OpenUCT :: Browsing by Subject "Kenya"

Browsing by Subject "Kenya"

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Open Access
An analysis of the user-free policy for health care in Kenya : is the effort worth it?
(1999) Mwangi, PK; Thomas, Stephen
This study analyses the user fee policy for health care in Kenya that was introduced to try and recoup some of the costs incurred in providing care as well as rationalise the use of resources. The study aims to generate policy-related findings that are crucial to MOH policy makers in their attempt to provide quality and affordable care. In particular, factors associated with proper function or malfunction of the user fee policy are discussed. The study focussed on four hospitals located in Central province of Kenya. This province was purposefully chosen for its convenience and its high potential for cost recovery. Equity in health care consumption, efficiency, sustainability and perceived quality of care are reviewed. Both primary and secondary data were used. Quantitative and qualitative data were solicited by way of administering questionnaires. Respondents were divided into two categories: providers (staff) and consumers (patients) of health care. The latter were subdivided into inpatients and outpatients. Each of these categories had a specific questionnaire. Further, an attempt is made to estimate net revenue generated in the year 1997/98 by the facilities under study. Costs associated with fee collection were estimated on monthly basis and then projected for the whole year. There are important findings from the study; though patients are charged higher fees at hospitals than at primary levels in order to bolster the referral system, many patients are bypassing the nearby primary care facilities. This study recommends that bypassing patients should be charged higher fees than referred ones.
Open Access
Climate change adaptation and sustainable agricultural intensification in developing countries
(2020) Mulwa, Chalmers Kyalo; Visser, Martine
The recent threat of climate change has exacerbated the inherent risks in smallholder farming such as soil degradation, resulting in an unprecedented decline in agricultural yields in developing countries. This has threatened the livelihoods of large segments of populations that are heavily dependent on agriculture for survival in these regions. This dissertation focuses on identifying barriers and enablers of effective management of these risks, with an aim of coming up with potential policy interventions that can reduce vulnerability to the mentioned risks. To achieve this, the dissertation utilizes various methods and approaches as well as diverse datasets in two countries in sub Saharan Africa i.e. Namibia and Kenya. Diversification into non-farm activities is seen by many as a risk management strategy in rural areas where highly variable low farm incomes are transformed into stable high non-farm incomes, thus improving the welfare of the rural populations. While this theory of change is uncontested, the importance that the agricultural sector plays as a source of livelihood for rural populations, as well as food provisioning for urban populations, cannot be downplayed. This is more so given the limited non-farm opportunities in developing countries and the exponential population growth in these countries. The two factors combined impede on the envisioned transformation of rural production sectors and also create a sub-population of food insecure urban poor due to rural-urban migration. To mitigate these problems, rural agricultural development is still paramount and strategies that enhance resilience to risks in the sector are still vital. Chapter 2 of this dissertation focuses on this issue and addresses how farm diversification can be leveraged for improved food security in the rural areas, which has potential spill-over effects to other segments of the population. Focusing on northern Namibia, the study evaluates how different levels of diversification in both crop and livestock farming affect household food security outcomes i.e. per capita food expenditure and dietary diversity score. The study employs relatively new econometric methods in these type of studies to evaluate the joint determinants to both crop and livestock diversification, as well as their singular and joint effect on mentioned food security outcomes. The results show that high levels of diversification in either enterprise leads to high food security outcomes. Combined with climate change adaptation strategies that create resilience of agricultural production to climatic shocks, the use of sustainable agricultural intensification practices can further enhance productivity in the sector. Inputs like inorganic fertilizer, organic manure and improved seeds can further build on resilient systems to improve yields. Chapter 3 of this dissertation addresses this issue by looking at whether changes in the larger agri-food systems can be used to incentivize take up of