Introduction
Health care systems play important role in ensuring that health needs of any given population are met. This can be achieved by organization of sufficient resources, establishment of credible healthcare institutions and harnessing of human resource required in healthcare delivery. The main goal of human resource management in health care in Kenya, Uganda and Rwanda is to provide better health care services with positive outcomes that benefit patients. It has been pursued through stewardship, financing and generation of other resources needed to deliver healthcare. However, the latter is prone to management problems. This essay will compare and contrast health care provision in Kenya, Uganda and Rwanda based on human resource perspective.
Situational analysis- overview of each country
Kenya
Kenya is an East African country located at Longitude 42 E and 34 W, Latitude 4.28 S and 4.21 N. The country borders Indian Ocean with a shoreline of up to 400 kilometers (AHWO, 2009). To the east, it borders Somali. The southern neighbor is Tanzania while Uganda is located in the western side of Kenya. Additionally, Sudan borders Kenya to the northwest while Ethiopia shares a common border with Kenya to the north.
It covers a total are of 84,646 km2 out of which arable land constitutes only about 20% of land mass while the rest is semi arid and arid land. It is also well endowed with parks and water bodies. The latter covers an area of 11,230 km2. Population growth rate, distribution, age and gender constitute Kenyan demography. According to statistical reports, Kenyan population has been growing steadily growing over the years. The figure below illustrates population growth rate in Kenya for three consecutive decades
Source: KNBS 1979, 1989, 1999 census, growth rate facts and figures 2008.
Economy
Kenya’s economy can be analyzed in terms budget comparisons, unemployment, budget proportion for HRH as well as proportion of health GDP and poverty. Other areas include inequality in wealth and income, labor force, growth in GDP and GDP per capita (Ministry of health-Kenya, 2006). The table below shows the GDP and GDP per capita.
Health
Health issues affecting Kenyan population are largely demonstrated in the morbidity and mortality rates that have been compiled over a considerably long period of time (Ministry of health-Kenya, 2006). Some of the major illnesses that heavily contribute to disease burden in Kenya include diarrhea, lower respiratory tract infections, malaria, prenatal period conditions and HIV/AIDS among others. In addition, it is important to note that some of the indicators that have been used to analyze health in this country include sanitation levels, accessibility to safe drinking water, prevalence rate of HIV/AIDS, l life expectancy and mortality rates (see appendix II).
Rwanda
Rwanda shares its borders with Uganda, Burundi, Tanzania, and the Democratic Republic of Congo (DRC). It is a landlocked country with high population density within an area of 26338km2. It has 30 districts and 5 provinces. Additionally, two dry and wet seasons define the distinct vegetation and tropical climate of Rwanda. In 2010, Data from the National Institute of Statistics (NISR) indicated that the population of Rwanda was approximately 10 million. Projections made by the NISR indicated that only 15% of the total population lives in urban centers. The remaining percentage lives and work in rural areas (Brown, 2006). Birth rate is relatively high in Rwanda compared to Kenya. According to a survey conducted by the Demographic and Health Department in 2007, the rate of population growth rate in Rwanda stands at 2.7% per annum (Ministry of Health-Rwanda, 2009). The male to female ration in Rwanda is 1:1.
Distribution of population in Rwanda according to age group and year
Source: NSIR 2002.
Source: NSIR 2002.
Economy
Since 1994, Rwanda’s economy has experienced growth as depicted by a recent GDP average of 8.83% (Ministry of Health-Rwanda, 2009). According to Human Development Index report in 2005, Rwanda was ranked 161 out of 177 in terms of GDP per capita growth. Its goo track record in alleviating poverty has made it easier for the country to receive debt relief from major international bodies such as Multilateral Debt Relief Initiatives (MDRI) and the Heavily Indebted Poor Countries (HIPC) as well as IMF. In spite of its exports, balance of payments is still unfavorable due to quite a number of factors such as over dependency on tourism and reliance on external aid (Brown, 2006).
Rwanda boasts of good governance, stable economic growth and security. Its major sources of revenue are statutory taxation, tourism, loans, multilateral and bilateral grants as well as agriculture.
Economic growth indicators in Rwanda
Source: MINECOFIN, NISR & BNR, 2009; EICV 2, (2005/6).
Governance and Political stability
Rwanda is headed by a president elected through democratic election. Additionally, it has a senate, parliament and a cabinet. In 2006, the country instituted reforms on public and decentralization process thereby fostering a structure that had cells, sections, districts, and provinces.
