Healthcare System in Kenya

Table of Contents

Access and Use of Healthcare Facilities for Pregnant Women in Western Kenya

Introduction

Healthcare system in Kenya is organized systematically, from the lowest level to the uppermost level, in that cases, which are categorized as severe and complicated, are referred to a topmost facility. The system is full of gaps, which are filled by the church and private healthcare facilities. The levels are as follows, Dispensaries and private clinics; Health centers; Sub-county hospitals and nursing homes; County hospital; and National hospital. Dispensaries are the lowermost healthcare facilities that are run by the county government. In most cases, registered nurses are in charge of these facilities. Strictly, these facilities handle outpatient cases and manage a common condition that includes flu, cold, uncomplicated malaria, and dermatological cases. Health centers were initially under the national government before the devolution of the entire health sector in Kenya. These centers are controlled and managed by clinical officers. In most cases, these centers focus on preventive care. Sub-county hospitals, on the other hand, more or less have similar services like those offered under healthcare facilities. However, these facilities have additional services, conduction of Caesarian section and other healthcare services referred from healthcare facilities. Still, these facilities are managed by clinical officers and medical officer in charge who handle complex cases and Caesarian section. The next level of the healthcare system in Kenya is Nursing Homes. Religious groups and private individuals run these facilities. They provide services that are offered by sub-county or county hospitals. Sub-county healthcare facilities act as a referral facilities for smaller healthcare facilities. These facilities provide surgical and medical services, and they are controlled and managed by medical superintendents. Sub-county hospitals refer complex cases to County hospitals. County hospitals are situated in all 47 counties in Kenya. These facilities offer specialized healthcare that includes specialist consultations and life support and intensive care. The superior level of the healthcare facility in Kenya is the National hospitals. Unlike other healthcare facilities, National hospitals are under the National Government of Kenya. They are only two in number: The National Spinal Injury and Referral Hospital and Moi Teaching and Referral Hospital. Kenyatta National Hospital Is The Major Referral Hospital In The Country

Purpose Statement

Despite the fact that there lots of concern with Kenyan healthcare system, there are areas that are affected most compared to others. Furthermore, some conditions are more in some places compared to others. For instance, Malaria is endemic in most of the Country’s Western region. On the other hand, maternal healthcare is a challenge in Kenya. Challenges in access to the facilities and quality regarding maternal services offered in some regions. It is with reason that this paper focuses on the access and use of healthcare facilities for pregnant women in Kenya, mainly western Kenya.

Background and Context

The utilization of maternal health services remains a significant approach for the reduction of maternal mortality and morbidity particularly in regions where maternal health care remains poor. Generally, women succumb to childbirth-related complications. According to Kitui, Lewis, and Davey (2013), approximately 500 thousands women succumb daily because of maternal-related complications with 99 percent of the deaths occur in developing nations (UNICEF, 2014). However, the problem of minimizing these deaths remains difficult in Kenya. According to Kenya Demographic and Health Survey in 2003 pointed out that the ration of maternal deaths was at 444 per 100,000 live births. Many studies indicate that the most efficient way of minimizing the dangers of maternal mortality and morbidity is maternal healthcare services (Kitui et al., 2013). This is particularly in regions where the general maternal healthcare remains poor. Tremendous low mortality and morbidity can be seen when a woman continually attends antenatal clinics as delivers in registered healthcare facilities with professional healthcare providers. This is made possible since any dangers signs are detected early on during gravidity period and managed early before parturition.

Maternal information from KDHS points out that, even though the general ANC service is regarded much in Kenya, many women in Western Kenya attend this clinic in their third trimester (Downe et al. 2016). Furthermore, the women opt to deliver with the help of local birth attendants that are going to a professional healthcare provider. This is tied to some reasons that include efficiency in the accessibility of healthcare facilities and poverty. In 2003, KDHS recorded a decrease in the delivery with the use of professional healthcare providers and deteriorating use of ANC among women. The main intervention to ensure that there is safety in the maternity. The MDG’s and the International Conference on Population and Development (ICPD) have been in use globally in enhancing maternal healthcare and making sure that there is access to quality maternity services to diagnose and treat risky complications as well as minimize maternal mortality and morbidity (Kitui et al., 2013).