such practices at the farm level. The study evaluates how the emergence of large traders in smallholder grain markets can drive the uptake of inorganic and organic fertilizer and improved seeds. The study thus expands the intervention space available to policy makers who have in the past resorted to potentially distortionary direct policies in the input markets e.g. through subsidy provision, as well as in the output markets e.g. through regulation of prices. To achieve this, the study uses a large panel dataset from Kenya spanning over a decade to evaluate how engagements between farmers and these market actors can be leveraged to drive adoption of these sustainable intensification inputs. Results show that engagements between large grain traders and farmers enhance use of inorganic fertilizer. There is no evidence that these engagements lead to enhanced use of improved seeds or manure. However, past use of improved seeds and manure are shown to affect their subsequent use, implying path dependency in the use of these sustainable inputs hence low dis-adoption rates. Traditional technology adoption studies show that access to information is a critical success factor for the uptake of new technology. Proxy variables for information access, for example proximity to extension services or frequency of extension contact, have consistently been shown to be positively correlated with technology adoption. In the context of climate change, access to weather information can be a critical factor to adoption of adaptation technology. Chapter 4 of this dissertation deals with this issue and assesses whether provision of weather information to farmers can enhance adoption of improved farming technologies that are resilient to climatic shocks. The study focuses on northern Namibia where access to such information, as the study shows, is very limited. A framed experiment approach is utilised to evaluate how climate change-induced uncertainty affects farmers' decision making in a farming season, based on their elicited behavioural attitudes towards risk and uncertainty. Further, the study tests whether providing weather information that reduces this uncertainty leads to adoption of technologies that are welfare improving. Lastly, the demand for weather information is assessed by eliciting the willingness to pay for information under various levels of weather uncertainty. Results indicate that high levels of uncertainty dampen uptake of welfare improving technologies, regardless of individual attitudes towards uncertainty. Availing of weather information leads to welfare improving technology choice, given the prevailing levels of weather uncertainty. There is also a high demand for weather information which is shown to increase with increase in the level of weather uncertainty. The chapters in the dissertation therefore identify key policy variables that can be used to manage vulnerability to risks emanating from climate change and unsustainable production in smallholder farming. Access to comprehensive climate information encompassing weather information and climate change-specific management information on both crop and livestock farming is shown to be a key factor in the uptake of adaptation strategies like use of resilient inputs and farm diversification. Interventions along the value chain like teaming up with large market actors in a private-public engagement is shown to be a potential pathway towards enhancing uptake of sustainable intensification inputs. Other policy variables like credit provision, high education and access to off-farm incomes are also key in explaining uptake of risk management strategies by smallholder farmers in Namibia and Kenya.
Open Access
A comparative study of an NGO-sponsored CHW programme versus a ministry of health sponsored CHW programme in rural Kenya: a process evaluation
(BioMed Central Ltd, 2014) Aridi, Jackline; Chapman, Sarah; Wagah, Margaret; Negin, Joel
The varied performance of Community Health Worker (CHW) programmes in different contexts has highlighted the need for implementation of research that focuses on programme delivery issues. This paper presents the results of process evaluations conducted on two different models of CHW programme delivery in adjacent rural communities in in Gem District of Western Kenya. One model was implemented by the Millennium Villages Project (MVP), and the other model was implemented in partnership with the Ministry of Health (MoH) as part of Kenya's National CHW programme.
Open Access
Contextual influences on health worker motivation in district hospitals in Kenya
(BioMed Central Ltd, 2009) Mbindyo, Patrick; Gilson, Lucy; Blaauw, Duane; English, Mike
BACKGROUND:Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. METHODS: Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255-66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. RESULTS: Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. CONCLUSION: Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change.
