In-depth: A deadly funding crisis

KENYA: Better funding key to improving rural HIV care

Photo: Obinna Anyadike/IRIN

Bringing HIV services to villages boosts efforts to prevent mother-to-child HIV transmission (file photo)

KAKAMEGA, 1 December 2011 (PlusNews) - When Christopher Okanga and his wife tested positive for HIV in 2006, they halted all plans to have children.

"We had just got married and we were looking forward to having children of our own, but I soon fell sick and went to the hospital to get treatment. I was referred to the voluntary counselling centre and I was later told I had HIV," Okanga told IRIN/PlusNews at his home in Kilingili, in Kenya's Western Province.

After his wife, Evelyn Cherutich, received her own positive diagnosis, the couple began seeking treatment at the nearest district hospital, some 60 km away. Their local health facility, the Kilingili health centre, was then not equipped to provide HIV services.

"I had to travel a long distance to get treatment and the services there were not very good because there were many people and the nurses had to attend to all of them - they didn't have much time to share with the many patients," Okanga said.

In 2008, the Kilingili health centre started receiving support from the Elizabeth Glaser Paediatric AIDS Foundation through the AIDS Population Health Integrated Assistance (APHIA Plus), funded by the United States Agency for International Development.

The money enabled the centre to start providing HIV services, including prevention of mother-to-child HIV transmission (PMTCT). Today, Okanga and Cherutich are the proud parents of two HIV-negative children.

"We go to the hospital and the nurses there teach us how to keep our children negative... we have also joined a support group, and we get our drugs easily because the hospital is near home," said Cherutich.

"With support from development partners, we have been able to integrate HIV programmes in our maternal and child health programme," said Zipporah Ombogo, a nurse at the Kilingili centre.

"[This] has helped us reduce cases of missed opportunities - when you have the opportunity to net all mothers and their spouses within that centred approach, it gets better results in trying to prevent mother-to-child transmission," she added.

This year, just one of the 39 babies whose blood samples were taken at the health centre tested positive. The number of women giving birth at the health centre has also gone up significantly. "In isolated cases where the child turns out positive, history reveals that they were delivered at home," Ombogo noted.

According to Dinah Akali, a nurse at the Kimilili District Hospital, in western Kenya's Bungoma North District, improved HIV services at a health facility act as an incentive both to the patients and the medical personnel.

"When you are able to offer better services to HIV patients as a health worker, it is an incentive because you know you will give the service, and the patient knows when they visit your facility, they will get the service they need," she said.

Health workers at less well funded facilities say they are frustrated by their inability to help people in need. "When we test mothers here and find them to be HIV positive, we refer them to another facility to get treatment, but we don't know how many of them actually go there," said Herine Onyango, a nurse at Gobei health centre in western Kenya's Bondo District.

"So you have an expectant mother who is HIV-positive, but you really can't know if they get any treatment. Sometimes, the next time they come to the facility, they show up with an HIV-positive child," she said.

Let donors do their bit, but we owe it to Kenyans as a government to invest heavily in health programmes. At the moment, I am afraid, we are not doing that

Dr Michael Audo, deputy director of APHIA Plus in Western Kenya, said improving funding to rural areas is critical to having an HIV-free generation. "It is important to ensure that health programmes are adequately funded; only this can help to realize better provision of HIV services."

Increasing government spending

Kenya's estimated funding gap in providing HIV services until 2013 is estimated at US$1.67 billion. In 2010, the national budget set aside an unprecedented 900 million Kenya shillings - about $10.5 million - for the purchase of antiretroviral (ARV) drugs, but much more money is required to put around 600,000 people thought to need treatment on ARVs.

Prof Peter Anyang' Nyong'o, Kenya's Minister for Medical Services, says donors have been critical in providing funding, but it is the time the government increased its own funding for health programmes.

"We must start to appreciate that the government has a role to play in funding health initiatives - that is more sustainable, because we are doing it with the resources that we have," he said. "Let donors do their bit, but we owe it to Kenyans as a government to invest heavily in health programmes. At the moment, I am afraid, we are not doing that."

Nyong'o says reliance on donor funding for health programmes has created a situation where there are vast disparities in the quality of care.

"When you have facilities unequally funded, and programmes funded on preference of donors, then you end up having excellent results in one area and lagging behind in another," he said. "I believe the government would be in a position to distribute funds equally to all programmes and facilities."

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A deadly funding crisis
December 2011

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