A review of the health sector in Kenya

On attaining independence, the Government committed itself to providing ?free? health services as part of its development strategy to alleviate poverty and improve the welfare and productivity of the nation. The development and expansion of health services and facilities in terms of spatial coverage, training of personnel, and in tertiary healthcare delivery services since independence has been commendable. Though the physical infrastructure for health provision in Kenya has expanded rapidly, distribution and coverage remains uneven especially in rural areas. Maintenance of public sector health facilities has been a big problem and a major burden for the Ministry of Health. Healthcare policy reforms have therefore been adopted as a strategy of supplementing government budgets to revitalize healthcare delivery systems. The most notable health reforms the Government has adopted include decentralization and cost sharing. The health achievements between 1960 and 1992 have been encouraging. During this period, there were improvements in infant, child and maternal mortality and morbidity rates, crude death rate, and life expectancy, among others. However, since the early 1990s, there has been a declining trend in the health status of the population. Mortality rates started increasing in 1993. Infant and under five mortality rates increased from 51 and 74 in 1992 to 74 and 112 in 1998, respectively. Chronic malnutrition or stunting prevalence remained at 33 percent in the period 1993 and 1998. The greatest challenge to independent Kenya has been the emergence of the HIV/AIDS pandemic. It is estimated that 2.2 million Kenyans are now living with HIV infection, representing about 14 percent of the sexually active population. Over 1.5 million Kenyans have died of AIDS since the epidemic started. The HIV/AIDS pandemic is becoming much more than a health problem as it encompasses economic, social, and cultural dimensions. The epidemic continues to exert pressure on the healthcare delivery system. Although there has been a massive expansion of health infrastructure since independence, increasing population and demand for healthcare outstrips the ability of the government to provide effective health services. Provision of effective health services requires that the government addresses issues of inadequate health personnel, financing, drugs, health infrastructure, inefficiency in health delivery, and inequality in delivery of healthcare. (Author abstract)