Open Access
Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programmes in sub-Saharan Africa
(Public Library of Science, 2011) Egger, Matthias; Spycher, Ben D; Sidle, John; Weigel, Ralf; Geng, Elvin H; Fox, Matthew P; MacPhail, Patrick; van Cutsem, Gilles; Messou, Eugène; Wood, Robin
Background: The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART. Methods and Findings: We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in a treatment programme is a weighted average of mortality among patients lost to follow-up and patients remaining in care. The nomogram gives a correction factor based on the percentage of patients lost to follow-up at a given point in time, and the estimated ratio of mortality between patients lost and not lost to follow-up. The mortality observed among patients retained in care is then multiplied by the correction factor to obtain an estimate of programme-level mortality that takes all deaths into account. A web calculator directly calculates the corrected, programme-level mortality with 95% confidence intervals (CIs). We applied the method to 11 ART programmes in sub-Saharan Africa. Patients retained in care had a mortality at 1 year of 1.4% to 12.0%; loss to follow-up ranged from 2.8% to 28.7%; and the correction factor from 1.2 to 8.0. The absolute difference between uncorrected and corrected mortality at 1 year ranged from 1.6% to 9.8%, and was above 5% in four programmes. The largest difference in mortality was in a programme with 28.7% of patients lost to follow-up at 1 year. Conclusions: The amount of bias in mortality estimates can be large in ART programmes with substantial loss to follow-up. Programmes should routinely report mortality among patients retained in care and the proportion of patients lost. A simple nomogram can then be used to estimate mortality among all patients who started ART, for a range of plausible mortality rates among patients lost to follow-up.
Open Access
Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission
(Public Library of Science, 2015) Kamali, Anatoli; Price, Matt A; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J; Anzala, Omu; Latka, Mary H; Bekker, Linda-Gail; Kaleebu, Pontiano
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
Open Access
Crises and resilience at the frontline-public health facility managers under devolution in a sub-county on the Kenyan Coast
(Public Library of Science, 2015) Nyikuri, Mary; Tsofa, Benjamin; Barasa, Edwine; Okoth, Philip; Molyneux, Sassy
BACKGROUND: Public primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers' jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers-or 'in-charges' in Kenya, and their challenges and coping strategies, under accelerated devolution. METHODS: The data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a 'learning site'. A learning site is a long term process of collaboration between health managers and researchers deciding together on key health system questions and interventions. Data were collected through seven formal in depth interviews and observations at four PHC facilities as well as eight in depth interviews and informal interactions with sub-county managers from June 2013 to July 2014. Drawing on the Aragon framework of organisation capacity we discuss the multiple accountabilities, daily routines, challenges and coping strategies among PHC facility managers. RESULTS: PHC in-charges perform complex and diverse roles in a difficult environment with relatively little formal preparation. Their key concerns are lack of job clarity and preparedness, the difficulty of balancing multidirectional accountability responsibilities amidst significant resource shortages, and remuneration anxieties. We show that day-to-day management in an environment of resource constraints and uncertainty requires PHC in-charges who are resilient, reflective, and continuously able to learn and adapt. We highlight the importance of leadership development including the building of critical soft skills such as relationship building.
Open Access
The effect of capital flows on the Kenyan economy
(2014) Muthuuri, Njoki; Gossel, Sean J
Foreign capital inflows (FCI) play an important role in the economic development of the recipient country as they fund investments and promote growth. However, the size and composition of such inflows are determined on the basis of country specific requirements. The study investigates the impact of capital inflows on the economy of Kenya at a time when the government implemented economic reform measures to stabilize the economy and restore sustainable growth. More specifically, the study examines the impact of foreign capital flows remittances such as overseas workers remittance, official development aid, and external debt, on selected macro-economic variables using monthly time series data and a single-equation empirical approach. The study findings reveal that some forms of FCI are not influenced by the macro economic variables in the country but by other factors such as political stability and policy variables.
