Health Systems in Kenya, Uganda and Rwanda – A Human Resources Perspective

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  1. Introduction
  2. Situational analysis- overview of each country
  3. References

Introduction

Health care systems play important role in ensuring that health needs of any given population are met. This can be achieved by organization of sufficient resources, establishment of credible healthcare institutions and harnessing of human resource required in healthcare delivery. The main goal of human resource management in health care in Kenya, Uganda and Rwanda is to provide better health care services with positive outcomes that benefit patients. It has been pursued through stewardship, financing and generation of other resources needed to deliver healthcare. However, the latter is prone to management problems. This essay will compare and contrast health care provision in Kenya, Uganda and Rwanda based on human resource perspective.

Situational analysis- overview of each country

Kenya

Kenya is an East African country located at Longitude 42 E and 34 W, Latitude 4.28 S and 4.21 N. The country borders Indian Ocean with a shoreline of up to 400 kilometers (AHWO, 2009). To the east, it borders Somali. The southern neighbor is Tanzania while Uganda is located in the western side of Kenya. Additionally, Sudan borders Kenya to the northwest while Ethiopia shares a common border with Kenya to the north.

It covers a total are of 84,646 km2 out of which arable land constitutes only about 20% of land mass while the rest is semi arid and arid land. It is also well endowed with parks and water bodies. The latter covers an area of 11,230 km2. Population growth rate, distribution, age and gender constitute Kenyan demography. According to statistical reports, Kenyan population has been growing steadily growing over the years. The figure below illustrates population growth rate in Kenya for three consecutive decades

Year Total Male Female Male/Female (%) Growth rate (%)
1979 15,327,000 – – – 3.4
1989 21,445,000 – – – 3.4
1999 28,673,000 14,162,000 14,511,000 0.98 2.9

Source: KNBS 1979, 1989, 1999 census, growth rate facts and figures 2008.

Economy

Kenya’s economy can be analyzed in terms budget comparisons, unemployment, budget proportion for HRH as well as proportion of health GDP and poverty. Other areas include inequality in wealth and income, labor force, growth in GDP and GDP per capita (Ministry of health-Kenya, 2006). The table below shows the GDP and GDP per capita.

Indicators 2006(Kshs) Source & year
GDP US$ 32.417 billion Central Bank of Kenya- 2010
National debt as % of GDP 52.1 % Central Bank of Kenya- 2010
Economic aid as % of GDP 4.9% Central Bank of Kenya -2010
Proportion of budget spent on health as % of GDP 4.6% 2006
GDP per capita (in PPP) $1,784 Central Bank of Kenya -2010
Proportion of population living below poverty line 45.9 KIBHS 2006
Proportion of population with malnutrition –
Unemployment rate NA
Inflation rate 9.2% KNBS: Economic survey 2009
Underweight children below 5 years 20%

Health

Health issues affecting Kenyan population are largely demonstrated in the morbidity and mortality rates that have been compiled over a considerably long period of time (Ministry of health-Kenya, 2006). Some of the major illnesses that heavily contribute to disease burden in Kenya include diarrhea, lower respiratory tract infections, malaria, prenatal period conditions and HIV/AIDS among others. In addition, it is important to note that some of the indicators that have been used to analyze health in this country include sanitation levels, accessibility to safe drinking water, prevalence rate of HIV/AIDS, l life expectancy and mortality rates (see table below).

Indicators Both sex Source and year
Life expectancy 57.5 KNBS facts and figures
Crude mortality rate 11.7 1999 census
Under-5 mortality rate 74 KDHS preliminary 2008
Maternal mortality ratio per 100,000 414 KDHS 2003
HIV/AIDS prevalence rate 6.9 KAIS 2007
% with access to safe water 42.3% KIBHS 2006
% with access to sanitation 85.2% KIBHS 2006

Source GBD 2004.

Rwanda

Rwanda shares its borders with Uganda, Burundi, Tanzania, and the Democratic Republic of Congo (DRC). It is a landlocked country with high population density within an area of 26338km2. It has 30 districts and 5 provinces. Additionally, two dry and wet seasons define the distinct vegetation and tropical climate of Rwanda. In 2010, Data from the National Institute of Statistics (NISR) indicated that the population of Rwanda was approximately 10 million. Projections made by the NISR indicated that only 15% of the total population lives in urban centers. The remaining percentage lives and work in rural areas (Brown, 2006). Birth rate is relatively high in Rwanda compared to Kenya. According to a survey conducted by the Demographic and Health Department in 2007, the rate of population growth rate in Rwanda stands at 2.7% per annum (Ministry of Health-Rwanda, 2009). The male to female ration in Rwanda is 1:1.