The 2010 Census in Kenya reported that teenagers who are about 36 percent of the entire Kenyan populace remain the fastest growing group (Desai et al., 2014). However, these persons encounter some challenges that include STI and HIV/AIDS, unemployment, abortions, early sex involvement, and unwanted pregnancies (Kitui et al., 2013). However, just like any other healthcare pointers, the problem of maternal mortality and morbidity remains high among young mothers, thus, risking them of having birth complications as well as ensuing death in pregnancy and parturition. Moreover, the religious and cultural biases as well daunt these groups of individuals from attending maternal healthcare clinics at the same time as some providers remain adamant to giving them the needed family planning intervention. This is mainly seen in the Western region of Kenya (Mason et al., 2015).

Notwithstanding the global concentration on the requirements for the enhancement of maternal healthcare, there is still maternal mortality and morbidity in Kenya and other developing nations. Maternal mortality and morbidity that arise from political, social, cultural and health disparities can be minimized by the use and provision of ANC and obstetric care. In general, about 80 percent of the maternal mortality rates are as a result of poor antenatal care and delivery. Some of the complications that occur are hemorrhage, infections, preeclampsia, and clandestine abortions. The remaining percentage is because of conditions like HIV/AIDS and malaria. Maternal mortality could be minimized by skilled birth attendants and proper healthcare facilities.

At the same time as the latest enhancements have indicated that the worldwide mortality rate has gone down by 47 percent by 2010, the present approximations suggest that the maternal death rate is still up in sub-Saharan Africa (World Health Organization, 2015). However, Kenya is the best example. The country signifies deficiency in improvement on this matter with maternal deaths being approximated at 488/100,000 in 2003 (Kasina, 2013). In Western region of the Country, these deaths are said to be high. The estimated deaths per live births are put a 740/100,000 by 2008 (Kasina, 2013). Importantly, this is higher than the estimated general country maternal mortalities.

At the moment, as demonstrated earlier, Kenya is made up of six levels of the healthcare system. However, the community healthcare unit is termed as the lowermost before dispensary. The three significant healthcare levels system is basically major in rehabilitation and treatment. The Country provides ANC for the entire pregnant and non-pregnant women who plan to give birth in future. This is intended for the provision of an integrated healthcare system that incorporates early diagnosis and intervention of risk and complications that may result in maternal death (Mason et al., 2015). ANC helps in the prevention of HIV and AIDS and cases of positive mothers; it helps to prevent transmission of HIV/AIDS to the child during delivery, Prevention of Mother to Child Transmission (PMTCT), treatment of underlining conditions that may complicate pregnancy and delivery process (syphilis, malaria, and anemia). In Kenya, these services are made free and recently with the current Jubilee administration, the government in its move to reduce maternal mortality rate, it has made all maternity services free for all mother who attends public healthcare facilities. This was a plus considering that people in western Kenya and the entire country pasted the cause of the increase maternal mortalities and reduced ANC visits to small fees levied on the services offered at various healthcare facilities. This included registration fees and payment for various laboratory tests. This is despite the fact that in 2006, the Ministry of Heath in Kenya had authorized free maternal services in public healthcare facilities (Mothupi, 2014).

The WHO recommends four ANC visits for pregnant women with the primary visit being programmed during the first three months (Mothupi, 2014). This is contrary to what Mason et al. (2015) reported on their research conducted in western Kenya. The authors noted that the majority of women in west Kenya visit ANC in their last trimester, about 64 percent. Moreover, the majority of women in this region of the country still regard TBA services than SBA. This is in agreement with the study done by Alden et al. (2013), that reported that approximately 80 percent of women give birth at home in Western Kenya. Another research that was recently done by Mason et al. (2015) pointed out that 48 and 52 percent of deliveries in Western Kenya took place a healthcare facility and at home respectively. Still, the latter study shows that most of these women opt for delivering at home rather than going to healthcare faculties.

Numerous studies majorly, qualitative research has reported a number of reasons that make women not to attend ANC clinics as stipulated by WHO or fail to give birth in a healthcare facility. This is despite the fact that these services are made to be free in Kenya. In Western Kenya as pointed out by Alden et al. (2013, most husbands and women complain of long distance to the healthcare facility, the levies that are still imposed to them by some facilities, and the quality of care provided by the healthcare facilities (cite). Nevertheless, some other factors that dictate the women are the best time to when and where to go for their antenatal care. As Mothupi (2014) points out, despite the fact that there are co-variates modeling to elaborate on the safe pregnancy and delivery care, there is still the existence of major unsolved community level disparity that may be explained by measuring the problems that occur during care. This denotes that there is more that is supposed to be done in the local setting, economically, socially, geographically, and culturally.