Open Access
Effects of agricultural biodiversity and seasonal rain on dietary adequacy and household food security in rural areas of Kenya
(2015-04-25) M’Kaibi, Florence K; Steyn, Nelia P; Ochola, Sophie; Du Plessis, Lisanne
Abstract Background Kenya has a high prevalence of underweight and stunting in children. It is believed that both agricultural biodiversity and seasonal rainfall influences household food security and dietary intake. In the present study we aimed to study the effects of agricultural biodiversity and seasonal rains on dietary adequacy and household food security of preschool Kenyan children, and to identify significant relationships between these variables. Methods Two cross-sectional studies were undertaken in resource-poor households in rural Kenya approximately 6 months apart. Interviews were done with mothers/caregivers to collect data from randomly selected households (N = 525). A repeated 24-hour recall was used to calculate dietary intake in each phase while household food security was measured using the Household Food Insecurity Access Scale (HFIAS). A nutrient adequacy ratio (NAR) was calculated for each nutrient as the percent of the nutrient meeting the recommended nutrient intake (RNI) for that nutrient. A mean adequacy ratio (MAR) was calculated as the mean of the NARs. Agricultural biodiversity was calculated for each household by counting the number of different crops and animals eaten either from domestic sources or from the wild. Results Dietary intake was low with the majority of households not meeting the RNIs for many nutrients. However intake of energy (p < 0.001), protein (p < 0.01), iron (p < 0.01), zinc (p < 0.05), calcium (p < 0.05), and folate (p < 0.01) improved significantly from the dry to the rainy season. Household food security also increased significantly (p < 0.001) from the dry (13.1 SD 6.91) to the rainy season (10.9 SD 7.42). Agricultural biodiversity was low with a total of 26 items; 23 domesticated and 3 from the natural habitat. Agricultural biodiversity was positively and significantly related to all NARs (Spearman, p < 0.05) and MAR (Spearman, p < 0.001) indicating a significant positive relationship between agricultural biodiversity of the household with dietary adequacy of the child’s diet. Conclusion Important significant relationships were found in this study: between agricultural biodiversity and dietary adequacy; between agricultural biodiversity and household food security and between dietary adequacy and household food security. Furthermore, the effect of seasonality on household food security and nutrient intake was illustrated.
Open Access
Essays on institutions and economic development in Kenya
(2015) Letete, Emmanuel Maluke; Mare, Sarr
This thesis focuses mainly on three related issues of the broader new institutional economics and political economy research: (i) the evolution of formal economic and political institutions over time (ii) the causality between political institutions and economic institutions, and that between institutions and economic development; (iii) and the role of institutions on economic development through the channel of foreign direct investment, and on the control of rent seeking and corruption in Kenya. These issues are discussed in four distinct essays, each essay constituting an independent and self-contained chapter. It adopts the conceptual framework on institutions proposed by Douglass North. The central theme of the thesis across all chapters is the demonstration of how political players holding de-facto political power operating under weak political rights and civil liberties use legal operators to benefit themselves and their close associates. For instance, starting with British rule - protectorate period (1885-1920) and colonial period (1920-1963) - an extensive legal apparatus designed by those holding de-facto political power expropriated much of the land and redistributed it to themselves at the expense of the indigenous populations whose political rights and civil liberties were crossly undermined. However, even after independence, several political players in the newly independent Kenya made little effort to fundamentally change the colonial laws that governed land rights and could not as well promote strong political rights and civil liberties. The thesis argues that despite pressures from the populace, political leaders and their interest groups holding de-facto political power entrench themselves in the system under weakly institutionalized environment, and oppose the constitutional reforms by all means including force, since such reforms go against their interests. The delay in such reforms often leads to the breakdown of governance. Such breakdown inevitably leads to conflict and social crisis such as the Kenya post-election crisis of 2007. The chapters in the thesis are organized in such a way that they start by tracing the evolution of rights promoted by people holding de-facto political power, then later the remaining chapters take on the assessment and implications of how such rights promoted under weakly institutionalized environment affect economic outcomes.
Open Access
Ethical issues in genomic research on the African continent: experiences and challenges to ethics review committees
(2014-08-21) Ramsay, Michèle; de Vries, Jantina; Soodyall, Himla; Norris, Shane A; Sankoh, Osman
Abstract This is a report on a workshop titled ‘Ethics for genomic research across five African countries: Guidelines, experiences and challenges’, University of the Witwatersrand, Johannesburg, South Africa, 10 and 11 December 2012. The workshop was hosted by the Wits-INDEPTH partnership, AWI-Gen, as part of the H3Africa Consortium.
