The Right to Health: Is Kenya Walking the Talk?

Realisation of the right to health in Kenya improved tremendously until 1990. Infant mortality rates dropped from 119 per 1000 in 1960 to 51 in 1992. During the same period, the under-five mortality rate dropped from 202 per 1000 live births to 74. Unfortunately, these gains were reversed in the 1990s, when Kenya experienced increasing rates of infant and under-five mortality.

According to the 2003 Kenya Demographic Health Survey, infant mortality rates had increased to 78 per 1000 while under-five mortality rates had risen to 114. Kenya's maternal mortality rate continues to be unacceptably high—some 11,000 women and girls die each year due to preventable, pregnancy-related complications.

The situation of health indicators in Kenya is grave, despite its commitment to translate international and regional covenants and charters on the right to health into operational initiatives at the national level. The various policy and strategy papers include the National Poverty Eradication Plan (NPEP), the Poverty Reduction Strategy Paper (PRSP), the Economic Recovery Strategy (ERS) and now Vision 2030.

However, the extent to which these policies are implemented, and whether or not they achieve their intended purpose", remains a mystery to most Kenyans.

Financing the health Sector

The achievement of the right to health is directly dependant upon the government's financial decisions. Unfortunately, in the last decade, financial allocations to the health sector have not had any significant improvement. Reviews of public expenditures and budgets in Kenya show that health spending stands at about 8% of the total government expenditure.

The per capita total health spending stands at about Ksh 500 (US$6.2), far below the World Health Organisation's (WHO) recommended level of US$34 per capita. This expenditure also falls short of the Government of Kenya's commitment to spend 15 percent of its total budget on health, as agreed in the Abuja Declaration of 2001. The persistent under-financing of the health sector has dramatically reduced the Government's ability to ensure the provision of quality, adequate and sustainable health services to its citizens.

To the common Kenyan, the cost of health care has remained a critical barrier to accessing health services. For instance, household expenses on health care account for an astonishing 77% of total health care expenses in Kenya. For sure, costs like these remain prohibitively high for the poor and most vulnerable sections of the population.

This has made it almost impossible for the poorest and most vulnerable segment of the population to access basic health care services, including physical and mental health services and immunizations from infectious diseases - an aspect that undermines fundamental rights of Kenyans.

Health workforce
The key bottleneck to accessing healthcare in Kenya—including scaling up access to HIV/AIDS prevention, treatment, care and support—is the lack of comprehensive human resources for health strategy. As a result, the country has 169 health workers for every 100,000 people, compared to the WHO recommended standard of 228.

Furthermore, the health workers who are currently serving Government facilities are inequitably distributed. For example, Nyanza province—with the highest HIV prevalence rate in the country—has one of the lowest proportions of health workers to population.

This lack of vision has created an unacceptable irony in which public health facilities in Kenya face a crippling shortage of health workers, despite the numerous and qualified graduates emerging from the local training institutions - many of whom remain unemployed. In the meantime the majority of the population continues to suffer from preventable illnesses and diseases.

The government must therefore provide the necessary political will and leadership to finalize and implement the long over-due Human Resources for Health Strategic Plan if it is serious about achieving the WHO recommended health workforce ratio by 2015.

This policy is instrumental in addressing the myriad of challenges confronting health care workers, including their welfare, motivation and HIV&AIDS-related stigma, which greatly hinder a majority of them from benefiting from universal access and offering quality services to their clients.


Currently, women in Kenya have a HIV prevalence rate of 8.7%, compared to men, whose rate is 5.6%. Unfortunately, there is little concerted effort by the Government to avail the critical tools for HIV prevention to women. Access to the female condom—the only woman-initiated HIV prevention measure—remains severely limited and prohibitively costly.

Furthermore, research into other women-initiated prevention methods, such as microbicides, lack guidelines and remain under-funded in Kenya. The government must invest the necessary resources and avail the most effective HIV prevention methods to all sectors of the population, especially women and children.


Every girl, boy, man and woman in Kenya has a right to the highest attainable standard of health. Of fundamental importance is the need to rise up and demand that the Government upholds its commitment to respect, protect and promote the right to health.

This may however, remain a mere pipe dream unless there are concerted efforts that demand improved investments in the health sector including allocating at least 15% of the annual budget to the sector and exploring other sustainable funding mechanisms.

The health system has been undermined and weakened and Kenya needs concerted measures to establish effective and inclusive health systems accessible to all. Evidently the inequity characteristic of the country is not only apparent in health indicators but also in the distribution of wealth. Unless a deliberate attempt to address economic, social and cultural inequities and impediments that condemn almost a half of the population in poverty, it is unlikely that the Kenya will attain the MDGs.

The government must also demonstrate through actions that it is fully committed to addressing challenges that confront health workers in Kenya by seeing to fruition the development and implementation of the pending Human Resources for Health Strategic Plan.

Though the government has attempted to operationalize various commitments through a range of policies, their implementation could remain a challenge unless Economic, Social and Cultural Rights are enshrined into the in the new constitution during the proposed constitution review. In addition, all Kenyans must realize they are stakeholders in the health sector, and ought to critically assess the achievements of the Government's various efforts to ensure that principles of availability, accessibility, acceptability and quality of health services are adhered to.

Kenya has said all the right words, but the question remains: is Kenya walking the talk?

Participants will come together to deliberate on this critical question at the Second Annual Right to Health Conference, organized by the Health Rights Advocacy Forum (HERAF) and supported by German Technical Cooperation (GTZ) Health Sector Programme. This will be held at LMS & Conference Centre, Milimani Road, Nairobi from December 3-4, 2008. Join us in advocating for the right to health in Kenya.


Kenya German Development Cooperation
German Technical Cooperation Health Sector Programme
Health Rights Advocacy Forum (HERAF)

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