Introduction
According to the United States Agency for International Development (USAID) (2013), 1.6 million citizens in Kenya are infected with the Human Immunodeficiency Virus (HIV). Statistics by the Kenya National AIDS and STD Control Council (2012) indicate that the disease had affected about 6.2 percent of the population aged over 18 years in 2011. As a result of the high prevalence, the country is reported to have the fourth highest HIV burden in the world. Additionally, the high prevalence has affected the global burden of HIV and AIDS. Kenya is located in the Sub-Saharan region in Africa, which has the highest HIV and AIDS (70.9 percent) burden in the world (Amornkul, et al., 2009).
In reference to AVERT (2014), the HIV infections are generalized across this population. However, several groups within the Kenyan population have been reported to be more vulnerable to the infection. These groups include; men who have sex with men (MSM) (18.2 percent), women (6.2 percent), drug users (18.3 percent), and sex workers (29.3 percent) (Kenya National AIDS and STD Control Council, 2012). In reference to the homosexual population, Mombasa (24.5 percent) is reported to have the highest HIV prevalence in Kenya.
Although Kenya and Uganda are classified as high-HIV burden countries, the prevalence of the disease in Uganda is higher with 7.2 percent of the population being infected (AVERT, 2014). In addition, the prevalence of HIV in Kenya is extremely high compared to that of Latin America (0.4 percent). This is an indication of the global HIV variation patterns. In reference to Amornkul et al. (2009), the high burden of HIV and AIDS in Kenya is a hindrance toward bringing the global burden of the disease to zero.
Health Indicators
Hyder, Puvanachandra, and Morrow (2012) define health indicators as summary variables that determine the health of a community. Each indicator is an important measurement and it contributes to the overall health of a certain population. Public health discipline requires that these indicators be tracked over time to give a picture of the health of a population. Specifically, this gives the trends of the morbidity and mortality rates of a population. In reference to Hyder, Puvanachandra, and Morrow (2012), there are two main groups of health indicators that are crucial in defining the health of a community.
The first group is the health status indicators, which define various characteristics of the health care. These include; prevalence of chronic illnesses, infant mortality, and disability rates. The second group comprises of the health determinants which are correlates of health within the population and include; age, sex, and access to healthcare among others. Health indicators are used in ranking the health status of a community and are useful in making policies regarding health. In addition, such policies are determined by the profiles of both communicable and non-communicable diseases, and dynamic forces within a population. Health indicators must be based on evidence collected on disease patterns within the population for them to be measured effectively.
Globally, different regions have different health indicators that are used to define their health status ( Hyder, Puvanachandra, & Morrow, 2012). Such indicators affect the prevalence and incidence of diseases on a global scale as some countries are likely to have more disease burden compared to others. Furthermore, eliminating the global burden of diseases requires concerted efforts from individual countries. As a result of variations on the health determinations across countries, health indicators are likely to vary globally. The economic status of a country also causes variations of health indicators and this could explain why the health indicators used in developed nations are different from those used in less-developed countries. Health inequalities across different countries contribute to the global burden of diseases (World Health Organization, 2014).
There are various issues that health professionals from different countries need to address in an effort to promote positive health indicators. Such issues include; access to health facilities, ability of the health facilities to cater for the needs of the population, education and level of knowledge of diseases within the population, government commitment in lowering the country-specific burden of diseases, and amount of healthcare funding ( Hyder, Puvanachandra, & Morrow, 2012). According to the World Health Organization (WHO) (2014), four major health indicators are used to determine the burden of HIV and AIDS In the world. These include; prevalence of HIV among adults, use of condom and HIV and AIDS knowledge within a given population, Mortality rate from HIV and AIDS (per 100,000 population), and the coverage of Anti-Retroviral Therapy among patients with AIDS.
In Kenya, there has been evidence of positive HIV health indicators (Kenya National AIDS and STD Control Council, 2012). Specifically, the prevalence, incidence, and mortality rates have been on a downward trend since 2000. There are several health indicators that are used to profile the HIV situation in Kenya (World Health Organization, 2014). These include: prevalence of HIV among adults (0-49 years), number of citizens aged 0 to 49 years who are living with HIV and AIDS, number of HIV and AIDS patients on ARV’S, Number of facilities offering HIV testing and counseling services, level of knowledge regarding HIV and AIDS prevention, and Knowledge on condom use. However, the Kenya National AIDS and STD Control Council (2012) reports that these indicators seem to provide a mixed picture on the burden of HIV and AIDS in this population. While some measures seem to indicate that the rates of HIV are reducing, others give a contrary view.
