By David Njagi
In the four years Monica Nyamosi has been married she has conceived three times. But 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, which is assisting expectant mothers access ante natal and post natal health care.
During her monthly visits to the facility which is about an hour drive away from Nairobi city, she likes to reflect on her first two deliveries, which she underwent through a traditional midwife because she could not afford hospital charges.
But there is another catch to the tribulations she had to go through. Monica got infected with HIV in the course of her marriage, a condition that she has so far kept secret from her husband. She however cannot be confidential with opportunistic infections that keep visiting her.
In several instances, she has come down with malaria, which is endemic in the Rift Valley region of Kenya, but on these occasions, accessing healthcare 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,” says Monica. “Sometimes we also fear the health workers because most of them are abusive.”
Like Monica, a growing number of mothers are failing to access health care in Kenya because of what reports link to corruption and strained resources.
The Transparency International (TI) report which also suggests that only 5.6 per cent of the national budget is allocated to Ministries responsible for health service delivery in Kenya says the emerging challenges are a big setback to the war on malaria and HIV/AIDS.
According to the Kenya Health Sector Integrity Study (KHSIS) report, Kenya is faced with an acute shortage of qualified health workers, while those on duty are poorly remunerated, hence the poor health service delivery to the public.
While shortage of drugs and medical supplies in public institutions also plague the health sector, the report mentions unaffordable health services and embezzlement of the user fee revenue stream as common practices by unscrupulous health care 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 health care services as required by the Constitution, but 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.
For instance, turf wars, which the document notes are an ingrained affair in the Ministries of Medical Services and Public Health and Sanitation, undermine the implementation of policy, especially one that addresses HIV/AIDS and malaria.
“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,” says Beatrice Misoi, the nurse in charge at the Rongai health center.
The Ministry of Public Health and Sanitation has previously announced a policy shift to waive the cost of malaria drugs from Ksh. 600 to Ksh. 30. But most of these end up lining the pockets of individuals, according to the report.
While the document links shortage of malaria drugs in the health facilities to hoarding by medical personnel who then secretly supply them to private pharmacies, 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.
Under the donor subsidised AMFm, 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.