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The Kenyan healthcare system is at a crossroads. The demand for quality healthcare is rising even as the workforce responsible for delivering these services is facing immense challenges. Inequitable distribution of healthcare professionals (HCPs), few training and employment opportunities, poor working conditions, and the amplifying issue of brain drain are straining the Kenyan healthcare system. Achieving Universal Health Coverage (UHC) will remain an uphill battle if these pertinent issues remain unaddressed.

Recognising these pressing concerns, the Kenya Medical Association (KMA) has contributed to the Healthcare Professionals Policy 2025. This policy aims to remodel how healthcare professionals are trained, employed, deployed, and retained.

At the heart of KMA’s recommendations is the establishment of a National Health Services Commission, a body structured to bridge the gap between the health workforce and government policy implementation.

What’s Going Wrong?

Kenya’s healthcare workforce faces perpetual challenges because of:

1. Poor Coordination Between National and County Governments. Leadership turnover at the county level erodes institutional memory. Additionally, there is poor collaboration between National and County levels of government, leading to the stagnation of health policy implementation, particularly at the grassroots level.
2. Inadequate Planning and Financing. Training programs don’t align with population health needs, and resources are often misallocated, with health facilities understaffed and under-equipped.
3. Shortages of Trained Professionals. Medical schools aren’t producing enough HCPs to meet the healthcare needs of all Kenyans. Career progression for HCPs in government employment also remains unclear, leading to poor employee retention and high turnover.
4. Poor Employment Conditions. Counties lack adequate budgets to hire and pay healthcare workers on time, making job security a major concern.
5. Healthcare Worker Migration. Brain drain is worsening due to poor working conditions, lack of career growth, and inadequate compensation for services rendered.
6. Weak Professional Regulation. Some HCP cadres operate without oversight from instituted regulatory bodies, leading to malpractice and unethical behaviour.
7. Lack of Reliable Data on Human Resources for Health. There is no centralised system to track healthcare professionals, leading to inefficiencies in healthcare workforce planning.

The Kenya National Health Services Commission: A Potential Solution to Kenya’s Healthcare Workforce Crisis

To address these challenges, KMA proposes the institution of a National Health Services Commission that would oversee the management of the entire Kenyan healthcare workforce.

The Commission would:

1. Improve Governance and Coordination. The Commission would act as a link between HCPs and the government, streamlining healthcare leadership and preventing delays in policy implementation.
2. Ensure Adequate Staffing and Retention. By tracking training and workforce needs, the Commission would facilitate better planning for HCP education, employment, and career progression.
3. Strengthen Health Regulatory Frameworks. A HSC would develop and enforce policies on licensing, training, and professional development for HCPs across all cadres.
4. Address Brain Drain. The Commission would support the retention of skilled HCPs by advocating for better working conditions and employment incentives.
5. Strengthen Workforce Data Management. The Commission would oversee a centralised HCP information system that would help in tracking workforce distribution, training needs, and deployment strategies.

The Way Forward

Kenya’s healthcare system can’t function without a well-supported workforce. A National Health Services Commission, through supporting better healthcare planning, could significantly contribute to building a more resilient health workforce that meets the healthcare needs of all Kenyans.

Written by Dr. Wairimu Mwaniki. KMA Policy Advocacy and Communications Committee Convener.

Date: 3rd October 2024
Moderator: Dr Victor M. Wauye, Member, KMA Policy, Advocacy and Communications Committee (KMA PAC), & Lead, KMA PAC Climate and Health Subcommittee
Panellists: Ms Lilian Khalai Mulaa, Project Officer, Pan African Climate Justice Alliance; Dr Martin Muchangi (PhD), Programme Director, Population Health & Environment, AMREF Health Africa; and Dr Dave Ojijo, Chair, KMA Planetary Health Committee

Author: Dr. Victor M. Wauye

Introduction

Climate change poses a significant threat to the health sector, necessitating collaborative efforts to build climate-resilient healthcare systems. The Kenya Medical Association (KMA), through its Policy, Advocacy, and Communications Committee, organized a panel discussion to explore the relationship between climate change and health, aiming for health decarbonization and green healthcare in Kenya.

Relationship Between Climate Change and Health

Climate change impacts health through environmental determinants, leading to storms, droughts, waterborne and vector-borne diseases, food insecurity, malnutrition, and premature deaths. In Kenya, cholera outbreaks and new malaria hotspots and breeds have recently been reported. Mental health issues, often overlooked, are also significant. Extreme weather events damage infrastructure, hindering healthcare delivery and access. Additionally, climate change drives communities into poverty, reducing their ability to afford healthcare.

