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"id": 211569,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/211569/?format=api",
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"type": "speech",
"speaker_name": "Mrs. Ngilu",
"speaker_title": "The Minister for Health",
"speaker": {
"id": 111,
"legal_name": "Charity Kaluki Ngilu",
"slug": "charity-ngilu"
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"content": "Mr. Temporary Deputy Speaker, Sir, I beg to move that Mr. Speaker do now leave the Chair to enable me initiate debate on Vote 11 of the Ministry of Health. Over the last three years, my Ministry has been implementing a programme to improve the quality of health services in the public health centres. The main components of the programme include improvement of infrastructure, provision of equipment, strengthening supply of drugs and commodities, increasing and training health workers and improving referral systems. Mr. Temporary Deputy Speaker, I am happy to note that we are already seeing the results of the investment in terms of increased utilisation of services and improved health outcome. The Government has over the four years increased funding to the health sector as stipulated in the Economic Recovery Strategy (ERS). Mr. Temporary Deputy Speaker, Sir, in the 2007/2008 Financial Year, my Ministry will receive Kshs34.4 billion up from Kshs18.3 billion in 2002/2003; an increase of over 88 per cent. Although these funds are still not adequate to address the many challenges facing the health sector, the resources have enabled us to reserve health care indicators which were on a declining trend. Mr. Temporary Deputy Speaker, Sir, the immunisation coverage is now at 72 per cent up from 57 per cent 57 per cent in 2003, while the HIV/AIDS prevalence has come down to 5.9 per cent from 14 per cent and 6.7 per cent in the year 2000 and 2003 respectively. July 31, 2007 PARLIAMENTARY DEBATES 2839 The number of people on anti-retroviral drugs has increased from 2,000 in the year 2003 to close to 160,000 today. In addition, the increased funding has facilitated us to provide the following inputs in the 2006/2007 Financial Year, which are critical for service delivery. We have procured essential drugs for our health facilities worth Kshs1.8 billion. This has enabled us to have adequate drugs especially in our rural health facilities. We have procured equipment worth Kshs1 billion to replace obsolete ones. In January, 2007, each health centre and dispensary received a minimum set of diagnostic equipment which included, among others, blood pressure machines and delivery kits. Mr. Temporary Deputy Speaker, Sir, hospitals have also received the most critical items such as X-Ray machines and theatre tables based on their priorities. We have provided, to each dispensary and health centre, Kshs40,000 to Kshs60,000 respectively, for refurbishment. I am sure, hon. Members have seen improvements on the look of these primary level units. Mr. Temporary Deputy Speaker, Sir, malaria continues to be a major killer although preventable. To combat the disease, my Ministry has introduced a new treatment policy on malaria using arthemisinin combination therapy to address the problem of resistance to sulphur diaxon pyremethamin. We have also launched a malaria campaign whose focus will be to eradicate the disease. To this end, last year we issued more than 3.4 million bed nets targeting children and the pregnant mothers. Through this campaign, 68 per cent of children under five years received bed nets. It is estimated that 52 per cent of them, sleep under a bed net today. In addition, we have sprayed over 600,000 households in 16 malaria epidemic-prone districts and this efforts will be intensified to contain spectre. Mr. Temporary Deputy Speaker, Sir, in recognising that health care expenditures continue to impoverish households and hence the need to reduce the household burden to seeking care, the Government continues to provide free drugs for malaria, HIV/AIDS and Tuberculosis (TB) in public and faith-based health facilities. We have also removed fees payable for delivery services in all dispensaries and health centres as a means of encouraging mothers to deliver at the nearest facility under the supervision of a skilled health worker. This will go a long way in reducing the high maternal mortality rates, especially among poor women. Mr. Temporary Deputy Speaker, Sir, the above initiatives have brought back the consumers confidence to the public health care system. I am happy to note that we have observed 50 per cent increase in workload in public health facilities in the last one year. According to the Client Satisfaction Survey (CSS) undertaken by my Ministry, 76 per cent of the respondents reported that the services were friendlier, while 72 per cent reported improved availability of medical supplies in our health facilities. The increased utilisation of services in public health facilities have had a negative impact on services offered by other providers, especially the faith-based organisations. Mr. Temporary Deputy Speaker, Sir, due to reduction in workload in the faith-based organisation facilities, their revenues has also declined. Most of them, are unable to stay afloat. The Government realises that faith-based organisations are a major provider of health care services, especially in the rural areas. In order to prevent the faith-based organisations from collapsing, the Government will continue extending support to these providers. To