The health stories we won't forget and what 2020 holds

It has been a year marked by milestones from new vaccines for deadly diseases to a law that meant life for recipients of organs. But, along the way there were hitches that threatened crucial programmes.

Vaccines

In September, Kenya became the third African country to start the routine immunisation of children against malaria using the world’s first vaccine. Kenya was picked by the World Health Organisation (WHO) for the malaria drive to vaccinate 360,000 children per year. The drive has already taken place in eight counties in Western Kenya and all endemic counties in a pilot that will end in 2021.

Mosquirix, the brand name for RTS, S vaccine, triggers the immune system to defend itself against the first stages of the disease shortly after a malaria parasite enters the bloodstream through a mosquito bite.

Children in the eight counties will receive four doses of RTS, S at six, seven, nine and 24 months in addition to standard vaccines.

Kenya also became the 16th African country to introduce the cervical cancer vaccine. The Human Papillomavirus (HPV) vaccine works by preparing the body to fight the germs that cause the infections.

The vaccination rollout in Kenya targets 766,207 girls aged 10 and will cost the government Sh467 per dose for the same vaccine that costs more than Sh10,000 in high-income countries.

The vaccine is most effective when given to girls before they are sexually active and could be exposed to the virus.

Two doses of the vaccine are given to the girls six months apart at about 9,000 public, private and faith-based centres countrywide.

Health Act 2017

Signed into law in June and published in July, the 2017 Health Act operationalises and ensures important constitutional provisions for health services. Before its enactment, organ transplant donation procedures were not clear. With the law in place, patients have hope as it now allows people to donate their organs to others or for research when they die.

The law also gives weight to some of the more aspirational health language in the Constitution. It seeks to safeguard access to healthcare services for vulnerable groups by making clear the government’s obligation to provide these for women, the elderly, the disabled, children, youth and members of minority or marginalised communities.

The Act also instructs the national government to expand free maternity care and childhood immunisation by mandating funding for these services through ring-fenced, conditional grants — grants earmarked for a specific activity and must meet certain conditions. Employers and all formal workplaces will also be required to provide breastfeeding facilities to promote the well-being of infants, and health facilities must provide emergency care or face punitive measures.

ICPD

For the second time since 1994, renowned population and development scholars, scientists and researchers met in Nairobi in November for the International Conference on Population and Development (ICPD). The 179 governments present at the Nairobi meet reaffirmed their commitment to the goals they set in Cairo 25 years ago to end the unmet need of child spacing, to end preventable maternal deaths, to end sexual and gender-based violence and to end early marriages and other harmful practices against women and girls.

Countries agreed to bring down to zero cases of maternal and infant deaths, and gender-based violence by 2030.

For instance, as a way of reducing unsafe abortions, Kenya is expected to reinstate post-abortion care guidelines which had been revoked.

The aims of the ICPD are rooted in the sacred value and dignity of every human life.

Mental health task force

President Uhuru Kenyatta directed the Health ministry to establish a task force to assess the status of mental health in the country.

The team is expected to come up with new policies to address growing concerns about mental health among Kenyans.

The team’s findings will help the government in allocation of resources to mental health.

The task force is expected to assess the mental health systems including the legal, policy and administrative environment to identify areas that may benefit from reform for optimal delivery.

In addition, the team will consider the changing societal dynamics and associated threats to mental well-being such as substance abuse, gambling, sexual and gender-based violence, cyber bullying, child abuse and neglect.

Health Cabinet Secretary Sicily Kariuki said the implementation of the national mental health policy will create a sustainable response mechanism, including resource mobilisation, training and creation of awareness.

UHC pilot

Four counties have this year taken part in the Universal Health Coverage (UHC) pilot which kicked off in December last year.

Residents of Isiolo, Machakos, Kisumu and Nyeri have been receiving next to free medical services as part of the programme ahead of the nationwide roll-out.

About 80 per cent of the money for the pilot has gone into the purchase of drugs and basic medical equipment, the Health ministry said, with additional Sh800 million allocated to each of the regions for complicated cases that would be referred outside the participating counties.

The pilot has had its fair share of troubles especially in Kisumu where doctors have been on strike for the three months. Counties have also had to grapple with drug shortage.

The ministry’s approach to achieving UHC has been through removal of user fees at all public hospitals, including level four and five facilities and ensuring commodity security through the Kenya Medical Supplies Authority (Kemsa). Kemsa, however, has been unable to deliver 100 per cent of the required drugs.

The hospitals have also experienced a surge in numbers where the county data shows a 300 per cent increase, which could mean trust in the facilities or easier access to healthcare given the low costs.

Cuban doctors

A deal that would see 100 Cuban doctors come to Kenya was sealed in 2018. Under the agreement, 47 would work as specialists and 53 family physicians would be deployed to the counties.

At the same time, Kenya secured space for its 50 doctors to study in Cuba, famed for its world-class healthcare system.

The programme was meant to instill much-needed skills in the ailing sector.

However, this year, the suicide of a Kenyan doctor who was sponsored by the government to study family medicine in Cuba exposed the programme’s soft underbelly. Kenya Medical Practitioners, Pharmacists and Dentists Union Nairobi Secretary-General, Dr Thuranira Kaugiria, said the doctors who travelled to Cuba were given a raw deal and had on several occasions unsuccessfully sought to air their grievances with the ministry.

