Medical Review May 2018
Healthcare in Kenya Bathing every day increases risk of infections, experts warn Healthcare system in Kenya and the milestones
Magazine Experts raise alarm on rising cases of heart diseases in Kenya
Drugs agency Kemsa denies responsibility for expired medicine
Breast cancer treatment doesn't raise risk of heart disease – study
Conference themed “Meeting Kenya's Universal Health Challenge” ongoing in Makueni Experts raise alarm on rising cases of heart diseases in Kenya
Kenya doesn't have flu vaccine policy: Why it needs one for babies
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African Human Rights Body Urges Renewed Efforts on Human Rights in Response to HIV The report titled HIV, the Law and Human Rights in the African Human Rights System; key challenges and opportunities for rights-based responses, notes that in spite of efforts to respond to legal challenges posed by the epidemic, human rights violations in relation to HIV continue to occur..
The African Union Human Rights Body has urged renewed efforts on human rights in response to HIV/ AIDS, noting that women, youth and sex workers are the most affected by the disease. In its report African Commission on Human and Peoples' Rights (ACHRP) gives a comprehensive analysis of the legal and human rights issues pertinent to HIV in the continent. These include; discrimination and inequality, coercive HIV testing, barriers to treatment access, violations of the human rights of women and girls, failure to uphold the human rights of children, and criminalisation of people living with HIV and members of key populations.
rights of all the populations that are marginalised and left behind in our communities,” said Soita Maiga, the body's chairperson. While noting the progress made in the response to HIV in Africa, the report expresses concerns about the populations that are left behind—young women and girls, prisoners, sex workers, gay community, transgender community and people who use drugs.
People living with HIV in Africa and globally continue to experience high levels of discrimination and stigma on the basis of their HIV status. Negative social attitudes—including gossip about people living with HIV— remains high. According to the Stigma Index, 8 in every 10 Kenyans living with the disease are aware of being “There is need to address stigma and discrimination gossiped about while a and to pay greater attention further 6 in 10 fear being gossiped. to the effective and full protection of the human 2
The study states that such an environment hinders efforts to end the HIV epidemic because it discourages people living with HIV from disclosing their status to family members and sexual partners, and it undermines their ability and willingness to access and adhere to treatment. Similarly, stigma and discrimination, violence, negative gender and hetero- normative constructs, and criminal laws that affect members of key populations {particularly sex workers, people who inject drugs, transgender and gay men} have been shown to increase vulnerability to HIV and limit access to HIV services. Globally, approximately 30
per cent of all people living with HIV do not know their status. Practices such as mandatory testing, breaches of conďŹ dentiality and requirements for parental consent discourage individuals from accessing HIV testing services, and they may also place individuals at risk of increased violence or discrimination. “Women report stigma, exclusion and harassment within their families, communities, workplaces, schools, health-care facilities, churches and other places of worship,â€? the report says, adding that they also suffer physical and sexual abuse, expulsion from their homes and communities In addition, people living with HIV who have TB face the stigma and discrimination
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of both illnesses. “Stigma and discrimination targeting people with TB takes place in the workplace, health-care facilities and communities through travel restrictions and mandatory treatment,” said Maiga. The study points out that health workers have also been known to deny equal access to TB clinics for people living with HIV, sex workers, transgender people and other marginalised populations. A small number of countries also continue to impose travel restrictions on people living with HIV. Seychelles, for example, requires mandatory HIV testing for resident and work permits. To tackle these challenges many African countries have constitutional or statutory protections against discrimination on the basis of gender, disability and marital status.
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However these laws often are narrow in scope and fail to address the layers of discrimination people face due to HIV status. “Despite these achievements, stigma, discrimination, gender inequality, violence and other human rights violations continue to make people vulnerable to the epidemic and hinder access to HIV services,” said Michel Sidebe, the Executive Director of the United Nations Programme on HIV/ AIDS. According to the National Aids Control Council, a cumulative HIV stigma index score of 47 which is rated as high showed that many respondents judge and blame people living with HIV for their status. Some believe that HIV infection is considered to be a punishment from God or a punishment for bad behaviour.
Barriers Affecting Obstetric Fistula Treatment and Prevention in Kenya By Hilary Mabeya Health is one of the key elements of the social pillar of Vision 2030 that envisions Kenya as a middle level industrialized country by 2030. Obstetric Fistula (OF) cripples the woman in the physical and psychosocial domains and consequently, economically, resulting in a big blow to attainment of the vision 2030. Moreover, OF is a manifestation of lack of access to quality of maternal and neonatal health services which is also reected in other maternal and neonatal health indicators. Kenya continues to register unsatisfactory maternal and neonatal health indicators.
old. Kenya was not able to achieve Millennium Development Goals especially 4 (reducing child mortality) and 5 (improving maternal health). In Sub-Saharan Africa, only Rwanda, Ethiopia, Malawi, Cape Verde and Tanzania are on course to achieve goals 4 and 5. In 2015, Kenya was already in the 8th year of implementing its long term Economic blueprint, the Kenya Vision 030, which is being
Latest data shows Kenya is ranked at 138 with 362 maternal deaths per 100,000 which although lower than the earlier 488/100,000 still accounts for 14 per cent of deaths among women aged between 15 and 49 years 5
The overall impact is to implemented in 5-year rolling Medium Term Plans reduce OF. There are wide regional differences in (MTP). facility delivery rates and By the time the SDGs were the spatial distribution mirrors the differentials in adopted in 2016, the poor maternal and second MTP (2013-2017) neonatal health indicators was in its third year of and the occurrence of implementation. Maternal mortality is none-the-less a Obstetric Fistula (OF). relatively uncommon event Among the consequences making assessment of of prolonged or obstructed severe maternal labour are the formation of morbidities also called obstetric fistula (either 'near miss' morbidities a urinary or faecal) and a more feasible strategy for evaluating maternal health. host of other morbidities, including neurological affections such as foot The direct causes of drop, foetal death. The maternal mortality, also pathogenesis is chemic reflected in near miss necrosis of urinary, vaginal morbidities, include: and or rectal tissues due to haemorrhage, infections, prolonged pressure of the hypertension, prolonged and obstructed labour, and impacted foetal head. unsafe abortion among Obstetric fistula can only be others. The only effective prevented by prompt intervention to address identification of obstructed such complications is labour – usually through delivery under skilled careful monitoring of attendance. labour with pantographs and prompt emergency The free Maternal Care Caesarean Section. The Program has immensely contributed to reduction of challenges of preventing OF are tied to issues of maternal mortality in access to high quality of Kenya. The increased Emergency Obstetric and utilisation of maternity Neonatal Care (EMONC) services in public health facilities has contributed to capable of detecting and promptly managing the overall increase of obstructed labour. deliveries in health facilities from 44 per cent in 2012/13 to the current 70 These are complex and multisectoral factors, per cent.