date, a total of 70 doctors and 379 nurses have been seconded to the faith-based organisations. I will extend support to faith-based organisations in the Financial Year 2007/2008 by providing a drug kit in every three months to all dispensaries. Mr. Temporary Deputy Speaker, Sir, I am happy to note that hon. Members are allocating a big chunk of the Constituencies Development Fund (CDF) to the health sector. This will greatly assist in expanding the health sector network thereby increasing access to health services, especially in under-served parts of the country. I have already gazetted 294 facilities. A further 336 facilities will be gazetted this month. These 596 dispensaries will be operationalised by posting one 2840 PARLIAMENTARY DEBATES July 31, 2007 nurse and providing them with drug kits. Mr. Temporary Deputy Speaker, Sir, the development of health infrastructure in the country will need to be undertaken in a rational approach to ensure equity. To date, there are areas where patients have to travel more than 50 kilometres to the nearest health facility compared to overall average of a distance of nine kilometres. To guide the health infrastructure development process, my Ministry will be undertaking a health facility mapping which will provide the necessary information for policy development. This information will also assist the hon. Members to target CDF funds appropriately. Mr. Temporary Deputy Speaker, Sir, the Government is aware of the low absorption of budgetary resources attributed to bureaucracy in financial and other logistical management systems within the health sector. My Ministry, in consultation with the Ministry of Finance, intends to streamline and enhance community participation and ownership in the management of health resources at the local level through a review of the legal and administrative framework. I will soon be presenting amendments to the Public Health Act to facilitate disbursement of funds to the health institutions. In order to ensure accountability at the health facility level, I intend to train the health facility committees and the boards to empower them to become public watchdogs for funds and commodities issued to these institutions. Mr. Temporary Deputy Speaker, Sir, to date, we continue to operate our health care systems with staffing norms below those recommended by the World Health Organisation (WHO). For example, there are 16 doctors, two dentists, 15 clinical officers and 88 nurses per 100,000 population each with considerable variation within and between provinces. There also exists regional disparities with North Eastern and Nyanza provinces falling below the national average while Central and Eastern provinces are significantly higher. In order to respond to the human resource strategy, my Ministry will embark on developing a human resource strategy which will identify the demand both in terms of numbers and skills and realign the training output to meet the demands. The human resource strategy will review the health sector in totality in line with the sector-wide approach. Mr. Temporary Deputy Speaker, Sir, maternal mortality remains high, primarily due to lack of access and under-funding of the healthcare systems. In Kenya, maternal mortality stands at 414 per 100,000 deliveries. This means that every year we lose over 5,300 mothers during delivery. These are women who, today, would be contributing to economic development of our country. While there has been an increase in contraceptive uptake, it is estimated that 26 per cent of women in reproductive age group have no access to family planning services when needed. This is because of frequent shortages of these commodities in our healthcare systems. In order to reduce the maternal mortality rates, I intend to scale up the provision of reproductive healthcare services targeting the youth. As indicated earlier, the provision of free delivery services at primary level facilities would go a long way in reduction of maternal mortality. My Ministry has over the past years invested substantial resources to upgrade equipment and infrastructure to enable our facilities provide emergency obstetric care services. Mr. Temporary Deputy Speaker, Sir, my Ministry recognises the need to intensify preventive health programmes in order to reduce the disease burdens in our populations. It is against this background that I intend to implement community strategy as a means of reaching more people to take care of their own health. Through the strategy, communities will be encouraged to take care of their own health by adopting simple preventive actions to avert outbreaks of diseases such as cholera and other diseases. The public health officers will be used as a springboard to intensify community supervision and education as was the case in the 1970s. It has been observed that where transport is available, the services utilisation, especially July 31, 2007 PARLIAMENTARY DEBATES 2841 maternity services increases since the patients are assured of immediate referral in case of any complication. As a result, the Government has continued to beef up the stock of available vehicles over the last three years. In 2006/2007, a total of 150 ambulances were procured and disbursed to our hospitals. As part of our commitment to support the faith-based organizations, the Ministry issued 15 ambulances to faith-based organization facilities. In 2007/2008, I intend to allocate Kshs50 million towards purchasing of additional ambulances. Mr. Temporary Deputy Speaker, Sir, drugs