Here in the country, two Cuban doctors were kidnapped in Mandera County which led the ministry to reassign 10 medics stationed in border counties to Kenyatta National Hospital, National Spinal Injury Hospital, Mathare Mental Hospital and Kiambu County hospitals.

Research and development

For the 37 million people who have HIV around the world, the news of a possible cure for the disease was more than welcome.

A London patient with HIV became the second person ever to be free of the virus after a bone marrow transplant, raising hopes of a cure. In 2007, another patient — identified as “the Berlin patient” — received a bone-marrow transplant from a donor with natural immunity to the virus.

Timothy Brown, the so-called Berlin patient, who later went public, and the London patient, who does not want to disclose his identity, received stem cells from a donor with a rare genetic mutation of the CCR5 gene, making them HIV-resistant. Brown has been virus-free ever since. The London patient stopped taking the medication 18 months ago and there is no sign of a return of HIV.

The procedure in itself can never be offered as a cure for HIV infection because stem cell transplants carry risks.

Food and nutrition

An exposé by NTV investigative team revealed how supermarkets are using toxic chemicals to make their meat look fresher for longer.

The exposé, which involved laboratory tests on meat samples which revealed that supermarkets use chemical as a food preservative to keep the food fresh for longer.

The documentary highlighted how rotten the system is. The fact that more than one supermarket was doing it means that it is an open secret which led the Ministry of Health to conduct a random survey on the safety of meat sold in the capital city.

The survey exposed just rotten the system is the results showing that six out of 40 samples collected tested positive to the preservative Sodium Metabisulfite which is harmful in large doses.

All the meat in the affected outlets were destroyed and some outlets were closed.

Floods

The year was characterised by adverse weather conditions, with drought being experienced at the start of the year and heavy rainfall at the end.

Just before the start of the short rain in October, between August and October, at least 3.1 million people were projected to be facing acute food insecurity.

The most hit areas were Turkana, Marsabit, Mandera, Wajir, Garissa, Tana River and Baringo counties, according to the Integrated Food Security Phase Classification report.
Then came the floods caused by the October-November-December rainfall.

As of December 2019, at least 130 people had been reported dead from the flooding and landslides and more than 17,000 displaced.

Earlier in December, the government announced it had set aside Sh6.1 billion to restore infrastructure damaged by floods.

What to look out for

Blood test for breast cancer

Recent findings by scientists from University of Nottingham in England that a blood test could potentially detect breast cancer at least five years before other symptoms and lumps appear, could just be the answer to the killer disease that claims lives in millions globally.

A more elaborate research on the blood test is set to kick off in 2020. According to the scientists, if all goes well, the test could be in the market within the next five years.

According to the Kenya Medical Research Institute cancer registry, eight out of 10 cancers in the country are detected late due to low awareness of symptoms.

Breast cancer is the second most common type of cancer in the country, with women under 50 accounting for 50 per cent of cases.

The test, which would be much cheaper and easier to conduct than a mammogram, looks for autoantibodies – which are produced by the body in reaction to the presence of cancer bodies in the blood. According to WHO’s International Agency for Research on Cancer, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. One in five men and one in six women worldwide develop cancer during their lifetime, and one in eight men and one in 11 women die from the disease.

“These new figures highlight that much remains to be done to address the alarming rise in the cancer burden globally and that prevention has a key role to play,” said International Agency for Research on Cancer Director Christopher Wild.

UHC nationwide roll out

Kenyans countrywide will experience UHC in 2020. This is after a 12-month pilot programme that has been running in the four counties of Nyeri, Machakos, Isiolo and Kisumu.
Speaking during the last meeting of the Council of Governors held early this month in Nairobi, chairman Wycliffe Oparanya hinted that counties are ready for the roll out.

“But, the national government should find ways to solve the challenges that have been experienced in the four counties,” he said.

Speaking to HealthyNation, Cabinet Secretary Sicily Kariuki had said her ministry was ready for the scale up and had outlined the challenges experienced. “The lessons we have picked is that once we invest right, once we are consistent and speak to the population, the issue of confidence comes back within the shortest time possible,” she said.

Malaria larviciding

The Kenya-Cuba relationship is set to bring in an additional tactical move in the fight against malaria in 2020. The ministry is setting sights on the introduction of malaria bio larvicide method to combat transmission in endemic areas.

Larviciding refers to the regular application of chemical or microbial insecticides to water bodies or water containers to kill the aquatic immature forms of the mosquito (the larvae and pupae).

According to Ms Kariuki, the collaboration with the Cuban government would help Kenya learn how the country eradicated the disease.

“In the first quarter of the coming year, we have identified the experts that we will require to bring in and train our own people in collaboration with the experts coming from Cuba.

It is good to note that there is no malaria in Cuba. They got to that stage by applying the technology, which we believe will play a big role in Kenya in the fight against Malaria,” she said.

The aim of larviciding is to reduce the adult population of mosquitoes by killing the aquatic immature forms, so that fewer will develop into adults. This should reduce the number of mosquitoes that bite and infect humans with malaria.

Additional reporting by Bernadine Mutanu