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this is according to Dr Mabeya PhD, a specialist Obstetrician/Gynaecologis t/Fistula Surgeon is the Chief Executive Officer Gynae-care Women's and Fistula Hospital Eldoret. Contributing factors have been conceptualized under the three delays model: The first delay encompasses factors that affect the ability of the pregnant woman to identify the need to go to the health facility at onset of labour. The second delay includes factors that influence her capacity to reach the facility promptly. The third delay includes facility factors that determine readiness to provide the woman with timely and high quality EMONC services including emergency Caesarean Section. For women who go into labour and reach the facility early, obstructed labour is a clear indication of poor quality obstetric care. If any part of this cascade of events and actions fails for a woman with obstructed labour and Caesarean Section is delayed, the sequelae include development of OF. Once a woman develops an OF, she faces a myriad of challenges
including self and social stigma, gross impairment of their capacity to function in society and medical consequences of OF. Some find little support from family or society because of lack of awareness about OF, its cause and treatment. Access to OF care is challenging due to few facilities that have expertise to provide the highly specialised surgical repair services. Moreover, even after surgical repair, there is need for reintegration into society through dealing with psychosocial and economic rehabilitation. OF is both preventable and treatable, but women experience delays in seeking repair due to a number of barriers affecting access to fistula repair, including information and awareness, psychological barrier, physical and geographical barriers, socio-economic and cultural barriers and facility shortages.
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Bathing Every Day Increases Risk of Infections- Experts Warn Bathing every day could increase people's risk of infections, experts warn.
body odour.
Dr Brandon Mitchell, assistant professor of dermatology at George According to infectiousWashington University, disease expert Dr Elaine adds that washing strips Larson from Columbia the skin of its natural oils, University, showering excessively can reduce skin which can disrupt 'good' bacteria that supports hydration, causing it to people's immune systems. become dry and cracked, which allows germs to According to Dr Mitchell, enter. bathing just once or twice a She adds that most people week is usually sufficient for most, adding, “A daily bathe in the belief it will reduce their risk of illness, shower isn't necessary.” however, it actually does MOST PEOPLE OVERlittle more than remove BATHE Dr Mitchell told TIME: “Your body is naturally a welloiled machine. I think most people over-bathe.” He urges people who wish to shower daily to only do so if their skin feels healthy and hydrated. Dr Mitchell also recommends people do not lather their entire bodies with soap but just focus on smelly areas, such as their armpits or feet. He even adds those with dry hair only need to wash 8
it every few weeks, while people with scalp issues, like dandruff, may beneďŹ t from shampooing a couple of times a week. Dr Larson says people should focus on washing their hands frequently, as well as cleaning their clothes, which collect dead skin cells, to reduce their risk of illness. Cleaning destroys 'good' bacteria that support immune systems. A study released in January last year suggested over-cleaning can damage the healthy bacteria, viruses and other 'bugs' that live in and on
people's bodies. Researchers from the University of Utah analysed the residents of a remote village in the Amazon. Results suggest such people have the highest diversity of bacteria and genetic functions ever reported in a human group. The scientists concluded westerners are overly clean, which affects their populations of microbes. They did not comment on how often people should be bathing. -Daily Mail
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Breast Cancer Treatment Doesn't Raise Risk of Heart Disease – Study But a study of almost 350,000 women has found breast cancer patients given chemotherapy and radiation treatment have no greater risk of death from There have long been fears heart disease than the general population. about heart cells being damaged by the toxic drugs It may be that treatment used to blast breast cancer has become more precise, so that heart cells are less tumours. likely to be damaged by Radiotherapy to the left breast cancer. breast is a particular concern as this is the same It also might be that side of the body as the medics have simply heart. become more aware of the threat than before and carry out more screenings for heart problems in breast cancer patients. Breast cancer patients have no greater risk of dying of heart disease following chemotherapy and radiotherapy.
“Patients do not need to be worried about deadly heart diseases,” the study's coauthor, Dr Hermann Brenner from the German Cancer Research Centre, said, “We consider the result of our study to be very positive for the treatment of breast cancer.” “It is particularly good news for the large number of affected patients that if 10
they are in good medical care and have survived breast cancer, they do not need to be more worried about deadly heart diseases than women at the same age without breast cancer.” The largest study of its kind evaluated data from women who were diagnosed with breast cancer between 2000 and 2011 in the US, and subsequently received treatment by radiotherapy or chemotherapy. For both treatments, they found no increase in the risk of death from heart disease. There are more than 55,000 cases of breast cancer in Britain every year, with one in eight women diagnosed during their lifetime. No connection between breast cancer and heart disease. Philippa Hobson, senior cardiac nurse at the British Heart Foundation, said, “Historically, high doses of some chemotherapy drugs used to treat women with breast cancer were associated with increased production of an enzyme that is related to causing
heart failure.” She added: “Prior to their breast cancer diagnosis, some women may already have undiagnosed coronary heart disease, increasing their risk of a heart attack and subsequent heart failure.” “In the past it may have appeared that there was a connection between the treatments for breast cancer and heart disease, however it is reassuring to discover that this is not the case.” A number of clinical trials have suggested that both chemotherapy and radiotherapy are linked to a higher risk of suffering heart disease. Little had been known about the risks of dying from heart disease. The study's lead author, Janick Weberpals, from the German Cancer Research Centre, said, “At first we were also surprised by this result. But we assume that our study paints a more realistic picture of the actual situation of treatment than clinical trials.” -Daily Mail
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Breathe of Relief for Patients as MTRH Oxygen Plant Resumes Operations MTRH is the first Hospital to install 250 AMB Ecosteryl Microwave Clinical Waste Management equipment in East and Central Africa. The new technology will improve the efficiency of clinical waste management that is in line with global best available technologies and best environmental practices.
