Child Health Services in Kenya

Given the worrying trends in infant and child mortality rates, there is a clear need to assess current practices in the management of childhood illnesses and to identify opportunities for intervention. The 2004 Kenya Service Provision Assessment Survey (KSPA) findings indicate that most health care providers are not taking care of sick children holistically, but rather are treating children only for the presenting illness. Using data obtained from the 2004 KSPA, this study aims to establish the factors that are associated with the promotion of child health using a holistic approach, such as the Integrated Management of Childhood Illness (IMCI) strategy to manage a sick child. The IMCI strategy aims to reduce morbidity and infant and child mortality by implementing three main components: improving health workers' skills in case management; improving the health systems; and improving family and community childcare practices. Three composite dependent variables representing the holistic approach to child health care were created to measure the following: full assessment of sick child; proper counseling of the child’s caretaker; and facility support services for holistic care of sick children. The independent variables used in the analysis include facility type, facility managing authority, region, qualifications of the provider, and sex of the provider. Almost all health providers surveyed missed critical opportunities to conduct a full assessment of the sick children who presented to them for care. According to the survey, enrolled nurses and doctors were doing better in full assessment and counseling of sick children compared to registered nurses and clinical officers. This difference can be attributed to the fact that doctors and enrolled nurses were likely to have received IMCI training in the previous year compared to registered nurses. Notably, about twice as many female health providers as male health providers assessed major signs and thrice as many female health workers assessed for all three danger signs. Female providers were also more likely than male providers to properly monitor child growth. Counseling caretakers on children’s illnesses was generally poor, with only one in every five caretakers being counseled in clinics and one in every ten caretakers being counseled in health centres. Male providers were more likely to counsel caretakers than their female counterparts. Providers in private facilities were twice as likely to counsel caretakers as providers in public facilities. The full range of essential equipment was lacking in almost all facilities. Hospitals were more likely to be stocked with all essential equipment, followed by dispensaries and maternities with health centers and clinics the least likely. The results reveal that the quality of care provided to sick children at the first level of health facilities should be improved. Also, help is needed to determine the areas that should be emphasized during the training and supervision of IMCI and other child survival strategies. The KSPA results also suggest the need to improve the skills of more health workers managing children younger than five years and to mobilize more resources for child health. LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ANC Ante Natal Clinic ART Anti Retroviral Therapy CBS Central Bureau of Statistics DHMB District Health Management Board DHMT District Health Management Teams DPHN District Public Health Nurse EmOC Emergency Obstetric Care FP Family Planning HFS Health Facility Survey HIV Human Immunodeficiency Virus ICPD International Conference on Population and Development IMCI Integrated Management of Childhood Illnesses KDHS Kenya Demographic and Health Survey KEPI Kenya Expanded Programme on Immunization KSPA Kenya Service Provision Assessment MCE Multi Country Evaluation MOH Ministry of Health NCAPD National Coordinating Agency for Population and Development NHIF National Hospital Insurance Fund NHSSP National Health Sector Strategic Plan PMTCT Prevention of Mother to Child Transmission PNC Post Natal Clinic SMH Safe Motherhood STI Sexually Transmitted Infections TB Tuberculosis UNFPA United Nations Population Fund UNICEF United Nations Children's Fund USAID United States Agency for International Development WDR World Development Report WHO World Health Organization