The counties that make up the Luo part of the former Nyanza province are not in a good place – healthwise. This has been so for a while. But the problem faced, is that many public health issues are not linear but exponential in nature, that is they compound, when not addressed in a timely fashion.
In the 1962 census, Luos (1.15 million) were the second largest community in Kenya after the Kikuyu (1.65 million). In the 2019 census, Luos (5 million) were counted as the fourth largest community after Kikuyu (8.1 million), Luhya (6.8 million) and Kalenjin (6.35 million). They will soon be fifth.
The population figures in themselves are not a public health issue. What is of concern is that population figures tend to go down relative to others when there are extremes, either increased wealth or increased disease or war.
We are not at war, Luo Nyanza is so prosperous relative to other Kenyans to explain the drop in population, so it leaves disease as a possible explainer. The major disease is HIV-Aids. We can use Siaya county as an example.
The population of Siaya is about one million, about half of whom are children, so about 500,000 are adults. Of these adults around 100,000 are on HIV treatment. There are 250,000 households in Siaya. So, what this means is that on average every second household has someone with HIV.
Pause for a moment for this to sink in. Most of Siaya is rural. That means that what they call a home – typically a cluster of households around a patriarch – will have several households. So on average every home in Siaya will have several people with HIV. Yet this represents progress by the health sector. Because they are alive.
In the last 10 years, the number of people in Siaya dying from HIV-Aids-related disease has gone from 30,000 a year to about 10,000 a year. That is still high – around 30 deaths a day. Without the public health work going on – the health systems strengthening that creates awareness, traces, tests, puts on treatment and follows up the patients with HIV, the population of Siaya would have disappeared in the next 20-30 years.
In case you think this is a Siaya county problem only, these figures are mirrored across any of the Luo counties. Alarmist? No. Alarming? Yes.
Alarming for two reasons. The first is that HIV infection is still going on. Mother-to-child transmission, which is 100 per cent preventable if a mother with HIV gives birth in a health facility and is given treatment to stop the virus from entering the newborn baby, is still happening across Kenya.
The second reason is that much of HIV care in Kenya is funded by donors from outside of the country, friendly governments but with their own foreign policy agenda. As we saw when Covid-19 pandemic started, when it is necessary to make the choice, every country chooses to protect its own citizens first. Across the world, there are currently economic difficulties. You can work out what will happen next.
There are myths about the ostrich, that it buries its head in the sand and that it has poor eyesight. Neither is true. It is humans who with age, develop presbyopia, the inability to focus on near objects; so that even when the problem is staring you in the face, the details are still hazy, unless, that is, corrective glasses are worn.
Few take the time. Many are stuck in a time warp and a lot of hand-wringing. Our ability to bury inconvenient facts is legendary. But here we have a real and big public health problem that touches at the core of public policy, what government should be concerned with.
HIV is a chronic disease and care is lifelong, taking pills every day, visiting the health facility several times a year for check-up, at risk of developing non-communicable diseases like diabetes and obesity because of the drugs.
Financing HIV care is not cheap. Relying on foreign donors to pay for our healthcare forever is not a good long-term strategy. Fundraising for the dead, attending burials every weekend and having many partial orphans unable to complete their education because poor families have lost a breadwinner just mimics ostrich behaviour.
Good health is the foundation upon which agriculture, business and education build. Is it really possible to develop when the health status is in such a precarious state?