Moi Teaching and Referral Hospital [MTRH] is the first Hospital to install 250 AMB Ecosteryl Microwave Clinical Waste Management equipment in East and Central Africa. The new technology will improve the efficiency of clinical waste management that is in line with global best available technologies and best environmental practices.
saying that the oxygen plant had no fault but was just shut down after facing legal issues with the Onsite Gas Company from South Africa that was servicing the plant.
The plant roared back to life on 2nd January, 2018. The plant was assembled by On-site Gas Company from South Africa and was commissioned by the then Minister for Medical Services, Prof. Peter The oxygen plant at the Anyang Nyong'o, on 30th MTRH has resumed April, 2008 at a cost of operations, after being non- functional for a couple KSh83 million. of years. The hospital's Chief Executive Officer, Dr. The resumption of operations means that the Wilson Aruasa is quoted oxygen plant will be able to supply oxygen, through the piping system- which is already in place, to all the wards in the hospital. Theatre, New Born Unit (NBU) and Intensive Care Unit (ICU) are served by liquid oxygen from the oxygen tank. The pipelines are used to supply highly concentrated oxygen to intermediate cylinders placed at various
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locations. These cylinders would be transported to end-users. The system would help the hospital save significant amount of money every month, said Aruasa. The teaching and referral hospital has been spending millions yearly on oxygen bought from outside to save lives because its oxygen production plant was shut down. Further, it will also improve on convenience and stability of the oxygen supply in the hospital. Majority of county hospitals in Kenya buy or filter their own oxygen because it's expensive to set up a plant. Many of the most vulnerable patients in low- and middleincome countries— including new-borns, children, and pregnant women—do not receive the oxygen therapy that could save their lives. Medical oxygen is used to aid breathing for patients with respiratory challenges, especially in theatre, obstetrics, and intensive care units. It is also used to treat ailments like pneumonia. At the global level, in 2012 WHO, the United Nations Population Fund, and the United Nations Children's Fund included oxygen as one of the 20 most effective interventions for preventing deaths among new-borns, children, and pregnant women in their “Priority life-
saving medicines for women and children” list. In addition, WHO has published recommendations and guidelines for integrating oxygen delivery at various levels of the health system. MTRH tendered for servicing of the plant last year (August 2017). Atlas Copco, an international firm dealing with innovative sustainable solutions that create value for customers in more than 180 countries, won the tender.
The Microwave Clinical Waste Management Plant Project is a Belgium Government funded project through the Ministry of Health. The adoption of the new technology will not only improve the management of clinical waste in the hospital but will also support waste management from other medical facilities in Eldoret.
The company has expertise in compressors, vacuum solutions and air treatment systems, construction and mining equipment, power tools and assembly systems. The MTRH is recognized as a referral hospital serving the residents of upper Rift Valley and Western parts of Kenya; it has been reclassified by the Ministry of Health as a Level 6 referral hospital. A spot check by Health Business Magazine indicated that the hospital has been experiencing increase in patient numbers in the recent past and in order to sustain the increase, several expansion activities such as new facilities should be put up. Meanwhile, the hospital has adopted a Sh100 million new modern clinical waste management technology that uses microwaving to sterilize medical waste. 13
Conference Themed “Meeting Kenya's Universal Health Challenge” Ongoing in Makueni Health stakeholders from across the country are gathered in Makueni for a two day conference on Universal Health Care. The conference whose theme is “Meeting Kenya's Universal Health Challenge” was officially opened by the Makueni Governor, Hon. Kivutha Kibwana on Wednesday.
While welcoming guests to Makueni County, the governor gave a report on the development his county has made towards universal health care over the last five years. “I want to welcome you all to Makueni County, we pride ourselves in being the capital of Universal Health Care and over the next two days we hope to share the knowledge we have with you.” “Ever since we set the goal to achieve Universal Health Care in 2013, we have made some great strides, right now every household in Makueni has access to affordable health care. 33% of our budget currently goes to the health sector, we have built the Makueni trauma center and will be opened soon and the Makueni Maternal Health care hospital,” he added. Former Director General Vision 2030 and current
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Principal Secretary Ministry of planning Dr. Julius Muia emphasized on the importance Universal Health Care, in achieving Vision 2030. “Vision 2030 aims to make Kenya a globally competitive and ensure that Kenyans lead a high quality life. This cannot be achieved without a healthy people that is why the health sector sits under the social pillar of Vision 2030.” “According to a recent survey, health has been one of the better performing sectors under Vision 2030, we have so far achieved 56% of our goal, with notable improvements in combating Malaria,” Dr. Muia stated. Other speakers who spoke on the first day include Dr. Githinji Gitahi group CEO, Amref Health Africa, Professor Khama Rogo, Lead specialist at
the World Bank and Dr. Charles Kandie, head, department of health standards quality assurance and regulations, Ministry of Health. Among some of the topics discussed on the opening day were; Implementing the National Human Resource for Health Policy, Implementing the Kenya Quality Model of Health and Tracking Performance in Health Services.
The 2018 Universal Health Care Conference is an Initiative of the Ministry of Health, County Government of Makueni, Vision 2030 and Amref Health Africa.
The second day will saw the stakeholders tackle; Indicators for Measuring Health System Governance, Financing Universal Health and conclude with formulating a framework for action. The conference was closed by His Excellency Governor Turkana County, Koli Nanok and the Cabinet Secretary for Health, Mrs. Sicily Kariuki.
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Delivering Together for Healthy Empowered Women, Children and Adolescents – UN General Assembly (UNGA) 2017 In Line with PSHP Kenya project that is managed by KHF and UNFPA, the session on 20th September 2017 at the Every Woman Every Child Hub deliberated on what it takes to deliver on an integrated agenda for women, children and adolescents to achieve healthier, more prosperous and peaceful societies
KHF was on the 20th September 2017 represented by the Chairman Dr Amit Thakker at the 72nd Regular Session of the UN General Assembly (UNGA 72). The meeting which convened at UN Headquarters in New York had the general debate opened on 19 September 2017 and focused on the theme, 'Focusing on People: Striving for Peace and a
Decent Life for All on a Sustainable Planet'. . The session which was moderated by Ms. Tikhala Itaye: President Afri YAN was attended by H.E Ms. Ana Helena Chacon Echeverria: Vice president of Costa Rica, Mr. Michel Sidibe: Executive Director UNAIDS, H.E Hala Bsaisu Lattouf: Minister of Social Development Jordan, Mr. Elhadj As Sy: Secretary – General IFRC, Mr. Wade Warren: Acting Deputy Administrator USAID and Dr Amit Thakker, Chairman Kenya Healthcare Federation. Dr Amit on behalf of PSHP- Kenya announced a new private sector member, Unilever and a new masterplan during this event.