Distribution of population in Rwanda according to age group and year

Age Group 2007 2008 2009
0-14 years 42.3% 42.2% 42.3%
15-59 years 55.1 55.2 55.3
60+ years 2.6 2.5 2.4
Total 100.0% 100.0% 100.0%
Total population 9,556,670 9,831501 10,117,029

Source: NSIR 2002.

Year Total Male Female Male/Female (%) Growth rate (%)
2007 9,556,670 4,597,277 4,959,393 92.7% 2.7
2008 9,831,501 4,736104 5,095,397 92.9% 2.7
2009 10,117,029 4,880,233 5,236,796 93.2% 2.7

Source: NSIR 2002.

Economy

Since 1994, Rwanda’s economy has experienced growth as depicted by a recent GDP average of 8.83% (Ministry of Health-Rwanda, 2009). According to Human Development Index report in 2005, Rwanda was ranked 161 out of 177 in terms of GDP per capita growth. Its goo track record in alleviating poverty has made it easier for the country to receive debt relief from major international bodies such as Multilateral Debt Relief Initiatives (MDRI) and the Heavily Indebted Poor Countries (HIPC) as well as IMF. In spite of its exports, balance of payments is still unfavorable due to quite a number of factors such as over dependency on tourism and reliance on external aid (Brown, 2006).

Rwanda boasts of good governance, stable economic growth and security. Its major sources of revenue are statutory taxation, tourism, loans, multilateral and bilateral grants as well as agriculture.

Economic growth indicators in Rwanda

Indicators 2006 2007 2008
GDP (Million $) 3076 3746 4691
External Debt as % of GDP 15.8% 15.5% 14.3%
Domestic + External Debt as % of GDP 24.4% 22.7% 20.3%
Economic Aid as % of GDP 9.9% 10.1% 10.9%
Proportion of Budget on health as % of total GoR budget 11% 11%
Proportion GoR total expenditure on health 18.8%4 6.7%5
GDP per capita (in PPP) $340 $8666 $492
Proportion of population living below poverty line 60.4% (2001) 56.9% (2008)
Proportion of population in extreme poverty 41.3 (2001) 36.9 (2008)
Proportion of Under 5 with severe malnutrition 45%7
Unemployment rate 1.2*
Inflation rate (Consumer price) 8.9 9.1 15.4

Source: MINECOFIN, NISR & BNR, 2009; EICV 2, (2005/6).

Governance and Political stability

Rwanda is headed by a president elected through democratic election. Additionally, it has a senate, parliament and a cabinet. In 2006, the country instituted reforms on public and decentralization process thereby fostering a structure that had cells, sections, districts, and provinces.

Uganda

Uganda is a land locked country in East Africa with a population of 27.7 million. It covers a total area of 241,038km2. Ugandan land surface occupies about 197,096 square kilometers while the remaining portion is swampy. Mortality rate during child birth per 100,000 births stands at 506 while infant mortality rate per 1000 live births is 88 (United Nations Organization, 2005). The table below shows the population and housing report for four consecutive decades.

Census year Total
population
(million 		Male
population
(million 		Female
population
(million 		Male/female
ratio 		Per cent point
change of sex
ratio
1969 9.5 4.8 4.7 101.7
1980 12.6 6.2 6.4 98.2 -3.69
1991 16.7 8.2 8.5 96.5 -1.71
2002 24.2 11.8 12.4 95.3 -1.20

Source: 2002 Population & Housing Census Report, UBOS.

Economy

Uganda has been commended by various international bodies such as the World Bank for its ability to control inflation and steer economic growth (Anon, 2002). According to a report finding by World Bank in 2002, absolute poverty in Uganda had reduced by 21% owing to its proper allocation of resources to health, education and other social needs (Anon, 2002).

Governance and political stability

Politically, Uganda has three organs of governance namely the judiciary, legislature and an executive. It is headed by a president supported by a cabinet of ministers. The legislature addresses issues such as sanitation, water, education and health. Additionally, the judiciary tackles contentious issues regarding implementation of heath policies (United Nations Organization, 2005).

