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It was only four years later, when Grace became so ill she had to be
carried to hospital, that she found they were both HIV positive.
The pair now receive free, world-class treatment at one of the
capital's top private hospitals.
Most of the 3,000 patients at Mater Hospital's Comprehensive Care
Clinic, dedicated to HIV/AIDS treatment, come from nearby shanty
towns. It is entirely donor funded, mainly by the United States
President's Emergency Plan for AIDS Relief (PEPFAR).
"If I hadn't come here I would be dead," said Grace, a 32-year-old
single mother from Nairobi's Fuata Nyayo slum, who declined to give
her full name.
Earmarked funding from donors like PEPFAR and the Global Fund to
Fight AIDS, Tuberculosis and Malaria has benefited millions of
people like Grace.
In Kenya, HIV prevalence among adults has almost halved since the
mid-1990s to 5.3 percent in 2014, according to UNAIDS.
Around 60 percent of Kenya's annual $1.25 billion health budget is
spent on HIV/AIDS, the Thomson Reuters Foundation calculated, using
government and UNAIDS figures. Of that, about three quarters comes
from international sources, UNAIDS says.
Yet HIV/AIDS remains the leading cause of death in Kenya,
responsible for nearly three in 10 deaths in the east African
country, where 1.6 million Kenyans are infected, government data in
2014 shows.
The disproportionate focus on HIV/AIDS has come at the expense of
other diseases and the wider health system struggling to reach
people in slums and remote arid regions, experts say.
"We should have tackled the reproductive health issues and HIV
together," said one Kenyan working with an HIV charity who declined
to be named. "HIV got a momentum and... the rest... got forgotten."
STRONGER HEALTH SYSTEM
The new U.N. Sustainable Development Goals (SDGs), due to be agreed
by world leaders later this month, seek to build on the Millennium
Development Goals by reducing maternal mortality and ending the
AIDS, tuberculosis and malaria epidemics by 2030.
One goal is universal health coverage - good quality, affordable
health services for all - and greater recruitment, training and
retention of health workers.
If Kenya and other developing countries are to meet the SDGs, they
need to shift investment away from diseases like HIV and towards
strengthening health systems, experts say.
Although maternity, under-five and emergency services are nominally
free in Kenya, cash-strapped government facilities are
overstretched, forcing patients to buy their own medicines.
Grace and her daughter had to sleep on the floor when they were
admitted to Nairobi's government-run Mbagathi Hospital because all
the beds were full.
Patients have died because of an ongoing strike by nurses over
non-payment of salaries, according to local media reports. Staff
morale is low and patients often complain of abuse.
To build a better health system, Kenya must prioritize preventative
and primary level care and eliminating wasteful systems, experts
say.
Half of Kenya's health budget is wasted through inefficiency and
corruption, said Peter Kimuu, head of the health ministry's
Directorate of Policy, Planning and Health Care Financing.
Globally, the World Health Organization (WHO) estimates that 20 to
40 percent of health budgets is wasted.
"The agenda in the next 10 to 15 years is really... the efficiency
agenda rather than the revenue-raising agenda," said Joseph Kutzin,
a WHO expert on health financing.
For example, a nutritionist hired to advise people with HIV on their
diets could also be employed to counsel diabetic patients and
pregnant women.
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EBOLA
On the donor side, funders need to focus more on the long-term
health picture and become more flexible in their funding, analysts
say.
"When there is a crisis, everybody is mobilized ... It's very easy
to get money," said the United Nations' resident and humanitarian
coordinator in Kenya, Nardos Bekele-Thomas.
Around 70 percent of U.N. spending in Kenya between 2009 and 2013
was on emergencies, such as hunger and displacement caused by
drought, poverty and conflict.
"There is nothing to show (for it)," she said. "We have to mobilize
this energy and resources for preventing crises."
Reform is under way.
In Kenya, PEPFAR is phasing out Kenya Pharma, a parallel procurement
system set up by U.S. development agency USAID, to deliver HIV
drugs. Instead, it is investing in the Kenyan government's supply
chain.
Yet problems persist.
Some 60 percent of Kenya's donor support is off-budget, the health
ministry's Kimuu said, which means it is spent on items that are not
in the government five-year health sector strategy.
"Many donors will not give money to support that strategy," said
Kimuu. "They will come and set their own projects."
Where there is corruption, it is easier for donors to track spending
and achieve their targets via standalone programs.
GAME CHANGER
Universal health coverage could be a catalyst in improving health
indicators among poor, forgotten populations.
Globally, over 1 billion people cannot access the healthcare they
need, and 100 million are pushed into poverty each year due to
"catastrophic" spending on medical care, the WHO says.
In Kenya, 37 percent of healthcare is funded by patients, which hits
the poor hardest, 35 percent by donors and 28 percent by government,
the government says.
It plans to introduce compulsory health insurance which would
entitle Kenyans to a package of services from 4,000 public or 6,000
private health facilities, Kimuu said.
Government medical centers would have an incentive to improve their
services as they would be paid according to the number of patients
they treated, he added.
Without a shift in focus to primary healthcare interventions such as
vaccination campaigns, the SDG targets will not be met.
"We see a lot of preventable illnesses ... things that with a bit of
public awareness and education would not be in hospital," said Mercy
Korir, a doctor, who estimates that such cases account for
two-thirds of medics' caseload.
($1 = 104.1000 Kenyan shillings)
(Additional reporting by Alex Whiting in LONDON. Editing by Katie
Nguyen; Please credit the Thomson Reuters Foundation, the charitable
arm of Thomson Reuters, that covers humanitarian news, women's
rights, corruption and climate change. Visit www.trust.org)
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