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Does Vaginal Seeding Boost Health? Should Caesarean-section babies be smeared with a sample of their mother's vaginal fluids as soon as they are born?
respond are to those first few bacteria,” says Prof Peter Brocklehurst, from the University of Birmingham.
The idea is to give these new-borns something they missed when they emerged into the world – the good bacteria that live in their mother's vagina.
“That we believe is important for, in some way, setting the baby's immune system. There is a noticeable difference between the microbiomes – the collection of bacteria, viruses, fungi and archaea – of babies born vaginally and by Caesarean section.” It lasts for about the first year of life.
A swab is taken of mum's vaginal fluid, which is then rubbed on to her child's skin and mouth. The hope is that this microbial gift will boost their child's long-term health – particularly by reducing their risk of immune disorders. It is a crucial time. We might have been sterile in the womb, but in our first few moments of life an invisible bond is being established between baby and bacteria. It's a relationship that will last a lifetime, and the first contact is as important as a first date. “The first time a baby's own immune system has to
“Vaginal seeding” is not mainstream medicine, but it is growing in popularity.
A baby born vaginally is first exposed and colonised by microbes from their mother's vagina and gut. “But for Caesarean-section babies, the first exposure if they're lucky”, says Prof Brocklehurst, “comes from the very different organisms on their mother's skin”. He is running the Baby Biome Study to see if these different microbial colonists on Caesareansection babies explain why they have higher rates of diseases such as asthma and allergies later in life. BBC 17
Drugs Agency Kemsa Denies Responsibility for Expired Medicine The Kenya Medical Supplies Agency has denied responsibility for the expired drugs and other medical supplies seized in Nairobi last month.
“From the list of seized items, Kemsa did not issue medicines, drugs or pharmaceuticals,” said Mr Wanyonyi in a statement Wednesday evening.
The seizure of the expired drugs sparked fears of unsafe medication in the market.
He said the gloves and the x-ray films were given out to assist Enzaro and Inyali health centres in Vihiga County as part of Kemsa's corporate social responsibility. The Kemsa boss also attached documents he said were proof to the institution that the organisation was going to conduct the medical camp through a health facility.
Fredrick Wanyonyi, the agency's acting chief executive officer, said only two of the 40 items impounded at a house in Parklands on February 20 belong to Kemsa. The two were latex gloves and x-ray films valued at a combined Sh288,295.
When the police and staff from the Pharmacy and Poison's Board raided the home in Parklands where the medical supplies were found, they also found machines they suspect were used to change the expiry dates on the drugs. This suggested to investigators that some of the drugs' origins and expiry dates could have been changed.
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At Parklands, the police and the PPB officials also found a letter addressed to the Kemsa CEO from South Maragoli Youths Development authorising one Gilbert Mboya to collect short expiry drugs from Kemsa for a medical camp. Mr Wanyonyi said that Mr Mboya is believed to be the mastermind of the crime and police are still looking for him.
was arraigned on March 23 and is currently in custody at the Industrial Area Remand and Allocation Prison in Nairobi. Kemsa is Thursday morning scheduled to meet the Senate's Committee on Health in relation to related issues and reports from the Office of the Auditor-General that they had Sh352 million worth of expired drugs in their stores last financial year. -Business Daily
The suspect believed to be working with Mr Mboya
Experts Raise Alarm on Rising Cases of Heart Diseases in Kenya Cardiovascular diseases affect one in every four Kenyans as undiagnosed and untreated hypertension, a major contributing risk factor for increased cardiovascular diseases, affects one in two Africans over the age of 25. This is highest rate of any continent in the world Healthy Heart Africa Programme, has said. Healthy Heart Africa is AstraZeneca's innovative
programme that tackles hypertension and increasing burden of cardiovascular disease (CVD) in Africa. According to Ashling Mulvaney, Senior Director, Healthy Heart Africa (HHA) Programme, screening for hypertension and blood pressure should be part of routine cardiovascular care in Kenya. “Non-communicable diseases are projected to be the most common 19
cause of death in Africa by 2030 and for most middle and low-income earners; treatment of conditions such as hypertension is expensive. Healthy Heart Africa works very closely with the Ministry of Health and other partners, to not only drive awareness of the dangers of high blood pressure, but also provide affordable and high-quality medication to patients diagnosed with hypertension,” Ashling said. HHA is working with local and global partners to raise awareness on lifestyle choice and cardiovascular diseases risk factors, train providers and drive care to lower levels of the healthcare system and facilitate access to low-cost but high quality branded
anti-hypertensive drugs. She also stressed HHA's commitment to provide accessible hypertension care across Kenya in 2018 by widening its reach to 40 counties, up from the current 27 in Kenya. Latest data from Ministry of Health Stepwise survey 2015, the first nationwide survey on noncommunicable diseases, revealed low awareness of heart health amongst Kenyans. The survey found that 23.8 per cent of Kenyans had raised blood pressure, yet 56 per cent had never been screened for it. Since its launch in Kenya in 2014, HHA has conducted over 5.3 million blood pressure screenings in community and healthcare facilities and identified over 1 million people living with high blood pressure. It has also trained over 4,000 healthcare workers as well as activated over 660 healthcare facilities. Recently HHA signed a Memorandum of Understanding (MoU) with the Kenya Medical Supplies Authority (KEMSA) to have HHA's medicines made available to participating public health facilities, which will enable broader access to treatment.
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AstraZeneca's HHA was launched in collaboration with the Ministry of Health in a bid combat Non-Communicable Diseases (NCDs). NCDs have been on the rise in Sub-Saharan Africa, partly due to lifestyle across age groups, posing a challenge to the already overstretched health facilities in Kenya. According to Dr. Ephantus Maree, deputy Head of the Non-communicable Diseases Unit, Ministry of Health, and Noncommunicable diseases are yet to receive the attention they require yet they have surpassed communicable diseases in terms of morbidity and mortality rates. “The partnership Ministry of Health has with Healthy Heart Africa has been a rich source of learning for us and uncountable gain for Kenyan citizens,� said Dr. Maree. Kenya's Health Policy 2012-2030 calls for the halting and reversing of the rising burden of Non-Communicable Diseases. HHA aspires to reach 10 million people with high blood pressure in Africa
in support of the World Health Organisation's (WHO) global hypertension target of a 25 per cent reduction in the prevalence of raised blood pressure by 2025. Last year, HHA also entered into a partnership with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to improve access to testing and treatment for people with hypertension and HIV/AIDS. Following a pilot programme in Western Kenya, the PEPFAR-HHA partnership is leveraging PEPFAR's existing HIV infrastructure in HomaBay and Kisumu and working with the Kenyan Ministry of Health.
