KENYA: Testing the integration of HIV and public healthcare
Will the new system work?
KAKAMEGA, 21 March 2011 (IRIN) - HIV could lose its "special status" in Kenya's health system if a new pilot programme integrating HIV care and public healthcare proves successful.
Traditionally, public hospitals in Kenya have a "comprehensive care clinic" (CCC) dedicated to people living with HIV; under the new system, these would no longer exist. For more than six months, the Ministry of Health and its partners have been piloting the move in Western Province; senior government officials say it will not reduce the focus on HIV, but will ease pressure on an already overburdened and understaffed health system.
"Integrating HIV treatment with other outpatient services doesn't mean it has become less important; it only means maximizing on space and reducing the burden on healthcare personnel and to help increase focus on other equally important diseases like malaria," said Ibrahim Mohamed, head of the National AIDS and Sexually transmitted infections Control Programme, NASCOP.
Joshua Omoro likes the new system; he can sit easily with other patients as he waits to see the clinical officer on duty at the Tonguren Health Centre in Bungoma North District in Western Province. "I have come today to pick my [antiretroviral] medicine but nobody can know; people are just guessing what I might be suffering from just like I am also just guessing for other people," he said. "It puts you at ease... before when you went to a specific room, people just knew you had HIV."
Health workers in western Kenya say the new system has reduced levels of stigma and, in turn, increased the number of people seeking HIV care.
"It is not only reducing stigma but is also easing the staff shortages that had been experienced earlier when too much focus was placed on HIV/AIDS," said Beatrice Misoga, HIV/AIDS integration officer for US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II) in Western Kenya.
Consolata Msamali, the clinical officer in charge of the Tonguren Health Centre, says she has already noticed a difference since the CCC was closed.
"Drug adherence has increased and many more are seeking treatment," she said. "Things have become very discreet for HIV patients because even their drugs, they don't take from the pharmacy like anybody else but they get it from the clinician's room."
Getting drugs from the pharmacist - usually a public room - runs the risk of people discovering one's HIV status from the type of drug they are prescribed.
Strategic integration of HIV and health systems has been promoted by the US President's Emergency Plan for AIDS Relief
(PEPFAR) as a "smart investment" that has the potential to increase health system efficiency and have a greater impact on healthcare.
|It is good that HIV should be treated like any other health condition, but the public health system needs to improve greatly in order for it to work efficiently
AIDS activists in Kenya have welcomed the move as a good way to end stigma, but say the integration must be accompanied by large investments in improving the health system and training healthcare workers in HIV management.
"When donors came in with their money and set up these very efficient CCCs, they exposed the inefficiencies within the general health system," said James Kamau, coordinator of the Kenya Treatment Access Movement. "At one point, people in rural areas would wish they were HIV-positive so they could benefit from the better service at the CCC."
Health system overhaul
Poor drug supply chain management, corruption, funding shortages and insufficient training mean Kenya's health system
lacks the capacity to function properly, according to civil society activists.
"It is good that HIV should be treated like any other health condition, but the public health system needs to improve greatly in order for it to work efficiently," he said. "Also, we must remember that HIV still needs special management, so training of health workers must be a priority."
Kamau noted that the stigmatization of HIV-positive patients by health workers had to be tackled as well. A 2007 survey
by the US government's Health Policy Initiative found that 65 percent of health facilities had policies to protect people living with HIV but only 27 percent reported implementing them. About 25 percent of health providers surveyed reported discriminatory care toward HIV-positive people while 12 percent blamed them for their status and 17.5 percent expressed fear of casual contact with HIV-infected people.
APHIA II's Misoga agreed that training should be a key part of integrating HIV into the health system. "Managing HIV isn't easy - healthcare workers need constant mentorship from experienced health personnel because some of them are coming into HIV management and treatment for the first time," she said. "Mentorship involves both mentoring them within the facility and taking them to other busy facilities to get a feel of what it means to manage HIV and AIDS."
An estimated 1.4 million Kenyans are HIV-positive; more than 400,000 are receiving antiretroviral (ARV) medication, and the government intends to put an additional 300,000 on ARVs over the next three years in accordance with the UN World Health Organization's 2009 guidelines