Neglected Tropical Diseases on Aljazeera

Following on from our blog on NTDs last week, this is the broadcast from the Al Jazeera news channel publicising and explaining the partnership between Pharmaceutical companies, governments and the public. What are your thoughts, readers? Positive or negative?

And Public Private Partnerships in Water Development - (Swimming Pools and Power Showers??)

We have now sunk and capped the new community bore hole in Kimanjo.  Finding water was a great day. Still waiting for the hydrology report which will tell us the recharge rate along with the water quality. 

Despite the usual Kenyan hiccups in the process: transport dilemmas and break downs for the drilling rig as the November rains had washed out  roads; a broken rod down the borehole which meant many days of arduous work for the guys operating the machine etc. etc ;  this has been a project  enormously assisted at every stage by the District Water Officer who has unfailingly given practical assistance to mitigate hold ups and given sound professional advice throughout. His ability to overcome obstacles in the cause of getting water to a remote area shows how successful  the much vilified government agencies (how often are those two terms African government agency  and corruption used synonymously?)  can be when they have committed, honest, active  and knowledgeable personnel on the ground.  A good news story from an African government agency? Without doubt.

In the next phase of development we very much look forward to continuing this partnership with the  District Water Office to equip the bore hole with a solar pump, put in two pipe lines-  to the Primary and new secondary school, and a second to the upcoming Health Centre with  a new holding tank at the top of the village. In addition the extreme cooperation and assistance of the Kimanjo Water Users Association, and their highly active Chairman, have meant that achieving the necessary licenses and permits and the cooperation of the community has been made easy. Whilst in future wars will undoubtedly  be fought over water (and the lack of it)  in Africa, it must also be remembered that water is capable of uniting communities for the common good.Two good news Africa stories here then. On all those occasions when we are feeling cynical in the field of African development how important it is to remember the good days and so, so many  good people .

Does this mean everyone in Kimanjo will now be able to use water ad lib? Far from it. Even should the recharge rate be better than anticipated , families are unlikely to be collecting much more than 20- 40  litres of water a day. That is whole families.  Compare this to the US average  of 700 litres per day per person.... with 153 litres  per person merely for washing and drinking. The rural African average water consumption is around 30-40 litres a day, but far less in these semi arid and arid lands. One eight litre flush of the toilet in Europe will use more water than adults here would use in a day... with considerably less used during drought periods.

So.... no swimming pools or power showers just yet.... but, if our partnership with the Water Office continues as successfully as it has been for the past few months it should not be too long before life is a good deal easier for many women and children.. with the added advantage that our Health Centre build can now ramp up momentum.  And this will be down to a great Community effort.

Public -Private Partnerships – a way forward for Kenyan healthcare?

In 2012 Kenya has one doctor to 7,142 people  -  since only 2,300 doctors work in the public sector,  those unable to afford private care have to make do  with one doctor to   17,390 patients. Compare this to the USA  and UK where there is approximately one doctor to 450 people- whilst  lucky old San Marino has  a somewhat unrealistic  one doctor for every 21 people. Kenya’s ratio now falls behind both Afghanistan and Yemen.

Consequently the maternal mortality rate in Kenya stands at a shocking  530 per 100,000 live births significantly worse than in the 1980s; compared to the USA which has  17 per 100,000. To reach one doctor per 1000 patients, another 40,000 doctors are needed. Insufficient numbers of doctors are trained and each year doctors depart for better pay and conditions to America, Europe and Asia.

The irony of the situation was heavy in the November 2011 doctor strike when the dispute took longer than necessary  to reach arbitration because BOTH Health Ministers were abroad.......... seeking medical treatment.

The government spend on health as a percentage of the total budget is 5.4 %, lower than in the 1990s, compared to 15% in the UK. This transfers to an annual per capita spend on health of $23 whilst the UK spend is  $2,843 and a massive $7,420 in the US. Even with an agreement to raise the healthcare budget significantly major change in the doctor patient ratio is a long way off.

So what are the short and medium term solutions to improved health care, particularly in the much neglected arid and semi arid rural areas?

The GOK plan to build new health centres is a welcome start, and it is good to see some of these going up. Equipping of these health centres and staffing with clinical officers and nursing staff is the next step. NGOs are increasingly active in training of Community Health Workers, but in most instances these CHWs are expected to work in a voluntary capacity, meaning  little activity can be expected of them,  moreover these schemes need a good deal of clinical support and organisation that is frequently lacking. Likewise NGOs are enormously active in many other  areas  of health care, yet a lack of coordination mean that often efforts are duplicated whilst some populations are missed out.

The recent rollout to target 10 of the 17 Neglected Tropical Diseases through Bill Gates’ encouragement to create   an unlikely spirit of cooperation  with the world’s 13 biggest drug companies,  is an example of Public Private Partnership that  will undoubtedly have a major affect on these diseases. As Bill gates states, soon they will just be ‘Tropical diseases’, no longer deserving of  yet another  Three Letter Acronym  -  NTDs.

 The Health Ministries in Kenya appear very positive to embrace Public Private Partnerships in many areas and  perhaps this should be seen as a major bright light  for future health care development here.