Open Access
Factors influencing institutionalization of health technology assessment in Kenya
(BioMed Central, 2023-06-22) Mbau, Rahab; Vassall, Anna; Gilson, Lucy; Barasa, Edwine
Abstract Background There is a global interest in institutionalizing health technology assessment (HTA) as an approach for explicit healthcare priority-setting. Institutionalization of HTA refers to the process of conducting and utilizing HTA as a normative practice for guiding resource allocation decisions within the health system. In this study, we aimed to examine the factors that were influencing institutionalization of HTA in Kenya. Methods We conducted a qualitative case study using document reviews and in-depth interviews with 30 participants involved in the HTA institutionalization process in Kenya. We used a thematic approach to analyze the data. Results We found that institutionalization of HTA in Kenya was being supported by factors such as establishment of organizational structures for HTA; availability of legal frameworks and policies on HTA; increasing availability of awareness creation and capacity-building initiatives for HTA; policymakers’ interests in universal health coverage and optimal allocation of resources; technocrats’ interests in evidence-based processes; presence of international collaboration for HTA; and lastly, involvement of bilateral agencies. On the other hand, institutionalization of HTA was being undermined by limited availability of skilled human resources, financial resources, and information resources for HTA; lack of HTA guidelines and decision-making frameworks; limited HTA awareness among subnational stakeholders; and industries’ interests in safeguarding their revenue. Conclusions Kenya’s Ministry of Health can facilitate institutionalization of HTA by adopting a systemic approach that involves: - (a) introducing long-term capacity-building initiatives to strengthen human and technical capacity for HTA; (b) earmarking national health budgets to ensure adequate financial resources for HTA; (c) introducing a cost database and promoting timely data collection to ensure availability of data for HTA; (d) developing context specific HTA guidelines and decision-making frameworks to facilitate HTA processes; (e) conducting deeper advocacy to strengthen HTA awareness among subnational stakeholders; and (f) managing stakeholders’ interests to minimize opposition to institutionalization of HTA.
Open Access
Genetic diversity in L1 ORF of human papillomavirus in women with cervical cancer with and without human immunodeficiency virus in Botswana and Kenya
(2022-01-27) Tawe, Leabaneng; Choga, Wonderful T; Paganotti, Giacomo M; Bareng, Ontlametse T; Ntereke, Tlhalefo D; Ramatlho, Pleasure; Ditshwanelo, Doreen; Gaseitsiwe, Simani; Kasvosve, Ishmael; Ramogola-Masire, Doreen; Orang’o, Omenge E; Robertson, Erle; Zetola, Nicola; Moyo, Sikhulile; Grover, Surbhi; Ermel, Aaron C
Background The variation of human papillomavirus (HPV) genotypes shapes the risks of cervical cancer and these variations are not well defined in Africa. Nucleotide changes within the L1 gene, nucleotide variability, and phylogeny were explored in relation to HIV in samples from Botswana and Kenya. Methods A total of 98 HPV-positive cervical samples were sequenced to identify different HPV variants. Phylogenetic inferences were used to determine HPV genotypes and investigate the clustering of sequences between women living with HIV (WLWHIV) and -women not living with HIV (WNLWHIV). Results Out of 98 generated sequences, 83.7% (82/98) participants had high-risk (HR) HPV genotypes while 16.3% (16/98) had low-risk (LR) HPV genotypes. Among participants with HR-HPV genotypes, 47.6% (39/82) were coinfected with HIV. The prevalence of HR-HPV genotypes was statistically higher in the Botswana population compared to Kenya (p-value < 0.001). Multiple amino acid mutations were identified in both countries. Genetic diversity differed considerably among WLWHIV and WNLWHIV. The mean pairwise distances between HPV-16 between HIV and HIV/HPV as well as for HPV-18 were statistically significant. Six (6) new deleterious mutations were identified in the HPV genotypes based on the sequencing of the L1 region, HPV-16 (L441P, S343P), HPV-18 (S424P), HPV-45 (Q366H, Y365F), and HPV-84 (F458L). The majority of the patients with these mutations were co-infected with HIV. Conclusions Genomic diversity and different genomic variants of HPV sequences were demonstrated. Candidate novel mutations within the L1 gene were identified in both countries which can be further investigated using functional assays.