Conversely, the healthcare sector contributes to climate change mainly via three scopes as in Fig.1. In Kenya, it is primarily through waste disposal practices like dumping and burning.
burning.

Figure 1: Healthcare sector greenhouse gas scopes

Role of Healthcare Sector in Climate Change Mitigation and Adaptation

The healthcare sector's role in climate change mitigation and adaptation in Kenya can be viewed through the WHO health system building blocks:

• Governance: Kenya has made strides with the Climate Change Act and Climate Change and Health Strategy, providing a policy framework, though the position of climate change in the health ministry remains unclear.
• Health Workforce: Few healthcare workers who are mainly driven by passion in Kenya understand the health impacts of climate change. However, passion alone is insufficient without proper systems.
• Health Information: Kenya lacks innovative surveillance systems to interpret and warn about climate change scenarios.
• Service Delivery: The healthcare workforce is not well-empowered to handle climate change impacts.
• Healthcare Financing: Climate funding is unstable, and the health sector has not fully leveraged available funds like the green climate fund.

Health Sector Decarbonization Strategies

Various strategies can be adopted in Kenya:

• Renewable energy sources like solar panels, as seen in Rwanda.
• Electric vehicles for ambulances instead of diesel-fuelled ones.
• Transition to public transport or cycling, as in Sweden.
• Paperless systems and telemedicine to reduce waste and transport-associated emissions.
• Improved medical waste management, including innovative protocols and grey water recycling.
• Education of healthcare workers on climate change and health.
• Eco-friendly manufacturing of medical supplies from local materials.

Conclusion

Climate change is a significant health crisis, primarily caused by human activities. It adversely affects health, but the healthcare sector also contributes to climate change. Building a climate-resilient healthcare system is crucial for mitigation and adaptation. By adopting innovative strategies, there is an opportunity to decarbonize the healthcare sector and establish green healthcare in Kenya.

Recommendations:

• Conduct health systems carbon emissions audits.
• Invest in local capacities for manufacturing medical supplies.
• Involve communities in addressing climate change health challenges.
• Improve medical training curricula to include climate change and health.
• Develop innovative surveillance and response mechanisms.
• Allocate resources for implementing climate change and health policies.
• Explore funding opportunities by collaborating with governmental and non-governmental organizations.
• Advocate for a coordinated multisectoral approach.
• Develop innovative waste management strategies.

The Kenya Medical Association is a voluntary membership association of all doctors registered to practice in Kenya. It is mandated to Champion for the Welfare of Doctors and Quality Healthcare in Kenya.

On this World No Tobacco Day (WNTD), the Kenya Medical Association joins the World Health Organization and affiliate countries, the Ministry of Health Kenya, the Tobacco Control Board, Civil Society and other Global Tobacco Control Organizations in commemorating this year's WNTD.

We celebrate this year’s theme ‘We Need Food, Not Tobacco’ cognizant of the negative impact that tobacco growing and curing has on farmers through green tobacco sickness, exposure to carcinogenic chemicals and chronic lung conditions.

We further recognize, the negative impact tobacco growing has on the environment, its’ effect on food insecurity and the poor labor and business practices by tobacco the industry that make it difficult for tobacco farmers to make a profit or switch to alternative crops that are more profitable.

As Kenyans, we are proud to host this years' Global Celebrations in Migori and to have the farmers recognized for being the pioneers of the ‘Tobacco Free Farms’ initiative. This has seen at least 2000 farmers in the county transition from growing tobacco to high iron beans providing them with healthy, economically viable alternatives and impacting on the local supply of tobacco leaf.

Lastly, we appreciate the devastating role that tobacco products old and new, continue to play as the biggest modifiable risk for disease and responsible for the deaths of 6000 Kenyans annually. We shall continue to work with the Ministry of Health, the Tobacco Control Board and all other organizations to ensure full implementation of the Tobacco Control Act. We shall further play a very specific part in sensitizing the public on the harms of tobacco use and in ensuring that we champion for and provide access to tobacco cessation services wherever possible.

KMA PUBLIC HEALTH COMMITTEE
31.05.2023

DOWNLOAD THE STATEMENT HERE

International Condom Day – 2021
Theme: ‘SAFER IS SEXY’

Dr. Leon Ogoti
Public Health Committee

When King Minos of Crete devised a sheath fashioned from sheeps’ bladder in 3000 B.C. and used it to protect his wife from his semen – which he believed to contain scorpions and spiders – he had no idea that 5,000 years later this revolutionary act would be celebrated globally on the 13th of February and would play its part in preventing 50 million HIV infections and many more cases of Syphilis and Gonorrhea and countless unplanned pregnancies.