Comparisons

Health Systems and services

  • Public
    • In Uganda, Rwanda and Kenya, the public health care system services are effective and resources are availed from the community to national level.
  • Private
    • Kenya and Uganda partly supports private health care systems while Rwanda does not support.
  • Financial
    • Financial resources to tackle health issues are not adequate in all the three counties owing to poverty and slow economic growth.
  • Insurance
    • Uganda health care and human resource department lacks health insurance for the public while Kenya and Rwanda have insurance cover on public health.
  • Governance
    • All the three countries receive support from government in terms of offering health care policies and governance from health sectors and the government
  • Hospital
    • Kenya, Uganda and Rwanda lack enough hospitals to take care of overwhelming number of patients. Hospital resources are insufficient.
  • Other health care service provider facilities.
    • All the three countries have private health care facilities that offer health care resources
  • Ranking on global scale
    • Kenya leads by 141 in global ranking in provision of health care services ahead of Rwanda that ranks 144 while Uganda trails at 149.
Kenya Uganda Rwanda
Public Effective Effective Effective
Private Partly support Partly support Does not support
Finance Not adequate Not adequate Not adequate
Insurance Offers health insurance Has no health insurance Offers health insurance
Governance Good governance and support from the government Good governance and support from the government Good governance and support from the government
Accreditation
Hospitals Not adequate Not adequate Not adequate
Other health service provider facilities Are few Are few Are few
Ranking on global scale Ranks 141 Ranks 149 Ranks 144

Health status

  • Life expectancy in Kenya is higher than Uganda while Rwanda has the lowest life expectancy. However, they share the same life expectancy at birth which is 49.
    • IMR
  • Infant mortality rate in the three countries is high. However, Uganda leads by 138 followed by followed by Rwanda and Kenya with 203 and 200 respectively.
    • HIV/ AIDS
  • The prevalence of HIV/AIDS in Kenya is higher among adults with up to 6.7 than Rwanda which has 5.1 and Uganda that has 4.1
    • TB prevalence
  • The prevalence and incidence of TB is higher in Kenya than Uganda and Rwanda.
    • 10 causes of death
  • Kenya, Uganda and Rwanda share causes of death emanating from injuries, pneumonia, malaria, measles, diarrhea diseases, HIV/AIDS, birth asphyxia severe infections and neonatal causes.
Kenya Uganda Rwanda
138 Life expectancy 51 48 44
IMR 120 138 203
HIV/AIDS Prevalence high by 6.7 Prevalence at 4.1 Prevalence at 5.1
TB (Incidence and Prevalence), major infectious diseases Highest High Higher
10 causes of death Similar Similar Similar

Human resources for health

  • Health workforce. Kenya and Uganda have a high number of workforce while Rwanda’s health workforce is not sufficient to meet health care needs for patients
  • Identify shortages. Rwanda has limited laboratory technician and dentists while Kenya has less community health workers. Uganda has less community health workers and dentists
Kenya Uganda Rwanda
Health workforce Many Not sufficient Not sufficient
Identify shortage Less Community health workers Less Community health workers and dentists Less Lab technicians and dentists

Strategies to solve HRH

Kenya, Uganda and Rwanda share strategies for solving HRH.

  • Plan. The various health sectors in the three countries should set up strategies, policies and programs that would optimize the use of available resources.
  • Development. Dedicate more finances to health care systems. There is need for more health workers to be deployed in healthcare system
  • Support. Support should be given to create more health facilities, and finances
Kenya Uganda Rwanda
Plan Set strategies, policies and programs Set strategies, policies and programs Set strategies, policies and programs
Development Initiate financial programs and add more health workers Initiate financial programs and add more health workers Initiate financial programs and add more health workers
Support Financial support Financial support Financial support

References

AHWO (2009). Human Resources for Health Country Profile Kenya. Web.

Anon(2002). “WHO CAM strategy advocates national policy creation, increased R&D”. The Blue Sheet, 45(22): 18-19.

Brown, G. (2006). International nursing department Rwanda: A Country Still in Post War Syndrome – Twelve Years Later. ABNF Journal, 17(4), 143-6

Ministry of health-Kenya (2006). The second national health sector strategic plan of Kenya –NHSSP II– 2005–2010. Reversing the Trends, 1-96.

Ministry of Health-Rwanda(2009). Situational analysis of the health sector. Health Sector Strategic Plan. 4-100.

United Nations Organization (2005). Preparing the health workforce. The World Health Report 2006. 41-67.

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