The HHA partnership in Ethiopia is designed to provide the same elements that have been successful in Kenya while ensuring appropriate adaptation to meet the needs of the Ethiopian healthcare system by capitalising on the Government's Health Extension Programme to bring care closer to the community.
HHA expanded into Ethiopia in 2016 facilitated by the partnership formed with the national Federal Ministry of Health; this aimed to integrate HHA programming into the local healthcare system in support of the Government of Ethiopia's National Strategic Action Plan for NonCommunicable Diseases. 21
Government to Establish Eye and Dental Centres in Referral Hospitals- President Kenyatta says (PSCU) – President Uhuru Kenyatta during the event said that the government will allocate funds to establish ultra-modern Eye and Dental facilities in referral hospitals, which must be built within 12 months. He warned again that the days of wastage of resources was over, and put CS Health Sicily Kariuki and her team on notice. He said the Government will set aside Sh 300 million for each referral hospital including Kenyatta National Hospital, Moi Teaching and Referral Hospital, Nyeri and
Mombasa hospitals. The President spoke at Tenwek Hospital grounds after unveiling a Sh 275 million ultra-modern Eye and Dental Centre put up with the assistance of donors. The new centre has a capacity to handle 20,000 clients and conduct 5,000 surgeries annually. “I have seen what less than Sh 300 million can do to uplift the lives of Kenyans. I want to see similar facilities at Kenyatta National Hospital, Moi Teaching and Referral Hospital, Nyeri and Mombasa,” said President Kenyatta. The Head of State said he had learnt a great lesson from the Tenwek hospital example which his government is ready to transfer and replicate elsewhere. “I have picked several lessons here. You will not be able to blind me again,” he told top officials from
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the health Ministry led by the Cabinet Secretary. He said he could not see any reason as to why the government, with all its huge resources, could not achieve similar successes like Tenwek with its meagre resources. The President therefore said the National Government, in partnership with County governments will work towards achieving its key agenda of Universal Health care – a crucial pillar in the Big Four Agenda. The President, who was accompanied by Deputy President William Ruto, put on notice government officials who use their positions to enrich themselves. “Those who thought they had blinded me should now know they are on notice,” said President Kenyatta adding that top Government officials starting with Cabinet Secretaries and their Principal Secretaries should be fully accountable of their dockets. He said he will no longer be deceived by dishonest activities and manoeuvring by those entrusted to run public institutions. The 81-year old Tenwek Hospital which started as a dispensary in 1937 is under the management of the Africa Gospel Church of Kenya (AGCK). President Kenyatta congratulated the management of the institution and health experts who have
enabled Tenwek Hospital put up the new Eye and Dental centre adding that, if need be, their expertise might be called in when and where need arises. “We as the government support this great work. We appreciate the great work you have done here,” said President Kenyatta who announced a Sh 20 million government donation to the hospital to repair its Kitchen and other facilities which were recently destroyed by fire. He also donated a school bus to the Tenwek High school. President Kenyatta praised Bomet Governor, Dr. Joyce Laboso for nurturing a working unity of purpose to develop the agriculturally rich county. “The transformation of Kenya will not happen if we do not mobilize every resource and every sector- the Nongovernmental Organization, religious organizations and the public sector, so that we can push the transformation of our country under the agenda four items that you have identified as the President of Kenya,” said the DP. The Deputy President also said that every sector will be mobilized to cement President Kenyatta's legacy of transformation. Bomet Governor Joyce Laboso pledged to help President Kenyatta achieve the Big Four agenda by working closely with the National Government.
“The transformation of Kenya will not happen if we do not mobilize every resource and every sector- the Nongovernmental Organization, religious organizations and the public sector, so that we can push the transformation of our country under the agenda four items that you have identified as the President of Kenya,” said the DP.
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Healthcare in Kenya Kenya, a former British colony which was named after the second highest mountain in Africa, gained its independence in 1963. Today, Kenya is a leading travel destination due to its scenery, magnificent wildlife and high yearround temperatures.
managed by the nurse are referred to the health centres.
Sub-district, district and provincial hospitals provide secondary care, i.e. integrated curative and rehabilitative care. Subdistrict hospitals are similar to health centres Kenyan Healthcare system with the addition of a surgery unit for Caesarean at a glance sections and other Basic primary care is procedures. District provided at primary hospitals usually have the healthcare centres and dispensaries. Dispensaries resources to provide comprehensive medical are run and managed by and surgical services. enrolled and registered nurses who are supervised Provincial hospitals are by the nursing officer at the regional centres which provide specialised care respective health centre. including intensive care, life They provide outpatient support and specialist services for simple consultations. ailments such as the common cold and flu, uncomplicated malaria and The Central Province and Nairobi have the best skin conditions. Those healthcare facilities, patients who cannot be whereas the North-Eastern Province is the most underdeveloped. Standard of hospital care in Kenya The Kenyan health system consists of three main categories of service providers. Public providers, Private not-for-profit organisations (including faith-based and mission hospitals, local and international NGOs) and 24
Private for-proďŹ t health care providers. Public health services are organised across 8 provinces, in 6 levels of care: Community health units, Dispensaries, Health centres, District hospitals, Provincial referral hospitals, and National Tertiary hospitals. Public health care providers serve the majority of the population, and are focussed on addressing public health disease burden. The government operates 41% of health facilities, NGOs run 15%. The Private sector operates 43% of health centres, and is becoming more prominent. Private clinics of varying complexity exist in most major urban centres, including the coastal beach resort towns. Private hospitals for inpatient care exist mainly in Nairobi, with a few options in Mombasa. Hospitals Most health care facilities in Kenya are below international standards with limited resources, and limited capabilities. Public hospitals are understaffed, poorly
equipped and lack supplies. Private clinics with limited inpatient capability are in operation in Nairobi, Mombasa, and the beach resort areas of Diani and Malindi. These services include radiology, laboratory and pharmacy services. The private AGA Khan hospital, located in Nairobi, is operating at western standard level of care. Malaria and vaccinations Travellers who come from countries where Yellow Fever is prevalent are required to carry certiďŹ cates of vaccination against Yellow Fever in order to enter the country. According to the WHO, malaria is a risk which exists throughout the whole country, all year round. You should consult your doctor about antimalarial prophylaxis and obtaining additional vaccinations for polio, typhoid and hepatitis, prior to travel. Quote available upon request for International individual health insurance or corporate international health insurance. 25
Healthcare system in Kenya and the milestones While access to quality health care is a constitutional right, millions of Kenyans are denied access to quality health care due to various reasons such as, affordability, geographical barriers, shortage of health care providers among others.
and (c) The Private Commercial (“for-profit”) which include; health care facilities, medical distributors / supplies, ICT in health, health management advisory and training institutions.