Open Access
How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya
(BioMed Central, 2017-09-15) Tsofa, Benjamin; Molyneux, Sassy; Gilson, Lucy; Goodman, Catherine
Background: A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and technical efficiency in resource management. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, and a substantial transfer of responsibility for healthcare from the central government to these counties. Methods: This study analysed the effects of this major political decentralization on health sector planning, budgeting and overall financial management at county level. We used a qualitative, case study design focusing on Kilifi County, and were guided by a conceptual framework which drew on decentralisation and policy analysis theories. Qualitative data were collected through document reviews, key informant interviews, and participant and non-participant observations conducted over an eighteen months’ period. Results: We found that the implementation of devolution created an opportunity for local level prioritisation and community involvement in health sector planning and budgeting hence increasing opportunities for equity in local level resource allocation. However, this opportunity was not harnessed due to accelerated transfer of functions to counties before county level capacity had been established to undertake the decentralised functions. We also observed some indication of re-centralisation of financial management from health facility to county level. Conclusion: We conclude by arguing that, to enhance the benefits of decentralised health systems, resource allocation, priority setting and financial management functions between central and decentralised units are guided by considerations around decision space, organisational structure and capacity, and accountability. In acknowledging the political nature of decentralisation polices, we recommend that health sector policy actors develop a broad understanding of the countries’ political context when designing and implementing technical strategies for health sector decentralisation.
Open Access
How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya
(2017) Tsofa, Benjamin; Molyneux, Sassy; Gilson, Lucy; Goodman, Catherine
A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and technical efficiency in resource management. In 2010, Kenya passed a new constitution that introduced 47 semi-autonomous devolved county governments, and a substantial transfer of responsibility for healthcare from the central government to these counties.
Open Access
Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya
(Public Library of Science, 2015) Ibinda, Fredrick; Bauni, Evasius; Kariuki, Symon M; Fegan, Greg; Lewa, Joy; Mwikamba, Monica; Boga, Mwanamvua; Odhiambo, Rachael; Mwagandi, Kiponda; Seale, Anna C
BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. METHODS: We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. RESULTS: There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. CONCLUSIONS: Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage.
Open Access
The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study
(BioMed Central, 2016-09-30) Barasa, Edwine W; Cleary, Susan; English, Mike; Molyneux, Sassy
Background: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. Methods: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long’s actor interface analysis and VeneKlasen and Miller’s expressions of power framework to examine and interpret our findings Results: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Conclusions: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes
Open Access
Innovative Financial Inclusion for migrants and refugees living in urban areas: Practical lessons for Southeast Asia from Africa
(2019) Tongboonrawd, Baranee; Alhassan, Abdul Latif; Makoni, Patricia
The purpose of this study is to examine the innovative financial inclusion for the under-served urban migrant and refugee population in Thailand, respectively. The increasing number of urban migrants and refugees in Thailand requires innovative financial inclusion and livelihood interventions. Many migrants and refugees do not have access to formal financial services due to their legal documentation, although their demands for financial services still exist and remain unsatisfied. The evidence from Kenya in Africa could provide implications and viable options for Thailand in implementing financial inclusion and livelihood programmes in different ways. Using data from the migrants and refugees residing in Bangkok, Thailand through individual interviews, the discourse and narrative qualitative analytical methods were employed to analyse data. The key findings from this study include financial needs, financial inclusion options, livelihood assets and strategies, financial literacy, as well as the livelihood approaches that can support the wellbeing of urban migrants and refugees in the host countries. The findings also revealed the difference in financial needs between urban migrants and refugees in Thailand due to their unique needs and livelihood goals. The data analysis suggested that the financial inclusion and livelihood interventions in Kenya could be applicable for refugees and migrants in Thailand. The roles of financial technology and innovation also have a positive impact in accelerating the financial inclusion of refugees and migrants. The recommendations from this study can help to create the enabling environments for financial inclusion of migrants and refugees in the urban context of Thailand. A comprehensive needs assessment on livelihoods and financial inclusion could explore the actual needs of the migrant and refugee population in in Thailand. The coaching sessions for new arrival groups of migrants and refugees can help them to adjust their livelihood strategies while residing in the host country. The innovation and technology will promote the cost-effective informal banking and open up employment and economic opportunities. The advocacy for the rights of migrants and refugees should be strengthened, including the legislations regarding basic healthcare and education. With a dramatic increase in migration, a better understanding of urban contexts will help develop workable interventions for financial inclusion of urban displaced persons, eventually building resilience and reducing poverty among migrants and refugees.
