NAIROBI, Kenya, Jun 24 – The health sector is represented in three of the eight Millennium Development Goals (MDGs).
Goals four, five and six call for a reduction by two-thirds of the under-five mortality rate, reduce by three-quarters the maternal mortality ratio and reverse the spread of HIV/AIDS respectively between 1990 and 2015.
“If you look at the way we have been allocating the national budget to the health sector it is likely that we may not be able to achieve the MDGs,” Action Aid National Health Coordinator, Ruth Laibon- Masha says.
In the Abuja Declaration of April 2001, African leaders committed to set a target of at least 15 percent of the annual budget to improvement of the health sector.
But Mrs Laibon-Masha says looking at the national allocation since then, not much has been done to ensure this target is reached.
“We have been doing an average of seven percent, 7.4, 7.5 and the highest being around 8.4 percent,” she told Capital News.
She is of the opinion that the health budget has been affected since the 1990s when there were structural adjustment programmes under International Monetary Fund (IMF) conditionalities.
“Some countries have been able to say no to this and therefore allocated money. So it is upon the government to decide if we have to adhere to the IMF conditionalities otherwise the right to health will not be attained and the millennium development goals will not be achieved,” she explains.
Reducing Child Mortality
On this MDG, which is the fourth goal, Mrs Laibon-Masha says there is an increase in infant mortality largely blamed on the rising poverty levels and the spread of HIV/AIDS.
“We are currently having about 52 percent of children being fully immunised, according to the 2003 Kenya Health Demographic Survey, but we need universal immunisation. The country has gone through many phases that by now we need to be talking about over 90 percent of immunisation coverage.”
She says the way in which budgetary allocation is made and managed, there is so much donor dependency.
“Isn’t it the high time we stopped and reflect on what it is that we are doing wrong?” posed the Action Aid official.
Improving Maternal Health
“Since 1998, we have actually had a constant maternal mortality ratio. We have about 400 per 100,000 live births, which is not good for us because we need to be seen moving forward,” she says.
Mrs Laibon-Masha says although some improvements have been made, as long as the country continues to stagnate in one place it means there is a problem. She adds that despite expectant mothers attending antenatal clinics, there are only 42 percent of the mothers seeking maternity services in hospitals.
“So there are still people who seek care from the traditional birth attendants and it means that we cannot effectively prevent the mother to child transmission of HIV/AIDS and the more we lose mothers giving birth, the more we are likely to lose newborns,” she says.
Combat HIV/AIDS, Malaria and other diseases
The Action Aid National health Coordinator says although there is a lot of money in the HIV/AIDS sector, which is largely donor funded, we may not achieve the universal access to treatment unless the government comes in and takes charge.
“We need to come out of the box; we need structural changes, revamp and integrate HIV services within the primary health care,” she says.
Mrs Laibon- Masha says last year, there was only one percent committed to the exchequer for HIV/AIDS programmes.
“If you are talking about universal access, what happens if the donor partners froze the funds? We just don’t have a plan B in this country.”
She says another problem with the HIV/AIDS sector is that it is largely project based.
“Every year you find that an NGO is trying to provide care, they come with a three year project then they move so the question is with the current structure of the health sector. Are we really going to achieve the MDG’s? I think we will not,” she says.
At a Millennium Summit in September 2000, world leaders adopted the UN Millennium Declaration, committing their nations to a new global partnership to reduce extreme poverty and setting out a series of time-bound targets, with a deadline of 2015.
They also include basic human rights like the right to health, education, shelter, and security.
“As we speak today over 200 cases of cholera have been reported in Marsabit district and 16 cases of polio in Turkana. This means the access to health facilities is extremely wanting and immunisation coverage for under-fives is not being conducted in Northern Kenya,” said Turkana Central Legislator Ekwe Ethuro, while contributing to the budget debate in Parliament.
He adds: “The Minister for Planning can confirm to this House that the only MDG that can be realised by the Kenyan government is one out of eight. It is a shame that 46 years after independence diseases like polio are still recurring in this part of the world.”
In his budget speech, Finance Minister Uhuru Kenyatta allocated Sh4 billion to the Ministry of Public Health, which translates to Sh20 million per constituency for the construction of health facilities.
The Director of Public Health Dr Shahnaaz Shariff told Capital News that the facilities will mainly be for maternal and child health in a bid to achieve the MDG’s.
He says these will be constructed in the neediest areas within constituencies.
“What we are targeting is the MDGs so we will be building maternities and children wards to reduce maternal and under five mortality,” he says.
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