Recommendation

In order to curb the problem of increased maternal mortality a morbidity rates in western Kenya, there are a number of approaches that need to be taken into consideration. There is a need for the creation of enabling government policy either the county or national government, which will enhance maternal health that incorporates strengthening the healthcare systems from the lowermost level. The administration through the MoH should increase the accessibility of compressive maternal healthcare services, particularly on those mothers who are not in a position of getting these services because of some reasons. There is a need for building an awareness campaign on the women’s rights to maternal health for them to appreciate how to demand their rights in instances where they are denied. Women should be encouraged, involved, monitored, and assessed with regard to their maternal health and services that impact on their lives. Furthermore, the administration should increase the money allocated to healthcare sector to strengthen these systems and make sure that there are enough resources put into practice universal maternal healthcare efficiently. Also, there should be the adoption of a holistic approach regarding maternal healthcare by improving the primary healthcare. The County administration should put its focus on the areas which are most affected in order for it to have an efficient effect on the general maternal health indicators. Lastly, there should be insurance of comprehensive, human-rights-based educations facilities for all healthcare providers.

Methods

Stepwise Implementation of Recommendations

In making sure that there is enough and efficient allocation of resources, there will be an outline of a plan to improve the resources to meet 15 percent of the entire county budget. This is per the Jubilee government 2013 promises and Abuja Declaration. Furthermore, there will be the establishment of tracking system that will make sure that Western counties administration adheres to the County healthcare allocation of 60 billion Kenyan shillings. Also, there will be creation and equipment of novel maternal resources and much investment on the ambulances to improve the accessibility and distribution of maternal faculties.

In ensuring that there is the adoption of holistic intervention to maternal health, there will be the inclusion of ANC and PNC into the national administration’s free maternity program. Also, there will be an investment in family planning to improve spacing and avert unwanted pregnancies. Furthermore, enough equipment will be provided in instances where there are needs for abortions; also, educational facilities on the same, particularly among the youth will be a provider as per chapter 4 of the country’s constitutional provision on the same.

With regard to focusing on the most affected areas, there will be the development of a strategic plan that will recognize and address the major etiologies of maternal mortality and morbidity. Furthermore, there will be the provision of additional allowances to hearten healthcare providers who work in interior regions. Transport and the entire infrastructure will be enhanced to increase accessibility of ambulances to interior areas.

Lastly, in making sure that there is the compressive training of healthcare providers, there will be insurance that healthcare providers are trained well to manage well maternal conditions. Workshops will be helpful for healthcare providers with regard to their rights and efficiently manage complaints. There will be the adoption of a positive action approach to employing of culturally-appropriate female healthcare providers.

Analysis

The current policies to curb maternal morbidities and mortalities are not working because of a number of reasons. In most cases, the leaders who are there to make sure that the maternal health policies are implemented fail to uphold their mandate on this. Furthermore, these leaders end up being the key to ensuring that the policies fail. This incorporates mismanaging the funds allocated to the healthcare sector. The devotion of the healthcare sector in Kenya following the promulgation of the 2010 constitution was a big mistake. Health like education was not supposed to be devolved to county levels. The devolution has made implementation of policies to curb maternal morbidities and mortalities to fail. Alternatively, the government should amend the constitution to enable the National government to take full control of the health sector.

Conclusion

To sum up, the access and use of healthcare facilities for pregnant women in western Kenya are still under siege. This study points out that most of the women in western Kenya remain acquiescent to antenatal care as well as they would be at will and prefer giving birth in a healthcare facility. However, this is if there is the provision of means of access and affordability to these institutions. To make these possible, Kenyan administrations through County government should put into practice factors that will entirely make women appreciate the significance of attending antenatal clinics; besides, early planning of delivery. Some of the recommends that this paper recommends in managing maternal mortality and morbidity rate in Western Kenya are making sure that there is a compressive training of healthcare providers, ensuring that there is adoption of holistic intervention to maternal health, making sure that there is enough and efficient allocation of resources; and focusing on the most affected areas.

References

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