History
Condoms have come a long way through the ages, with initial Condoms designed to cover just the glans. Initial fabrications ranged from goats’ bladder, to lamb intestine, to oiled silk paper. In Asia there was a preference for more rigid options with animal horns and tortoise shells making appearances and in Rome, in an ultimate show of spite, Roman gladiators adapted the bulging muscles of their slain opponents as protective sheaths.
In many societies Condoms were a preserve of the rich. For years they were only used for family planning with varied levels of acceptance as family planning was largely frowned upon in religious circles and by segments of the medical fraternity. Additionally, the aspects of unavailability and expense played a role in their ‘prohibition’.
Things began to change in the late 19th century when Charles Goodyear of the Goodyear tire brand discovered vulcanization of rubber and the production of rubber Condoms began. Despite this progress, the process of acquiring a Condom remained relatively cumbersome because though they were designed to be reusable, to get one a man had to walk to the Doctor’s office for fitting before the Condom could be ordered.
Then the 20th century rolled in and two separate disease outbreaks resulted in the unprecedented levels of Condom use seen to this day.
The first was during the 1st and 2nd World War: due to poor prevailing knowledge on sexually transmitted diseases, sexual hygiene, and the mental depravity caused by the conditions of war, the number of sexually transmitted infections shot up with Syphilis and Gonorrhea causing the death of as many as 18,000 soldiers a day. Syphilis was the cause of one in every eight hospital admissions and at the peak of its’ powers is known to have resulted in more deaths than HIV/AIDS has this far.
The introduction of penicillin in the 1940s provided some respite, shortening the duration of treatment and saving many lives, but the destruction caused by Syphilis and Gonorrhea was so significant that the USA and the UK had to dedicate a significant part of the War budget to avail Condoms as a part of their war effort just as other European countries had done.
In an effort to meet this skyrocketing demand, the greatest development in Condom manufacturing resulted and brought forth the now widely used and celebrated ‘lubricated latex Condom’. The result? 40-50% of sexually active persons at that time were using Condoms. Due to ease of manufacture of latex condoms - availability and affordability ceased to be an issue. Before this a single Condom would cost a commercial sex worker several months of pay.
The second was in the early 80s when the HIV pandemic came about and this singular event resulted in the greatest increase in demand for Condom use and this continues to be the case four decades on. Improvement to the rubbers continues to happen with manufacturers attempting to make their use as pleasurable an experience as possible and reduce the barriers to use with more recent innovations such as invisible Condoms.

Future of Condoms
Now a billion dollar industry, Condom use remains the single most efficient and available technology to reduce transmission of HIV and other STIs given the transmission of HIV still largely occurs by sexual transmission (over 80% of cases).
3 out of every 4 Kenyans, aged 15-64 know enough about Condoms, how to use them, and what diseases they prevent. However, studies on the rates of use at last intercourse were persistently below 50% for men and 40% for women, meaning there is continued need for increased knowledge on the role of Condoms but just as important is the need to interrogate the barriers to efficient and effective Condom use and identify strategies to address them.
Unrestrained access to quality and affordable Condoms has been hampered in recent times by:

• Progressive funding cuts to organizations involved in the provision of Global Family planning services and commodities due to the infamous and now repealed Global Gag rule.
• Failure to assess imported Condoms for the required standards of quality by KEBS leading to a sense of mistrust by Kenyans
• Pandemic occasioned lockdowns which have continued into 2021 - as new strains of the Covid-19 virus continue to emerge in the major Condom manufacturing countries such as Singapore and Malaysia - will also result in shortages for as long as the COVID-19 pandemic lingers.

These obstacles provide a grand opportunity for increased government funding and support towards local manufacturing of condoms and reducing industry bottlenecks, with an aim of feeding the huge unmet need for these products with the government only able to supply 160 of the 350million Condoms required annually in Kenya.
The drive to increase Condom use among sexually active persons must be complemented by more attention and stronger bolder conversations around combination prevention methods such as Pre exposure prophylaxis, post exposure prophylaxis and voluntary male medical circumcision as well as increasing support towards gender equality which gives women more decision making autonomy in their sexual relationships.
This will inevitably aid in addressing the HIV burden locally, the quietly rising STI burden and going some way towards attempting to meet the commitment on ‘Zero unmet need for Family Planning information and services and universal availability of quality, accessible, affordable and safe contraceptives’ made at the 25th International Conference on Population and Development (ICPD) summit, held in Nairobi in November 2019.