The Government of Kenya faces an
unprecedented crisis for which it has
instituted certain non pharmaceutical measures to respond, in order to secure its population. Since
29th January 2020, when the WHO Director-General Dr Tedros Adhanom Ghebreyesus
declared the 2019-nCoV outbreak a public health emergency of international
concern, countries started rolling out evolving strategies to curb the pandemic’s
ravaging consequences in a fluid and fast paced environment. Even the most advanced economies are learning
as the pandemic evolves. The Institute of Business Forecasting and Planning predicts
that although total accumulated cases in the USA currently stand at 1,208,904 with
total accumulated deaths at 69,458, by July these figures would rise to a total
accumulated caseload of 1,830,796 and total accumulated deaths of 94,194[i].
Upon the WHO declaration, on 11 March 2020, of 2019-nCoV as a pandemic, Kenya’s
Cabinet Secretary for Health (Health CS) declared COVID-19 a notifiable disease
vide Gazette Notice No. 2787 of 2020 and subsequently, declared it a formidable
epidemic vide Legal Notice No. 37 of 2020 in exercise of powers conferred
by Public Health Act.
OPPORTUNITIES
OPPORTUNITIES
On
the one hand, Health issues have taken center stage in Kenya and forced the
conversation on weak health systems and poor investment in health
- despite Health System Strengthening programs - into the limelight. COVID-19 should
leave Kenya with more medical staff hired plus expansion of hospital capacity
as counties scramble to prepare for the pandemic. The Kenya Health Federation[ii]
- which is the health sector board representing of the Kenya Private Sector Alliance (KEPSA) has
risen to the occasion to influence public policy and bridge the gap left by the
public sector. Medical personnel of Kenyan origin from across
the globe have rallied together through virtual platforms to exchange
solutions on case management. COVID-19
should also create a hub for innovation at the local level with citizens
seeking local solutions for local problems in the absence of external support. The
interruption of global supply chains has provided impetus for the revival of
two cotton/garment factories to manufacture & supply PPE & clothes in
line with the Government’s Big 4 agenda that promotes industrialization as one
of its pillars[iii]. Of note is that revival of such factories
quickly boosts the agricultural sub-sector for cotton farming. It has also
become evident that the alcohol/ethanol industry can produce large volumes of
hand sanitizers that are always in demand in hospital situations. Following
an initial impasse, the Kenya Revenue Authority has allowed the previously defunct
Mumias Sugar Company to manufacture ethanol under
bonded arrangement. An over reliance on
South Africa & India for treatment of many health conditions (and donors for solutions) & importation of
used apparel have always been seen as poor policy choices as these can be provided
for locally with a positive impact on the economy. Lastly, Kenya has
continued to export vegetables and flowers to its major markets throughout the pandemic to earn much needed foreign exchange and
keep jobs in the agricultural sector despite the lockdown.
STRATEGY
Challenges are apparent with the GoK facing an increasingly restless population that is either unable or unwilling to comply with the various legislative orders put in place, due principally to economic considerations. Critics have pointed to the GoK’s lack of foresight in its handling of the pandemic and a severance of the social contract between the Government and its citizens[iv]. Kenya’s saving grace is that COVID-19 has heretofore spared it the worst of the pandemic which would have been disastrous for a country with a fragile health system. However, having studied the COVID-19 pattern in harder hit countries, a second and third wave seems likely, if not probable. Of note is that, countries such as Nigeria & Germany reported an increase of COVID-19 cases the day their Governments relaxed measures. The GoK lacks a coherent strategy expected to clearly stipulate emergency preparedness, risk assessment, epidemic management, monitoring & case management, making it reactive rather than proactive. Many of these principles can be gleaned from the Ebola & HIV crises of years gone by and extend beyond the ambit of the Ministry of Health at the National Level.