A major concern in the health sector is the infant mortality rates. According The structure of the Kenyan to the World Health Health Care system can be Organization, the infant mortality rate stands at divided into three sub48%, a number that is very sectors namely; (a) The high considering the Public Sector; which changes that have taken includes government place in medicine's history. health facilities, medical The number is experienced schools and the public due to several causes pharmaceutical chain called KEMSA, (b) The Non- including; malaria, Commercial Private Sector; respiratory infection, FBOs, NGOs which include malnutrition due to high levels of poverty, diarrhoea mission health facilities, medical schools and MEDs causing diseases, HIV/AIDS, and TB. To reduce the under-five mortality rates, sensitization programs have been put into place by private companies and other organisations such as the Kenya Red Cross to sensitize people on the importance of hand washing in the prevention of diseases, and also raising funds to help those that have a chance of recovering such as 'Help a 26
child reach five campaign'. Besides infant mortality, several cases of maternal mortality are also on the rise where women lose their lives during child birth. This is highly associated with the fact that most women especially in the rural areas still make use of traditional birth attendants mainly due to inaccessibility to medical services or preference on traditional birth attendants as compared to skilled birth attendants. Some myths and religious beliefs are no exception. Hospitals and clinics are located far as per the recommended 5 km radius within reach from their homes forcing most of them to skip clinic days as required, therefore, relying on midwives. Lack of skilled attendance at birth, delayed treatment, and high costs incurred at hospitals are also key contributors to maternity mortality.
maternity mortality cases. Such measures include; the presidential directive on free maternity services to women giving birth in public hospitals since June 2013, mobile clinics specifically designed to reach women in areas where clinics are hard to access (beyond zero), campaigns that aim in educating women on the importance of prenatal care, improved infrastructure and equipment in hospitals and increased number of health care givers. The government abolished user fees in public sector at the dispensaries and health centres levels for specific groups i.e. children less than five years of age, are lagging behind in terms of health care development and yet it is the goal of the government to change this since the Constitution of Kenya was promulgated paving way for devolution. It is evident therefore, that geographical disparities in health care access in Kenya are very high.
Additionally, there has been enhanced sensitization on the need to sleep under insecticides treated mosquito nets and improved treatment on malaria infected cases to help reduce cases of infant deaths.
The government of Kenya has however put in place In conclusion, there has been tremendous measures that will improvement in the greatly reduce the 27
health sector where for instance, most people have taken up insurance covers after several campaigns and introduction of affordable rates across all classes of people, mostly convenient is the NHIF medical cover. The rate of HIV/AIDS infections has also gone down to 6.7% as compared to 10% in the 1990s. This was made possible due to awareness on how to prevent acquiring the virus, provision of free condoms and behaviour
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change communication amongst the youth, availability of medical care to those who are prone to getting infected, and sensitization on the importance of living positively amongst PLWHIV. Besides, there has been an increase in numbers of dispensing clinics to prevent congestion in referral hospitals. The government has also increased its total expenditure on the health sector to up to 30%. More workers and medicine has been acquired. The government has also provided funding to compensate the facilities for the revenue loss from the limited user fee income. Health care workers from various cadres have been expressing their grievances and demands in form of nationwide strikes, as witnessed in the recent past. Among these demands include; improved working conditions, conducive working environment, accessibility to hospital equipment and adequate health care workers. The grievances are inclusive of the following; poor remuneration, acute shortage of drugs and skilled workers and inadequate supplies which lead to poor service delivery.
Herbal expert welcomes KU Regional Reference Research Centre NAIROBI, KENYA A Chinese medical researcher Prof.Tian Shengxun specializing in herbal medicine has hailed the setting up of the first regional National Reference Research Centre for herbal medicine at Kenyatta University. “I hope the centre will enhance research especially in herbal medicine since the combination of herbal and conventional medicine has helped China and other Asian nations, to significantly reduce the spread of diseases like HIV Aids and other viral infectious diseases. I think it's time for Africa to embrace this strategy to help in the reduction of the Aids pandemic in the continent,” explained Prof Shengxun, who teaches at China's Henan University of Traditional Chinese Medicine.
cut down the replication of HIV virus. TIB is manufactured through modern technology as proper compounds extracted from more than 30 different Chinese herbs and can reverse opportunistic infections linked to lower immunity or HIV/AIDS.
TIB is manufactured through modern technology as proper compounds extracted from more than 30 different Chinese herbs and can reverse opportunistic infections linked to lower immunity or HIV/AIDS.
He said the centre will offer herbal medicine researchers an opportunity to document and apply traditional knowledge and skills in the war against the Aids virus among other ailments.
The Chinese don is renowned for the invention of Tian Immunity Booster (TIB) that has the ability to 29
The KU Centre will be used by its researchers and those from other national and regional institutions involved in phytotherapy, a science-based practice distinguished from other more traditional approaches such as medical herbalism. It is often linked to traditional knowledge. KU Vice-Chancellor, Prof. Paul Wainaina explained that with the facility, KU aims at entrenching the role of Science, Technology and Innovation (STI) in the East Africa region for social and economic development.
receive equipment to start running by August this year. The centre will be coordinated by Prof. Nicholas Gikonyo of KU whose area of specialization is pharmacognosy and traditional medicine. It is expected to build a vibrant natural health products industry through development and utilisation of an interface between indigenous knowledge and modern science. It will support one of the four pillars of President Uhuru Kenyatta's plan covering the health sector.