Uganda
Uganda is a land locked country in East Africa with a population of 27.7 million. It covers a total area of 241,038km2. Ugandan land surface occupies about 197,096 square kilometers while the remaining portion is swampy. Mortality rate during child birth per 100,000 births stands at 506 while infant mortality rate per 1000 live births is 88 (United Nations Organization, 2005). The table below shows the population and housing report for four consecutive decades.
Source: 2002 Population & Housing Census Report, UBOS.
Economy
Uganda has been commended by various international bodies such as the World Bank for its ability to control inflation and steer economic growth (Anon, 2002). According to a report finding by World Bank in 2002, absolute poverty in Uganda had reduced by 21% owing to its proper allocation of resources to health, education and other social needs (Anon, 2002).
Governance and political stability
Politically, Uganda has three organs of governance namely the judiciary, legislature and an executive. It is headed by a president supported by a cabinet of ministers. The legislature addresses issues such as sanitation, water, education and health. Additionally, the judiciary tackles contentious issues regarding implementation of heath policies (United Nations Organization, 2005).
Comparisons
Health Systems and services
- Public
- In Uganda, Rwanda and Kenya, the public health care system services are effective and resources are availed from the community to national level.
- Private
- Kenya and Uganda partly supports private health care systems while Rwanda does not support.
- Financial
- Financial resources to tackle health issues are not adequate in all the three counties owing to poverty and slow economic growth.
- Insurance
- Uganda health care and human resource department lacks health insurance for the public while Kenya and Rwanda have insurance cover on public health.
- Governance
- All the three countries receive support from government in terms of offering health care policies and governance from health sectors and the government
- Hospital
- Kenya, Uganda and Rwanda lack enough hospitals to take care of overwhelming number of patients. Hospital resources are insufficient.
- Other health care service provider facilities.
- All the three countries have private health care facilities that offer health care resources
- Ranking on global scale
- Kenya leads by 141 in global ranking in provision of health care services ahead of Rwanda that ranks 144 while Uganda trails at 149.
Health status
- Life expectancy in Kenya is higher than Uganda while Rwanda has the lowest life expectancy. However, they share the same life expectancy at birth which is 49.
- IMR
- Infant mortality rate in the three countries is high. However, Uganda leads by 138 followed by followed by Rwanda and Kenya with 203 and 200 respectively.
- HIV/ AIDS
- The prevalence of HIV/AIDS in Kenya is higher among adults with up to 6.7 than Rwanda which has 5.1 and Uganda that has 4.1
- TB prevalence
- The prevalence and incidence of TB is higher in Kenya than Uganda and Rwanda.
- 10 causes of death
- Kenya, Uganda and Rwanda share causes of death emanating from injuries, pneumonia, malaria, measles, diarrhea diseases, HIV/AIDS, birth asphyxia severe infections and neonatal causes.
Human resources for health
- Health workforce. Kenya and Uganda have a high number of workforce while Rwanda’s health workforce is not sufficient to meet health care needs for patients
- Identify shortages. Rwanda has limited laboratory technician and dentists while Kenya has less community health workers. Uganda has less community health workers and dentists
Strategies to solve HRH
Kenya, Uganda and Rwanda share strategies for solving HRH.
- Plan. The various health sectors in the three countries should set up strategies, policies and programs that would optimize the use of available resources.
- Development. Dedicate more finances to health care systems. There is need for more health workers to be deployed in healthcare system
- Support. Support should be given to create more health facilities, and finances
References
AHWO (2009). Human Resources for Health Country Profile Kenya. Web.
Anon(2002). “WHO CAM strategy advocates national policy creation, increased R&D”. The Blue Sheet, 45(22): 18-19.
Brown, G. (2006). International nursing department Rwanda: A Country Still in Post War Syndrome – Twelve Years Later. ABNF Journal, 17(4), 143-6
Ministry of health-Kenya (2006). The second national health sector strategic plan of Kenya –NHSSP II– 2005–2010. Reversing the Trends, 1-96.
Ministry of Health-Rwanda(2009). Situational analysis of the health sector. Health Sector Strategic Plan. 4-100.
United Nations Organization (2005). Preparing the health workforce. The World Health Report 2006. 41-67.
Appendices
Appendix I: Distribution of population in Kenya by age and year
Source: KNBS 1999 census.
Appendix II: Life expectancy, mortality and HIV/AIDS prevalence rates in Kenya
Source GBD 2004.