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September 26, 2017

Afya house cash cut: blow to urban poor women

Jane Akinyi a resident from kibera with International actress and humanitarian ambassador Tasha de Vasconcelos at the Kazuri Beads and pottery company in Karen state Apr 20 2017./HEZRON NJOROGE
Jane Akinyi a resident from kibera with International actress and humanitarian ambassador Tasha de Vasconcelos at the Kazuri Beads and pottery company in Karen state Apr 20 2017./HEZRON NJOROGE

The Global Fund is currently camped in the country as investigators probe whether any of its funding to the Ministry of Health was misappropriated. This is not the first time, they were here in 2010 over graft allegations.

They are also not the only donors showing significant agitation of the Afya House mega scandal, others are likely to follow suit.

The Sh5 billion scandal at Afya House alleged to have vanished instead of going into strengthening the health system while also providing crucial health services in public health facilities that largely cater for the poor and the marginalised is back in the spotlight.

US government has suspended financial support to the tune of Sh2 billion in a vote of no confidence to the ministry of health over graft claims.

A statement released by the Deutsche Stiftung Weltbevölkerung which is a leading stakeholder in the health sector indicated that this move is likely to affect health service delivery in public facilities in the long term.

However, activities that directly strengthen county health systems, surveillance and service delivery are exempt from the suspension, this move is not likely to be very severe and immediate.

Coming in the heels of other global developments such as the gag rule that are also expected to impact the health sector, the suspension will however have dire consequences to the health sector the longer it stays in place.

Further deepening the marginalisation of certain key populations that are already excluded such as the urban poor women.

The urban poor do not necessarily have better access to services based on the mere fact that they are close to them.

Statistics show that the “urban advantage” does not exist. Urban poor women are worse off than their rural counterparts who have to travel for many kilometres to access the nearest clinic.

The reinstatement of the global gag rule by the Donald Trump administration is going to have far-reaching immediate consequences for such women.

President Trump has essentially returned a ban on the United States funding of any international agency that provide any kind of abortion services, including counselling or providing advice to women on abortion.

Affected organisations include the United Nations Population Fund, which promotes family planning in many developing countries.

Family planning is crucial to improving maternal health in general and in reducing maternal deaths specifically.

Reproductive health experts such as Evelyn Samba of the Deutsche Stiftung Weltbevoelkerung have extensively documented the impact that the 2001-2009 gag rule had in Kenya.

In just four years, at least 9,000 Kenyans had lost access to crucial health services.

This was as a result of the closure of eight reproductive health services operated by NGOs due to a lack of funding.

Within this context, the urban advantage will only exist in theory. Despite urban poor women being close to services, this has not necessarily improved urban inclusion.

As a matter of fact, reports among women working in the four major flower farms in Naivasha show that this is a highly marginalized cohort where massive exclusion exists.

These reports further show that there has been too much focus on the urban poor in Nairobi slums and little focus on the urban poor in satellite towns such as Naivasha, Thika and Narok where reproductive health services are needed in equal measure.

Trends on maternal mortality nationally have been on a steady decline. According to the Kenya Demographic and Health Survey (KDHS) of 2014, maternal deaths now stand at an estimated 360 deaths in every 100,000 live births.

This is down from 488 deaths in every 100,000 live births in the 2008/09 KDHS report.

But for the urban poor such as those working in Naivasha flower farms, the numbers remain alarmingly high.

The burden of maternal mortality is heaviest among the urban poor where maternal deaths are estimated to be as high as 700 deaths in every 100,000 live births.

With dwindling funding for family planning and other reproductive health services, the situation is dire for these women.

Two issues at play, if Kenya is unable to close the gap in the unmet need for contraceptives there will be consequences.

Unmet need for family planning had dropped from 25 percent in 2008/09 to 18 percent. These are women who would like to use family planning methods but they do not have access to them.

The percentages are much higher among urban poor who still lack access to quality health care.

In the absence of sufficient family planning for all women who need them, this will consequently lead to unwanted pregnancies which will also lead to unsafe abortions.

In 2007, at the height of the 2001-2009 gag rule, an estimated 360,000 abortions were induced in that year alone.

In that same year, a group of NGOs working in the area of reproductive health and rights released a report which revealed that at least 40 percent of maternal deaths were a direct consequence of unsafe abortion.

Needless to say, a majority of them were urban poor women who are constantly in close proximity to backstreet clinics and quacks who offer abortion services using life threatening methods.

When structures that hold sexual and reproductive health services begin to collapse, it is the urban poor who feel the impact the most.

Government statistics show that nearly a quarter of women will have started child bearing by age 20. It is the urban poor woman who is more likely to have started child bearing by age 20.

But among the urban poor women be it those in Nairobi slums or the neighboring Nakuru County, the number of women who will have had a child by the age of 20 will be twice that of the national level.

This means that nearly a half of the urban poor women start child bearing by the age of 20 years.

The younger a woman is when she starts to have children, the higher are risks and complications she is likely to encounter during child birth.

Young urban poor women are highly vulnerable especially in light of statistics that show that at least 60 percent of maternal deaths occur in women aged 20 to 29 years.

This backdrop and dwindling donor funding is a wake-up call to both national and county governments to prioritize sexual and reproductive health services and to exercise zero tolerance to corruption.

In the absence of domestic funding, urban poor women are facing even tougher times ahead.

Domestic-driven interventions should focus on both the demand as well as the supply side.

The demand side interventions should remove barriers that hamper utilization of available services such as the attitude of health providers as well as the quality of services and products on offer.

The supply side should address the entire system and infrastructures around the health system. Such challenges could be in relation to human resources where frequent labor unrest can lead to a continued disruption of crucial services.

This can be achieved through partnerships between the government, private sector as well as NGOs.

These engagements and intolerance to graft will not only address existing challenges that continue to solidify the exclusion of the urban poor woman, but will lead to solutions that are not only practical, but sustainable.

The writer is a Nairobi based Science and Health Journalist

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