Kenya: Crises and Opportunities in Human and Environmental Health

After looking at the healthcare and pharma landscape in Nigeria, this week, we’re travelling across the African continent all the way to the home of the Maasai Mara. Kenya.

We can’t begin talking about healthcare, medicine, or anything else in Kenya before we first address the drought that’s left 6 million people in the country food insecure. Five seasons in a row, the rains have failed; things will only get worse before they get any better. The country is producing lower-than-average yields of key staples like maize, beans and millet. The country’s National Drought Management Authority estimates that nearly a million children between 6 and 59 months of age and 142,000 pregnant and breastfeeding women are malnourished. Hunger is high; incomes are low. In some counties, schools are closed, while conflicts and forced migration are on the rise. Even animals are not spared, with livestock deaths running in the millions.

The terrible water insecurity has even necessitated the launch of a Water Police Unit to protect scarce resources at water towers, catchment areas and sanitation infrastructure from siphoning, vandalism and theft. Amidst these crises, Kenya is looking hopefully towards debt-for-nature swaps to fund projects like dams which are urgently needed to provide water to its citizens and reach universal water access by 2030; the investment needed stands at about $14 billion, according to the World Bank.

Unfortunately, yet unsurprisingly, these food, water and sanitation crises have exacerbated the impact of infectious diseases in Kenya. As with many of its neighbours in the region, Kenya is struggling with a cholera outbreak. WHO experts are on-ground and vaccines are en route, but the country’s caseload stands close to 5,000 cases. And while malaria already claims approximately 3.5 million new cases and 10,700 deaths in Kenya every year, the discovery of a new dangerous mosquito vector which can thrive in the country’s growing urban environments all year long doesn’t bode well for the days to come.

Even with all its challenges, the East African country is the third largest exporter of pharmaceutical products on the continent, with just its prescription pharma market size estimated to be about $500 million in 2020. But while it is the largest exporter in the COMESA region, nearly 20% of its own land mass has deficiencies in patient access. Throughout its history, policies supporting import-substituting industrialisation and local purchasing in the pharma industry have expanded the sector’s role; still, it imports over two-thirds of its medicines. Low price regulation, inadequate health insurance coverage (only about 20% of the population), and counterfeit drugs challenge healthcare access even more.

Of the National Health Insurance Fund’s 15.4 million members, 8.8 million are dormant members. Poor insurance coverage means that out-of-pocket health spending in Kenya is high. Estimates suggest the number stands at Sh 150 billion (approx. $1.2 billion), driving large numbers of people into poverty. At 11%, Kenya spends a little less than the 15% of its GDP it pledged to allot to the health sector in its budget in the Abuja Declaration. In FY 2022/23, of the nearly Sh 150 billion Kenya’s treasury allocated to the healthcare sector, about Sh 62.3 billion was dedicated to cover UHC. Still, decision-makers reckon out-of-pocket health expenditure is one of the biggest issues ailing healthcare in Kenya.

Add to this concerns about the climate crisis and animal diseases, and the issue of health in Kenya becomes more than just a pharma or medical service issue – it is a problem of human, animal and environmental health, all working in conjunction to worsen the quality of life in the region.

Things are looking up, in some regards, with Kenya introducing a new strict regulatory process for imported health products validated through the Anti-Counterfeit Authority last year. Kenyan authorities hope this will stem the tide of falsified goods entering the Kenyan pharma market. Further, the country’s Kabarak University is working on building a Sh 35 billion private hospital which intends to house a cancer centre as well as a training and research centre for health professionals all over the region.

Last year, GSK chose to pull its commercial operations out of Kenya, transitioning to a third-party distribution model instead. Nonetheless, a bunch of other investments and partnerships are bolstering the pharma sector here. Further, Kenya’s new Income Tax Act amendment is offering a number of tax incentives for the local manufacture of human vaccines, setting the stage for a more self-reliant pharmaceutical system.

The country has set up the Kenya Biovax Institute as a vehicle to develop vaccines and produce pharmaceutical drugs locally, all while benefitting from membership in the International Vaccine Institute. Kenya’s Ministry of Health is partnering with Amref Health Africa and AstraZeneca to equip rural Kenya with mobile clinics; Moderna has its sights set on the country as the site of a $500 million mRNA vaccine manufacturing facility; the country’s AfyaRekod launched the first ever, fully automated, blockchain-enabled Universal Patient Portal for timely and efficient access to patient data.

Kenya is partnering up with Tanzania to battle trachoma, collaborating with France to boost relations in healthcare manufacturing and innovation. It is in trade talks with the EU to access opportunities in agriculture, green energy, tech and infrastructure. Moreover, France’s Proparco, a development finance institution, has acquired a majority stake in Kenya’s Diani Beach Hospital with Ascent Capital, its private equity fund partner.

Kenya has had some big wins, starting with being named one of the 6 African countries that would receive training at the WHO’s mRNA tech transfer hub in South Africa. Kenya is also now home to the WHO’s Health Emergency Hub. Also, the research group VAnguard – comprising stakeholders and researchers from multiple institutions – will start with Kenya and Uganda in its implementation of vaccine strategies based on social and biological factors to maximise effectiveness. And finally, the Gates Foundation has offered a grant to the Kenyan e-pharmacy MYDAWA for a telehealth programme for HIV.

Despite these gains, challenges persist in Kenya’s healthcare landscape. Primarily, the human resource crisis continues with medical professionals threatening to strike for better working conditions and public healthcare facilities with no measures being taken by the government for years on end. The situation is so dire that the government is restricting doctors from migrating abroad for employment.

Then there’s always the growing disease burden to look at. We’ve already spoken of the spread of cholera and malaria in Kenya, but there are other medical conditions as well as gaps in their treatment that deserve focus: cancer, hep B, HIV, diabetes and other NCDs all need more and more focused interventions to eliminate their threat to public health.

Kenya is one of the leaders in pharma in the African region, but it still has a long way to go. It has its fair share of infrastructure and human capital concerns, which are only compounded by other social, political and environmental problems like pollution caused by global “generosity”, stigma regarding women’s health, and a crippling drought. Currently, Kenya needs humanitarian aid in its ongoing water and food crisis. Still, in the long term, more steady investments in climate resilience, domestic pharmaceutical production, and improved healthcare access can transform people’s health and lives for the better.

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