The following is a guest blog, authored by Mayuko Hashimoto, a GlaxoSmithKline PULSE volunteer from Tokyo, Japan, who is working with the Millennium Cities Initiative for six months in Kisumu, Kenya to further maternal and neonatal survival.
Disclaimer: The views expressed by the author in this blog do not represent the opinion of the Millennium Cities Initiative, the Earth Institute at Columbia University or any of its professional consultants.
It’s hard to believe it has already been a month and a half since I arrived in Kisumu, Kenya. As a volunteer with GlaxoSmithKline, I’ll be in Kisumu for six months to support the Millennium Cities Initiative in its efforts to help the city become sustainable and improve its social services. My role here is to assess the existing capacity of neonatal and maternal health care services offered through health centres and the outreach efforts of community health workers. A large part of the project involves conducting a comprehensive assessment and using a questionnaire to examine services, staffing, equipment, medicine and so on.
Here is an example from the questionnaire used to assess the health centres:
1. Maternity equipment
1.1 Delivery bed
1.2 Examination couch
1.3 Blood pressure machine
1.6 IV drip stand
1.7 Vaginal speculum
1.8 Examination light
1.9 Curtains around delivery bed
This baseline data is indispensable not only for local and national health officials, but also for potential donors, to make decisions on how much they can and will support. The challenge, however, is that there are currently no existing data upon which to base such decisions, nor is there an existing survey instrument upon which we might base our questionnaire.
Health Care System in Kenya
Before I report on my work here, I would first like to comment on the current healthcare system in Kenya. There are six levels of health facilities in Kenya:
Level 1: Community/Household/Family Treatment
Level 2: Dispensaries/Clinics
Level 3: Health Centres/Maternity/Nursing Homes
Level 4: District Hospitals
Level 5: Provincial Hospitals
Level 6: National Hospitals
The health facilities I am currently working on are in Level 3, Lumumba Health Centre and Migosi Health Centre. At this level, generally speaking, there is no medical doctor. However, the health centres are considered accessible to the people in local communities. Unfortunately, since there is no standardized fee of medical treatment and medicine there are sometimes large differences among the health centres with regard to services, medicine and pricing.
With regard to the health insurance here, the Kenyan government is trying to improve it, though it is still expensive and a burden for the impoverished people. Before the current coalition government, individuals had to pay KES320 (USD4) /month for it, and it only covered the cost of inpatient consultations, regardless of the patient’s income. The government is now diversifying its fees, depending on income, and is planning to cover both in- and out-patient services.
However, considering the lower income of the people in the community we targeted, it seems that going to health facilities is still not a part of daily life for people here when they are sick, injured or become pregnant.
To be honest, there is a big difference between my work with MCI in Kisumu and my work with GSK in Japan. However, because of the cultural similarities, I am confident that I will be able to get reality-based data through my research. One of my colleagues here told me to build good relationships with the informants before beginning data collection. This is the common theory – even in Japan. So in the last two weeks, I have visited the health centres several times and I attended several live birth deliveries. I also worked with the staff, making records of pregnant women, weighing neonates, giving vitamins to babies and more. I have been enjoying these experiences.
I will provide another report about my work with MCI in a few weeks.