Key areas will include documentation, proďŹ ling Prof. Wainaina said establishment of the centre and securing indigenous knowledge, technologies will also address part of Kenya's Vision 2030 Goal on and associated biological resources, scientiďŹ c testing Commercialization of and validation. This is Research and expected to yield locally Development. derived natural health products. The new Centre project targets natural health products and is expected to
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Hundreds of fistula patients set to benefit as Flying Doctors raise Sh4.6 million The Flying Doctors Society of Africa (FDSA) has raised Sh4.6 million to go to free fistula treatment. The society yesterday recognised businessman, Manu Chandaria and his wife Aruna Chandaria, who donated KSh.850, 000 to go towards treatment of 17 fistula patients. A single fistula surgery costs between KSh.50, 000 and KSh. 65,000. Fistula is an injury caused by long and obstructed labour, involuntary control over urination or defecation among some women after delivery. While the condition is treatable, thousands of women suffer it in silence due poverty, lack of correct information about the condition or poor access to
treatment. "Fistula mostly affects women in the northern part of Kenya, because communities around there practice early marriages and female genital mutilation, resulting in complications for women during childbirth," said Dr Eunice Kiereini, chairperson of Flying Doctors Society of Africa. She said fistula cases in the region were amplified by limited medical access. According to the United Nations Population Fund (UNFPA), at least 3,000 new cases of fistula are reported in Kenya annually, with only 7.5 per cent able to access treatment.
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It is not always rosy for Cuban doctors on mission in developed countries As the arrival date of 100 specialised doctors from Cuba edges closer, questions abound about their fields of specialty, their stations of duty and remuneration. Some leaders are also questioning preparedness of counties to receive the Cuban doctors. Even as the Senate's Health Committee visits Cuba this week to make final touches on the deal, a member, Nyamira Senator, Okong'o O'Mogeni, questioned the infrastructure the Cubans will use once they land. Despite the lingering questions, sources in Cuba confirm that the doctors are now ready, waiting to be dispatched. Many doctors opt to participate in the missions as they are an upgrade from the Sh6, 000 monthly salary they receive in Cuba. More than 37,000 Cuban nationals are currently working in 77 countries in overseas medical missions. They earn their country close to Sh800 billion annually. Not rosy affair 32
The exchange has however not been rosy for all the doctors involved. Last year, at least 150 Cuban doctors working in Brazil filed lawsuits to challenge the arrangement. In what they termed a form of slave trade, the doctors went to court demanding to be treated as independent contractors, not agents of the Cuban state. It all started when the three-year contract given to Dr Anis Deli Grana de Carvalho ended. She had fallen in love with a Brazilian man, and wanted to stay. Cuba wanted her back. The doctor shared her frustration with a Brazilian clergy man who connected her with a lawyer. She sued in a bid to work as an independent contractor. Other doctors followed suit. Most lost, some won. The Brazilian government has appealed. It is not clear what the Cuban doctors will be paid in Kenya, or where they will be placed.
Kenya doesn't have flu vaccine policy: Why it needs one for babies Each year the World Health Organisation [WHO] gathers data on influenza strains and recommends which strains countries should include in formulating vaccines for the next year. Many countries around the world administer these vaccines because the influenza virus – known as the flu virus – is a significant contributor to respiratory illness.
quarter of Kenyan patients who seek medical care for respiratory symptoms have the flu virus in their systems. The reason there isn't a programme is because, until recently, there were no updated figures on the national burden of flu across age groups in Kenya. In addition, for many years data was only collected at a regional level. And when national data was available, it was
In Africa only a few countries issue the vaccine annually; Ivory Coast, Egypt, Libya, Mauritius, Tunisia and South Africa. Kenya is one of the countries on the continent that doesn't have a flu vaccination programme. The vaccine is available in the private sector but isn't affordable for most Kenyans. Because there is no national programme, children also don't receive it as part of their regular immunisation schedule in public hospitals. This is despite the fact that a 33
collected when there was a flu pandemic in the country in 2009. The data from this period was not helpful for policymakers to establish what the national burden of seasonal flu would be in a period when there wasn't a pandemic.
associated with 50 000 cases where people were severely ill, and about 10 000 admissions each year across the country.
We were able to draw several conclusions from our study. Firstly, the risk of children being admitted to hospital varied with age. We set out to get the first Children under the age of breakdown of Kenya's flu burden on a national scale five were 17 times more after the 2009 flu pandemic likely to be admitted with flu than older children and period, to inform the decision to approve and roll adults. Among children, those under the age of two out an effective seasonal were most likely to get sick flu vaccine programme. from the flu. Based on our findings we The rates of severe flu were conclude that children also high in elderly people under the age of two and primary school should be prioritised for children between the ages vaccination. of five and 14. But this was Understanding the burden not to the same degree as babies. We obtained data from health facilities across the country that are part of the Secondly, there were differences in the rates of national influenza disease across regions in surveillance programme. We collected samples from Kenya. The Rift Valley about 10 000 patients with region, for example, a cough and fever who were recorded the highest rates admitted to either Kenyatta of people who were admitted to hospital for flu National Hospital or five related symptoms. Nairobi county referral hospitals between January 2012 and recorded the lowest. December 2014. The These variations indicate samples were tested to confirm the presence of the that there are differences in risk factors for severe virus. respiratory illness between regions in Kenya. These The virus was found in 9% include the prevalence of of the patients who were malnutrition, overcrowding tested. We found flu was 34
within homes, and nonexclusive breastfeeding in children, household pollution and HIV. The North Eastern region of the country had the highest rates of severely sick people who had not been hospitalised for their illness. What this reveals is that people in this region were unable to access health facilities as easily as their counterparts in the rest of the country. Flu vaccination Kenya's warm climate means that it's not naturally considered to have a flu problem. Flu has usually been shown to be of concern in more temperate climates where there are clear summer and winter seasons. But our statistics reveal that Kenya has a higher rate of disease than many other countries which have a temperate climate where we would expect the burden of disease to be higher. If a flu vaccine is to be introduced in Kenya it would have to be administered annually. The vaccine's effectiveness each year would depend on how well the vaccine strain matches
the circulating flu strains. To address these fluctuations, the vaccine development world is looking into the viability of a universal flu vaccine. This would be effective against all circulating flu strains. The universal vaccine would require vaccination either once in a lifetime or once every few years depending on how long the protection lasts. In the Kenyan setting there are several considerations policymakers need to think about when deciding whether or not to introduce a vaccine programme. This includes evaluating whether it would be cost-effective in the country, what the staffing and cold chain requirements would be and how best it would be incorporated in the current immunisation schedule. In the meantime, our study provides the Kenyan government with the impetus it needs to seriously start considering this annual vaccination programme, particularly for young children. By Jeanette Dawa, Researcher, University of Nairobi. 35
Kenya takes the lead in tackling Neglected Tropical Diseases By Lilian Okwili Kenya has improved in the fight against Neglected Tropical Diseases (NTDs) that have affected many people due to negligence. This has been achieved by the Ministry of Health working together with the Kenya Medical Research Institute (KEMRI) and other partners. Director of Medical Services Dr Jackson Kioko has affirmed the ministry's commitment towards control of neglected tropical diseases by increasing financial support. NTDs are a diverse group of about 20 communicable diseases in tropical and sub-tropical regions affecting billions of people and about 130 countries, Kenya being one of them.