Open Access
Kenya and the ICC: the politics of the 2007 post-election violence
(2013) Fromet De Rosnay, Amandine; Seegers, Annette
In December 2007, Kenya held a presidential election. The incumbent was Mwai Kibaki of the Party of National Unity (PNU). His political opponent was Raila Odinga of the Orange Democratic Movement (ODM). The vote was peaceful and described by many in positive terms; that is, a continuation of the positive democratic transition that Kenya began toward the end of the 1990s. However, many in Kenya accused the government of foul play, when the Electoral Commission of Kenya (ECK) delayed declaring a winner for two days. The ECK eventually declared Kibaki President, and rushed the swearing - in ceremony, skipping the stipulated 72 hours. Two days after declaring Kibaki president, Samuel Kivuitu, the chair of the ECK, admitted he did not know whether Kibaki had won the elections. He insisted that he had agreed to release the results and announce Kibaki as president, under pressure from above. Kenya then experienced its worst bout of violence since the Mau Mau rebellion, before independence. The Post - Election Violence (PEV) lasted two months. It was resolved following an agreement, the Kenya National and Reconciliation Dialogue (K N D R), negotiated by a Panel of Eminent Personalities. The fighting parties agreed to form a Government of National Unity (GNU), a Commission of Enquiry into the Post - Election Violence (CIPEV) and an Independent Review Commission on the General elections (Kriegler Commission). The GNU was to have Kibaki reinstated as President, to add the post of Prime Minister for Odinga, and was to undertake a reconciliation and accountability process, prosecuting perpetrators. This thesis seeks to determine what were the politics that led Kenya to prosecute those who bore greatest responsibility for the PEV. More specifically, what were the politics that resulted in selecting the ICC, as the court where individuals were going to be held accountable?
Open Access
Male circumcision and sexual risk behaviors may contribute to considerable ethnic disparities in HIV prevalence in Kenya: an ecological analysis
(Public Library of Science, 2014) Kenyon, Chris Richard; Vu, Lung; Menten, Joris; Maughan-Brown, Brendan
BACKGROUND: HIV prevalence varies between 0.8 and 20.2% in Kenya's various ethnic groups. The reasons underlying these variations have not been evaluated before. METHODS: We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in Kenya's ethnic groups. Spearman's and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group. RESULTS: The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo) had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0-62.5%) and condom usage at last sex (Men 2008∶28.6%, 95% CI 19.6-37.6%), they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9-26.0) the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2-47.1%) and pre-marital sex (Men 2008∶73.9%, 95% CI 67.5-80.3%) and the youngest mean age of debut for women (1989 Survey: 15.7 years old, 95% CI 15.2-16.2). At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearman's rho = 0.79, P = 0.04). Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01) and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04). CONCLUSION: In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in Kenya's ethnic groups. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted.