Kenya health system has failed cholera test
What you need to know:
- If such an approach is aimed at downplaying the outbreak in order to save face, then it is a recipe for disaster. And the short rains expected in September are only likely to make things worse.
- We must answer key questions concerning the mandate and jurisdiction of the national and devolved governments when it comes to controlling infectious disease outbreaks or other national disasters.
- Perhaps a more appropriate response would be to address the system inefficiencies that have led to this situation, while at the same time preparing for the effect the coming short rains may have on the outbreak.
Over 120 confirmed and 30 suspected new cases of cholera have been reported in Migori and Kisumu counties respectively in the past week.
This comes in the wake of a number of political declarations across many counties that the cholera outbreak is over.
I see this as one of the strongest attestations to the lack of clear coordination in outbreak response within the devolved framework.
If such an approach is aimed at downplaying the outbreak in order to save face, then it is a recipe for disaster. And the short rains expected in September are only likely to make things worse.
The first cases of cholera were reported in December 2014, yet several counties delayed in declaring the outbreak and responding appropriately because they were concerned that it would cause shame and anxiety among the population.
OUTBREAK CONTROL
The Ministry of Health and the county departments of health have been unable to effectively control the outbreak, largely due to slow responses in many counties as well as the lack of clear harmonisation between the national and the county governments.
The national government declared that it was allocating Sh500 million to deal with the outbreak. However, without proper coordination between the national and the county governments, resources such as these will not have adequate impact.
We must answer key questions concerning the mandate and jurisdiction of the national and devolved governments when it comes to controlling infectious disease outbreaks or other national disasters. Who is in charge of detecting and controlling outbreaks?
Who should be held accountable for a poorly managed outbreak? How do we avoid turf wars between national and county governments in the response to such outbreaks?
In the US, the Centers for Disease Control and Prevention (CDC) has its mandate clearly defined as the health protection agency. Its jurisdiction is not limited by internal geographical boundaries and even extends beyond its borders.
With a clear mandate, jurisdiction, and pre-positioned resources, a country’s health protection agency should be able to swiftly respond to outbreaks without having to face the obstacles of bureaucracy.
DELAYED SUPPORT REQUEST
Some county governments have made formal requests to the national government for support. In most cases, the request was delayed, mainly to avert the “shame” that comes with cholera. A more progressive arrangement would see officers from the national government swiftly spring into action as soon as one case is reported.
The cholera outbreak does not make a case for or against devolution of health. However, it underlines the need to clearly define the mandate and jurisdiction of national and county governments when it comes to cross-county outbreak response. This is vital and may save many lives in time-sensitive ravaging outbreaks such as Ebola.
Cholera is one of the diseases that has a predilection for the poor. Perhaps a more appropriate response would be to address the system inefficiencies that have led to this situation, while at the same time preparing for the effect the coming short rains may have on the outbreak.
Dr Wanjala is the deputy medical coordinator for Médecins Sans Frontières in Kenya
