In the four years Monica has been married she has conceived three times. In the first two pregnancies she had to bear the labour of childbirth by a traditional birth attendant’s hands.
However in a few months, the 26-year-old mother will for the first time deliver her baby on a hospital bed. Monica owes her luck to a community outreach programme at the Rongai health center in Kenya’s Rift Valley, which is assisting expectant women to access antenatal and postnatal healthcare.
During her monthly visits to the facility Monica says she likes to reflect on her first two deliveries, which she underwent with the assistance of traditional midwife because she could not afford hospital charges.
Monica got infected with HIV in the course of her marriage, something that she has so far kept secret from her husband. However, Monica says she will not be able to keep her status confidential for much longer given the opportunistic infections that keep visiting her.
In several instances, she has come down with malaria, which is endemic in the Rift Valley, but says on these occasions accessing healthcare and medication has not been an easy feat.
“It is not easy for us to get treatment at the health centers because of the high costs involved and the distances we have to travel,” she says. “Sometimes we also fear the health workers because most of them are abusive.”
Like Monica, a growing number of mothers in Kenya are failing to access malaria treatment and other essential healthcare services, and a recent report from Transparency International, a global civil society organisation, says corruption is a key factor in this.
The Kenya health sector integrity study, released last year (2011) by Transparency International (TI), found only 5.6% of Kenya’s national budget is allocated to ministries responsible for health service delivery in the country creating a huge setback to Kenya’s malaria and HIV response.
The report highlights how Kenya is faced with an acute shortage of qualified health workers, while those on duty are poorly remunerated, leading to poor health service delivery to the public.
While shortages of drugs and medical supplies in public institutions also plague the health sector, the report also cites “unaffordable health services and embezzlement of the user fee revenue stream” as common practices amongst unscrupulous healthcare workers.
“Even with these limited resources allocated to the critical health sector, corruption remains rampant, impeding access to quality, equitable and effective health services,” says the report.
TI-Kenya executive director, Samuel Kimeu, is hopeful that Kenya could improve standards in healthcare services as required by the country’s constitution. But says if current trends are anything to go by it may take a while for the East African country to pull itself out of the jaws of inefficiency.
The TI report also links the shortage of malaria drugs in health facilities to hoarding by medical personnel who then supply the medication to private pharmacies in order to make a profit. Reports of cross border trafficking syndicates also worry officials. In one incidence the Kenya Medical Supply Agency (KEMSA), was at pains to explain how malaria drugs bearing the government’s tag had found their way into Uganda hospitals.
TI also found that when the Ministry of Public Health and Sanitation previously announced a policy shift to waive the cost of malaria drugs from Ksh. 600 to Ksh. 30 many health workers pocketed the difference instead of passing the saving onto patients.
However, Beatrice Misoi, the nurse in charge at the Rongai health center, said long delays in the delivery of medication can lead to shortages: “Although we do not experience prolonged shortages of drugs at our health facility sometimes we have to wait about two weeks before malaria drugs are supplied,” she said.
Under a donor subsidised scheme, nine countries won the privilege of accessing affordable malaria drugs. Kenya is among three countries in Africa, which have already placed orders for subsidized ACTs, according to director of Medical Services, Dr. Francis Kimani.
The TI report also finds that internal ‘turf wars’ in the Ministries of Medical Services and Public Health and Sanitation are ingrained affairs, and says this undermines the implementation of policy, especially ones that effectively address HIV, AIDS and malaria.