and non-pharmaceuticals are a critical input to the overall patients management. To ensure availability of drugs in public health facilities, I intend to allocate Kshs2.5 billion or 11 per cent of the Recurrent Budget. As a minimum, each dispensary and a health centre will receive a drug kit every three months, while hospitals will order their requirements based on their drawing rights. In addition, Kshs274 million will be allocated to Kenya Medical Supplies Agency (KEMSA) to facilitate distribution of medical commodities to the door- step of all health facilities. We have labelled our drugs \"GOKMOH\" for ease of identification. My Ministry has supplied equipment worth Kshs1.7 billion in the last two years to health facilities. I would like to observe that the status of the equipment in most health facilities is still wanting and we will continue replacing them. I intend to allocate over Kshs600 million for the replacement of equipment this year. Emphasis will be given to procurement of basic equipment necessary to make our facilities operational. Mr. Temporary Deputy Speaker, Sir, HIV/AIDS continues to be a major challenge to the health sector and to the economy. As you will recall, His Excellency the President announced provision of free Anti-Retroviral (ARV) treatment in public health facilities last year. To support this policy directive and reduce donor dependency, I will allocate Kshs325 million for procurement of ARVs. This will be in addition to what we will receive from the Global Fund and from PEPFAR. Drug-resistant tuberculosis (TB) is emerging as a key health problem. Some of the drug- resistant TB cases have increased from zero in 1995 to about 0.86 per cent of smear positive cases. About 50 per cent of multi-drug-resistant TB cases in Kenya are from neighbouring countries where TB programmes have been weak or non-existent as a result of civil strife, for example, Somalia and Southern Sudan. I intend to construct an isolation ward at Kenyatta National Hospital (KNH) to cater for these TB cases. It is estimated that over 74,000 people a year or 200 people a day, die of TB. All these deaths are preventable if people adhere to treatment protocols. I will allocate Kshs120 million for the procurement of TB drugs which will be provided free in all public facilities. My Ministry appreciates support provided by the Global Fund; Global Alliance for Vaccines and Immunization (GAVI) for the supply of vaccines which has enabled us to immunize over 70 per cent of 1.3 million children every year. However, the immunization programme is compromised by ageing cold-chain equipment. In order to replace this equipment, I will allocate Kshs234 million for purchasing of refrigerators. In addition, Kshs335 million will be allocated for the procurement of vaccines which includes Kshs110 million as our contribution to the GAVI Initiative. Mr. Temporary Deputy Speaker, Sir, the availability of water is critical for maintaining cleanliness in health facilities. Most hospitals have no alternative water source and often request patients to bring water when the main source is broken down. Hon. Members will have observed pregnant mothers carrying five litre jerricans of water to the hospitals which is used during delivery. To assist the hospitals secure a second source of water, I will allocate Kshs150 million for water supply. This will be for the provision of electro-mechanical works for the boreholes drilled in 31 districts. The demand for family planning services is on the increase and hence the need to ensure security of commodities. In the past, we have relied heavily on our partners to procure family 2842 PARLIAMENTARY DEBATES July 31, 2007 planning commodities. I would like to particularly thank the Germany Government and UNFPA for their support. In the year 2007/2008, my Ministry will allocate Kshs468 million for the procurement of family planning commodities. Mr. Temporary Deputy Speaker, Sir, the state of bedding and linen in our hospitals needs to be improved. Although some funds have been allocated to procure linen, this has not been enough due to the high wear and tear. I intend to allocate Kshs243 million for purchasing of linen and patients' uniforms. This will go a long way to further improve the image of our facilities. Mr. Temporary Deputy Speaker, Sir, one of the stalled projects in my Ministry is the staff houses at Kenya Medical Research Institute (KEMRI). These staff houses project which comprises a total of 126 houses stalled in 1994. The project which has been a subject of discussion by Public Investment Committee (PIC) requires approximately, Kshs270 million to complete. The project is expected to take ten months to complete. I intend to allocate Kshs150 million this Financial Year with the balance to be provided in 2008/2007. Mr. Temporary Deputy Speaker, Sir, the National Hospital Insurance Fund (NHIF) continues to mobilise funding for the health sector with members contributing approximately Kshs3.7 billion every year. The fund offers the cheapest family based in-patient cover to Kenyans based on social health insurance principles. The Fund has remarkably improved its benefits and has started financing a comprehensive healthcare package in over 222 contracted Government, faith- based and private hospitals. Mr. Temporary Deputy Speaker, Sir, a total of 145 hospitals are, so far, recognized by the National Health Insurance Fund (NHIF), and they provide services on a non-discriminatory system to members and their dependants."
}