicator of health is Health life expectancy. Kenya is 30 points lower than Finland. Other Health indicators are under fives mortality rates which are 12 times higher in Kenya than Finland or the developed countries. This could be related to the countries spending on health and concludes that the less the funding in to health care the more the diseases is prevalent. In terms of GDP most developed countries spend three times higher than the developing countries that focus more on disease prevention while the developing countries spend on treatment and other emerging problems (Drummond et al, 2005).

Health outputs in comparison with Financing
Health indicator Kenya 7.8% Finland 24%
Life expectancy 44 and 45 years for male and female respectively 44.5yrs 77.4Yrs
Physician per population 1 in 10,000 26 per 10,000
Access to clean environment 43% and 89% in rural and urban 66% 96%
Maternal mortality 500 per 100,000 25 per 100,000
Trained Health worker assisted delivery 30% 30% 3 89%
Under fives’ mortality 121 per 1000 live births6 9 per 1000 live births
Underweight 19% 2.2%
Source: http://www.hespa.org ©2010
Health care workforce
There is between 1 to 2 physicians per 10,000 people in developing countries compared to 26-30 per 10,000 in developed countries. This could be because of the little funding provided for in those countries to train, retrain and retain health acre workforce. Again those who remain in the developing countries are limited to towns and large cities. This hence has in impact on the quality of health care provided in the countries.
Criteria for allocating funds
The social economic status which determine the levels of cases of illness prevalent in the area. Only about 66% of people in developing areas have access to safer environment. Diseases are more prevalent in poor neighborhood. Health financing should focus on pockets of areas where diseases are prevalent rather than population. In some cases funds are even allocated based on political reasons rather than disease prevalence.
Recommendation
1. Promote affordable and equitable healthcare financing. Emphasizing preventive health financing requires government and other financiers involvement in financing outpatient care, health education and prevention of minor illness to make healthcare cost affordable.
2. Structural change. Increased private sector performance and greater community participation in health service management will enhance collaborative efforts and stakeholder involvement in matters concerning needs assessment and health financing.
3. Increase finances to health sector and efficient utilization. This is in effect will improve outcomes in health care service delivery in private and public health care organizations. The cost of financing health care should be translate to better quality of care offered to Kenyans
4. Improved governance through decentralization of health facility management
Emphasis on preventive services, enhanced collaboration with stakeholders, giving operational autonomy to health facilities at all levels of health care delivery system.

REFFERENCES

1. Ministry of health, sessonal paper on National Social health insurance in Kenya. Nairobi 2004.
2. World Bank (1998) World development indicators. Oxford University Press, New York.
3. http://devdata.worldbank.org
4. Kimani DN, Muthaka DI, Manda DK. Healthcare financing Through Insurance in Kenya: Kenya institute of for public policy research and Analysis.
5. George Schieber and Akiko Maeda – Health Affairs May/June 1999, Volume. 18, number 3.
6. Sustainable Healthcare Financing in South Africa, Papers from Health Policy Seminar held in Johannesburg, South Africa, June 1996. Economic Development Institute of the World Bank.
7. Richard G. Wamai – Comparative trends in transforming healthcare Systems in Kenya and Finland. Paper presented at the International Society for Third Sector Research Sixth International Conference on ‘Contesting Citizenship and Civil Society in a divided world. Ryerson University and New York University Toronto, Canada, 11-14-2004.
8. Michael F. Drummond, Mark J. Sculpher, George W. Torrance, Bernie J. O’Brien, Greg L. Stoddart (2005) Methods for the Economic Evaluation of Health Care
9. Marco R. Di Tommaso (Ed.) (2005) Health Policy and High-tech Industrial Development: Learning from Innovation in the Health Industry
10. Bedi AS, Kimalu P, Kimenyi M, Manda D, Mwabu G, Nafula N (2003) User charges and utilization of health services in Kenya. Working Paper Series No. 381. Institute of Social Studies, The Hague, The Netherlands.

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