The ability of the Kenyan health system to respond to droughts has improved in recent years, but a study by the Maintains programme suggests there is more work to do to strengthen its responsiveness to climate shocks.
The health system in the arid and semi-arid lands (ASALs) of northern Kenya has to deal with extreme spikes in cases of malnutrition and disease, such as malaria and diarrhoea, associated with climate shocks, especially drought and flood events.
As part of the Maintains programme, the Centre for Humanitarian Change interviewed over 60 frontline and county health, nutrition, and disaster professionals in the ASAL counties of Marsabit, Turkana, and Wajir to analyse their experiences of responses to drought and floods in 2019.
Based on a published report of the findings, seven recommendations for improving the shock-responsiveness of the Kenyan health system are made in a new policy brief. These will be validated and discussed during forthcoming workshops with Maintains partners in Kenya.
- Better integrate health into disaster governance mechanisms
New disaster policies and laws in Kenya have created county-level mechanisms for coordinating drought response in the ASALs. However, these are not fully adapted or applied in the health and nutrition sectors. The government health sector is generally focused on infectious disease outbreak response, with less attention paid to the public health impacts of climate shocks. There is a need to review how existing disaster governance mechanisms could be better put to work for health and nutrition.
2. Develop a human resource strategy for emergency response
Spikes in health facility admissions are currently absorbed by health staff working longer hours, not taking leave, and sharing duties.This causes stress and exhaustion, leading to absenteeism. A healthy and motivated workforce is critical for the health system to meet the extra demands on services created by climate shocks. While a sufficient number of frontline staff need to be employed and retained in the long run, the development of an emergency human resource strategy could set out procedures for leave management and the redeployment of staff to hotspots during droughts and floods.
3. Integrate real-time health information and early warning information
Kenya has well-developed early warning and health information systems, but these systems are not currently meeting the shock-response needs of the health system. Early warning bulletins describe the current situation but do not predict future impacts or provide early warnings of health and nutrition service demand surges. There is an opportunity, however, to use IMAM Surge data in early warning bulletins. The IMAM Surge approach involves frontline staff monitoring malnutrition admissions against predetermined thresholds (from normal to emergency) that trigger actions within the health facility and sub-county. Early warning bulletins could, for example, show the proportion of health facilities passing various capacity thresholds, providing early warning of the health system being overwhelmed by climate-related demand surges.
4. Expand surge approaches to monitor morbidity and community cases
The IMAM Surge approach only captures malnutrition admissions at health facilities, which in themselves often do not fully reflect the actual prevalence of malnutrition in communities because of access barriers, such as the opportunity costs of travelling to often distant health facilities. The approach also does not monitor cases of waterborne diseases, which can often rise during droughts and floods. The findings therefore suggest that the approach be expanded to monitor caseloads and set health facility capacity thresholds for diseases in addition to malnutrition, and that a surge approach be developed for the community health system.
5. Develop flexible and prearranged financing for health and nutrition
Kenya has developed a number of disaster financing mechanisms at national and county levels, but funds were widely considered by respondents to be insufficient to meet needs and as taking too much time to release, with most financial solutions still arranged after the onset of a climate shock, frustrating early action. Health tends to be prioritised less in these financing mechanisms than other sectors such as food security and WASH, meaning the Ministry of Health normally relies on its already stretched resources to respond to increases in admissions. The research suggests health and nutrition concerns need to be more fully integrated into prearranged and transparent disaster risk financing mechanisms in order to flexibly scale up health system financing to meet needs during climate shocks.
6. Basic strengthening of health system building blocks
Health expenditure by the Government of Kenya has increased over the past decade, yet the sparsely populated ASAL counties of northern Kenya remain underserviced by health facilities, medicines, and frontline health workers. The government health sector therefore struggles to absorb the additional caseloads associated with climate shocks. In the long term, building adequate spare capacity would better enable the health system to absorb spikes in demand for health and nutrition services, but existing health system resources could be used more efficiently during climate shocks, including through the abovementioned human resource strategy and continued improvements to medical and nutrition product procurement and distribution systems.
7. Strengthen relations with communities
In recent years there have been efforts to strengthen the capacity of the community health system, but there are limited opportunities for communities to contribute their knowledge and perspectives or participate in decision making to ensure health systems cater to their context and remove access barriers to formal services during climate shocks. Adapting the IMAM Surge approach to the community level, as suggested above, and reviewing how community knowledge could better feed into disaster governance mechanisms, such as contingency plans and disaster management committees, could be key first steps toward strengthening relations with communities.
Overall, significant advances have been made in regard to building government capacity to respond to climate shocks in the ASAL counties. Nevertheless, the health system remains dependent on international aid to address demand surges, especially for the provision of nutrition products and integrated outreach services for remote communities.
The challenge moving forward is to adapt and strengthen county mechanisms and decision making to better include health and nutrition, building on promising innovations such as IMAM Surge, drought management, and the emerging national disaster risk financing mechanisms. This will require a shift from a post-shock to a risk-informed mentality in the health system. At the same time, deeper transformative change toward a health system resilience paradigm is required, whereby capacities are strengthened for continuous proactive absorption of and adaptation to expected and unexpected surges and contractions in caseloads associated with climate shocks.
These emerging findings will be taken forward in the next stages of the Maintains programme research in Kenya. Read more about the programme of research in the Maintains Kenya research protocol.
Authored by Matt Fortnam