“In addition to the immense support that our NTD programme receives from donors, partners, the ministry has trained staff and equipped regional laboratories deliberately to build capacity in terms if mapping of NTDs and monitoring interventions. This year, Kenya is about to be declared guinea worm free and to this end the government has led from the front in conducting a high level Guinea worm campaign” said Dr Kioko. The theme of the conference is partnership towards the achievement of global goals for control, elimination, and eradication of neglected tropical diseases. “The second strategic plan for control of NTDs 2016-2020 outlines the approaches with which control and elimination of all NTDs of public health due to poverty, lack of safe water, proper sanitation and housing.” He added. He also said that building on the past successes, the ministry aims to foster and
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build more partnerships through advocacy that is driven by the need for a strong coordination mechanism resulting in a well-integrated NTD programme. The NTD was established in the ministry to spearhead the resource mobilization and lavage on cost cutting through a well- coordinated and intergraded efďŹ cient programme. He cited the school based deworming programme which is a big success story and has an estimated 80 per cent of all school age children receiving preventive chemotherapy every year. This has reduced school absenteeism by 25 per cent. Dr Kioko said that with the resultant soil transmitted helminthiasis (STH) prevalence among school age children the programme ought to think how to reach adult population whom studies have shown that they bear a big burden of the STH infection.
He further said that Filariasis control that was launched in 2015 is currently in the 3rd year of consistent implementation. More than 2.5 million people at risk of morbidity, disability and stigmatization are receiving drugs every year within the coast region. This has put well on course towards achieving the global goal of eliminating Lymphatic Filariasis by the year 2020.
“In order to inform policy formulation and change, there is need for extensive operational research for NTD control activities.
As we roll out the much needed interventions we appreciate the need for a robust monitoring and evaluation system which will be backed by an equal robust national and regional/ county surveillance mechanism. Am hoping that this will be the major focus of discussion in this conference because it is only with an effective monitoring and evaluation system in place that we can demonstrate achievement and of transmission breaking points,� said Dr Kioko.
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Losing teeth in middle age could raise your risk to heart disease Losing only one tooth during the study was not associated with a higher risk of the disease but those who already had fewer than 17 natural teeth at the beginning of the study were 25 per cent more likely to develop it.
Scientists have found that people who lose two or more teeth during middle age may be more likely to develop heart disease. A study of nearly 61,000 adults aged between 45 and 69 showed those who lost two or more teeth had a higher chance of developing coronary heart disease than those who didn't lose any teeth. Heart disease risk increased by almost a quarter among adults who had 25-32 natural teeth at the beginning of the study – most adults have 32 teeth – but lost two or more. Losing only one tooth
during the study was not associated with a higher risk of the disease but those who already had fewer than 17 natural teeth at the beginning of the study were 25 per cent more likely to develop it. People's risk had still increased after researchers took into account their diet, level of physical activity, body weight, hypertension and other risk factors. The researchers did not suggest how tooth loss and heart disease were linked, but experts have said in the past that bacteria could travel from infections in the mouth into the bloodstream and cause inammation in blood vessels, which is associated with heart disease. Coronary heart disease is a common killer in the UK and accounts for 22 per cent of all premature deaths, while in the US it kills 370,000 people every year. The Nurses' Health Study [NHS] says most cases are preventable. It is caused by a build-up of fatty deposits in the
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arteries, which restricts blood flow to the heart and can cause heart attacks. People at higher risk of developing coronary heart disease include smokers and those with high cholesterol, high blood pressure or diabetes. Links have been made between the condition and dental health in the past; tooth loss is a symptom of poor oral health and as this study suggests, an indicator of a higher risk of heart disease. The findings were presented at an American Heart Association event last month. Anyone who lost two or more teeth – regardless of how many they had at the start – had a 16 per cent higher risk, but the risk among those who had 25-32 teeth was 23 per cent higher than those who did not lose any teeth. Researcher Dr Lu Qi of Tulane University in New Orleans told Reuters: “In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in the recent past could be at increased risk for cardiovascular disease. “That's regardless of the number of natural teeth a person has as a middleaged adult, or whether they
have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure.” The study collected two sets of data beginning in 1986 and 1992, counting the number of teeth in women in the Nurses' Health Study (NHS) and men from the Health Professionals Follow-Up Study (HPFS), both in the United States.
Dr Russell Luepker, a spokesman for American Heart Association, suggested it was important to consider social factors as well.
All of the 60,967 participants were middle-aged – between 45 and 69 – at the start of the study and none of them had heart disease. “The relation between dental health such as tooth loss and cardiovascular risk remains unclear,” Dr Qi added. The research, which Dr Qi presented at the 2018 Epidemiology and Prevention, Lifestyle and Cardio metabolic Health Scientific Sessions in New Orleans in March, suggests that tooth loss was related to inflammation and bad changes to the diet, which could be indicators of a future cardiovascular risk increase. “We all get cavities and if you want to save teeth, you want to have good dental insurance and many people don't. So it's good to brush your teeth and it's good to have dental insurance,” he told Reuters. 39
Kenya, WHO Partner to Spearhead Attainment of Universal Healthcare The Ministry of Health is partnering with the World Health Organization [WHO] to spearhead the attainment of Universal Healthcare in the country.
Speaking ahead of the world health day to be marked on Saturday, Health Cabinet Secretary, Sicily Kariuki, said the government is keen on ensuring that all Kenyans are able to access quality healthcare. According to CS, Kariuki, Kenya, has already covered some milestones in offering free medical-care to its citizens starting with the introduction of free maternal healthcare to the establishment of health insurance subsidy program.
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