Kenyan health system
In reference to Quaye (2010), the Kenya health care system has experienced major problems that have over the years hindered quality delivery of services to the people. Additionally, the widespread income inequality and low socio economic status of the population limits uptake of health care. Access to the basic health services by the people and the inability of the government to distribute these services to the entire population has contributed to the high disease burden in the country. The country has a total population of about 41 million and the health care system has been unable to cater for the needs of the entire population.
Moreover, there is a major divide between the rural and urban regions in the country with majority of the services being concentrated in the urban regions. The slum areas located in the urban regions also experience inequality in health service delivery and massive poverty. Chuma and Okungu (2011) explain that the health care system of Kenya constitutes of both public and private health facilities. Access of health services in these facilities is determined by the level of income of an individual.
Chuma and Okungu (2011) indicate that the public sector comprises of the Ministry of Health (MOH), which is the policy-making organ on health matters. The public healthcare system encompasses five levels of health facilities. These include; national referral facilities, county hospitals, district facilities, health centers and dispensaries. The national referral facilities are few, contain state of the art diagnostic services, and cater for the low and high income earners. Majority of the private health centers are extremely expensive and only high-income earners can afford the services.
Chuma and Okungu (2011) also note that the national referral centers are distributed unequally across the population. In this view, there is limited access to these facilities by some individuals in the population. The health centers and dispensaries are only involved in the provision of primary care and lack advanced diagnostic services. Quaye (2010) indicates that health professionals tend to be more concentrated in the urban areas compared to the rural areas. Thus, majority of the disease burden in the population has been recorded in the rural areas.
Another challenge facing the system is the lack of medical supplies in some of the rural facilities (Chuma & Okungu, 2011). The Kenyan government has over the years been unable to standardize the cost of health care making it only available to the few citizens who are financially able. In semi-arid regions like Wajir district, individuals have to walk for long distances to access health care. According to the Kenya National AIDS and STD Control Council (2012), the limited access to healthcare and poor infrastructure in some regions has affected the uptake of Voluntary Testing and Counseling (VCT) services in HIV prevention. As a result, the incidence of HIV in some of these areas is high.
Furthermore, most rural populations lack access to education regarding the prevention of HIV and condom use. The lack of medical supplies in some facilities affects ART coverage and thus increasing the mortality and morbidity rates of HIV and AIDS. The Kenya National AIDS and STD Control Council (2012) also indicate that the limitation in the health system has led to an increase of mother to child transmission of HIV. This is because these mothers tend to deliver at home and hence increasing the probability of infecting their children with HIV.
The WHO (2015) defines health determinants as factors that influence the health of a population. These determinants vary across regions. The environment for example, is a major determinant of health in many settings. Other determinants of health include; socio demographic factors, level of education, level of income, genetics, and social support networks among many others. Access and utilization of health services are also classified as determinants of health. According to WHO (2015), the backgrounds of populations determines whether they are healthy or not. In addition, majority of the determinants of health cannot be controlled directly by the communities. In this view, different regions around the world exhibit different health determinants and thus variations in the health status.
In Kenya for example, majority of the population lives below the poverty line and hence affecting their health and burden of disease. It would be difficult to equate the health status of Kenya to that of the United States, which is more developed. Provided the health determinants of a certain country continue to increase the burden of disease, the global disease will continue to be high. In conclusion, the Kenya National AIDS and STD Control Council (2012) notes that the major limitations to lowering the prevalence of HIV in Kenya have been poverty and limited access to health services.
References
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Chuma, J., & Okungu, V. (2011). Viewing the Kenyan health system through an equity lens: implications for universal coverage. International Journal for Equity in Health, 10(22), 1-14. Web.
Hyder, A. A., Puvanachandra, P., & Morrow, R. H. (2012). Measuring the health of populations: explaining composite indicators. Journal of Public Health Research, 1(35), 222-228. Web.
Kenya National AIDS and STD Control Council. (2012). The Kenya AIDS epidemic: Update 2012. Web.
Quaye, R. (2010). Balancing public and private health care systems: The Sub-Saharan Africa experience. Lanham, Maryland: University Press of America. Web.
United States Agency for International Development. (2013). USAID Kenya HIV/AIDS. Web.
WHO. (2015). Health Impact Assessment (HIA): The determinants of health. Web.
World Health Organization. (2014). Global Health Observatory Data Repository. Web.