STIGMATISATION
It was obvious that the stigmatization of patients of COVID-19 would be the country’s Achille’s heel. The hurried internment, in the deep of the night of a 59-year-old man in Western Kenya who allegedly succumbed to COVID-19 – without the dignity of a prayer or a coffin - was touted as “barbaric” by most Kenyans[v]. That none of the family members subsequently tested positive for COVID-19 after an 18-day mandatory quarantine exacerbated the level of distrust, with many questioning whether indeed the deceased had succumbed to the dreaded disease. Interestingly, the county health officials were seen to have gone against the already laid out Ministry of Health procedures for burial during this period. The Senate Committee belatedly instructed the Ministry of Health to roll out robust programs for county health teams on guidelines & protocols for handling of a person who had died of COVID and address the associated stigma with coming into contact or having a family member die from COVID. The International Committee of the Red Cross addresses this challenge to ensure that those who have passed away during COVID-19 are properly handed in a dignified manner[vi]
COMMERCIALISATION
The quarantine procedure in Kenya has been grossly mismanaged and is regarded as callous and fraudulent. Those affected have complained of excessive hostel payments, secrecy around test results and lack of psychosocial support during the quarantine period. The unsanitary conditions in quarantine facilities render those facilities as vectors for the coronavirus and/or other pathogens[vii]. Whereas the WHO has advised that the “backbone” of the response is “isolation, testing and tracing”, the GoK now finds itself in a catch 22 situation where sections of the population refuse to present themselves for voluntary testing for fear of being isolated and their loved ones quarantined. A frustrated governor from a coastal county complained about the lack of utilization of voluntary testing services put in place despite assurances. The Health CS further decried the abnormally low frequentation of hospital services for routine services including for immunization & maternal and child health. Most disturbing are expectant women unable to access maternity services or losing lives during labor for fear of “breaking curfew rules”. Stable cancer, heart, hypertension and diabetes patients caught on one side of the boundary have been unable to access specialized services at referral hospitals. Following allegations of commercialization of the quarantine effort, on 6th May 2020, the Health CS recapitulated and indicated that the GoK would henceforth meet the costs for the testing and of mandatory quarantine as required under the Public Health Act.
STRATEGY
Challenges are apparent with the GoK facing an increasingly restless population that is either unable or unwilling to comply with the various legislative orders put in place, due principally to economic considerations. Critics have pointed to the GoK’s lack of foresight in its handling of the pandemic and a severance of the social contract between the Government and its citizens[iv]. Kenya’s saving grace is that COVID-19 has heretofore spared it the worst of the pandemic which would have been disastrous for a country with a fragile health system. However, having studied the COVID-19 pattern in harder hit countries, a second and third wave seems likely, if not probable. Of note is that, countries such as Nigeria & Germany reported an increase of COVID-19 cases the day their Governments relaxed measures. The GoK lacks a coherent strategy expected to clearly stipulate emergency preparedness, risk assessment, epidemic management, monitoring & case management, making it reactive rather than proactive. Many of these principles can be gleaned from the Ebola & HIV crises of years gone by and extend beyond the ambit of the Ministry of Health at the National Level.
STIGMATISATION
It was obvious that the stigmatization of patients of COVID-19 would be the country’s Achille’s heel. The hurried internment, in the deep of the night of a 59-year-old man in Western Kenya who allegedly succumbed to COVID-19 – without the dignity of a prayer or a coffin - was touted as “barbaric” by most Kenyans[v]. That none of the family members subsequently tested positive for COVID-19 after an 18-day mandatory quarantine exacerbated the level of distrust, with many questioning whether indeed the deceased had succumbed to the dreaded disease. Interestingly, the county health officials were seen to have gone against the already laid out Ministry of Health procedures for burial during this period. The Senate Committee belatedly instructed the Ministry of Health to roll out robust programs for county health teams on guidelines & protocols for handling of a person who had died of COVID and address the associated stigma with coming into contact or having a family member die from COVID. The International Committee of the Red Cross addresses this challenge to ensure that those who have passed away during COVID-19 are properly handed in a dignified manner[vi]
COMMERCIALISATION
The quarantine procedure in Kenya has been grossly mismanaged and is regarded as callous and fraudulent. Those affected have complained of excessive hostel payments, secrecy around test results and lack of psychosocial support during the quarantine period. The unsanitary conditions in quarantine facilities render those facilities as vectors for the coronavirus and/or other pathogens[vii]. Whereas the WHO has advised that the “backbone” of the response is “isolation, testing and tracing”, the GoK now finds itself in a catch 22 situation where sections of the population refuse to present themselves for voluntary testing for fear of being isolated and their loved ones quarantined. A frustrated governor from a coastal county complained about the lack of utilization of voluntary testing services put in place despite assurances. The Health CS further decried the abnormally low frequentation of hospital services for routine services including for immunization & maternal and child health. Most disturbing are expectant women unable to access maternity services or losing lives during labor for fear of “breaking curfew rules”. Stable cancer, heart, hypertension and diabetes patients caught on one side of the boundary have been unable to access specialized services at referral hospitals. Following allegations of commercialization of the quarantine effort, on 6th May 2020, the Health CS recapitulated and indicated that the GoK would henceforth meet the costs for the testing and of mandatory quarantine as required under the Public Health Act.