Kenya’s health infrastructure is relatively well developed. The Kenya Medical Research Institute (KEMRI) is one of the leading medical research centers in Africa. Despite this, 23 percent of Kenya’s 32 million people do not have access to basic health care facilities.

In 2003 UNAIDS and the WHO revised their estimates of HIV prevalence in Kenya downwards to 9.4 percent, much lower than the 15 percent UNAIDS had estimated in 2001. In early 2004 a Kenyan Ministry of Planning and National Development study showed a prevalence rate of 6.7 percent, sparking a debate with UNAIDS over estimates of HIV prevalence in Kenya (sources: AllAfrica.com, The East African (Nairobi), 1-19-2004; UNAIDS (Kenya page)). As is the case elsewhere in Africa, the HIV/AIDS burden tends to concentrate in urban areas. The HIV/AIDS infection rate in Kenya’s capital city of Nairobi is double the rate in the countryside.

Tuberculosis has made an opportunistic comeback in conjunction with the AIDS epidemic. From a low of 11,000 cases in 1988, tuberculosis cases reached 40,000 in 1997, and 73,000 cases in 2001. Kenya's government is offering free drugs to combat TB at hospitals throughout the country. Malaria is also a serious public health concern, with over 4.3 million cases reported in 1995.

Kenya is a remarkably young nation, with 70 percent of the population under age 20. It is the youngest adults who are hardest hit by the current AIDS crisis, with 70 percent of HIV positive persons between the ages of 18 and 25. HIV has hit young women much harder than young men, with HIV infection rates among 15 to 19 year old women exceeding 20 percent in some areas of the country, as opposed to 4 percent for men in the same age category. The Medicins Sans Frontieres program in the Lake Victoria region estimates that 35 percent of young women in the area have contracted HIV, and 60 percent of those women have latent, if not active, TB.

Peaceful general elections held on December 27, 2002 resulted in the landslide victory of opposition candidate Mwai Kibaki, ending 39 years of rule by the KANU party, and the 24 year presidency of Daniel arap Moi. This transition is evidence of a relatively mature, stable and democratic government in this critical African nation.

Sources: Synergy Project, CIA Factbook, Roll Back Malaria.

Since 1989 the government has privatized some parts of the health sector, and instituted or increased user fees for those parts not privatized. Some hospitals in Nairobi are encouraging people to purchase membership in associations which have a role in the governance of the hospital, and restricting admittance to association members and their families.

Given the nature of the current health crisis, the Ministry of Health is concentrating more on preventing the spread of diseases, rather than curing those afflicted. The government of Kenya is also shifting more of the responsibility for health care to individuals and away from the government. A Division of Health Education (DHE) has been created within the Ministry of Health, and with technical assistance from Johns Hopkins University, a National Health Communication strategy has been developed. The primary goal of the DHE is to reduce the transmission of STIs and other infectious diseases.

Kenya's national tuberculosis program is implementing its 2001-5 strategic plan and is already beginning to develop a plan for 2005-9. Kenya has had 100 percent DOTS coverage since 1996. The country had a successful treatment rate of 80 percent in the 2001 cohort of patients, but only a 49 percent detection rate. In 2003 there was a funding gap of $3.3 million for TB programs. It is estimated that about 51 percent of Kenya's adult TB cases are also HIV+. About 20 percent of Kenya's TB drugs are bought through the Global Drug Facility program of the Stop TB alliance, and Kenya works with many international technical partners in its TB programs. These partners include KNCV, WHO, the CDC, John Snow International, Family Health International, the Canadian International Development Agency (CIDA) and the World Bank.

Malaria is a growing problem in Kenya, and the local strains of p. falciparum have developed resistance to chloroquine. Kenya has as a result switched to sulfadoxine-pyrimethamine (SP) as its first-line response to malaria. Kenya's Director of Medical Services, Dr. James Nyikal, announced in December 2003 that Kenya was seriously considering resumption of the use of the pesticide DDT in order to combat malaria. Also announced in December 2003 was a policy to provide free treatment for TB and malaria at all government hospitals and health centers. Previously only children under five received free treatment for these diseases.

Sources: United Nations Statistics Division; WHO Report 2003: Global Tuberculosis Control; AllAfrica.com, The East African Standard (Nairobi), 4-28-2003; AllAfrica.com, The East African Standard (Nairobi), 12-19-2003; AllAfrica.com, The Nation (Nairobi), 12-10-2003 ; WHO Report 2004: Global Tuberculosis Control

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

Despite public and private sectors being roughly the same size, 80 percent of Kenya’s medical doctors are outside the public system, leaving treatment in the public system in the hands of less qualified personnel. The public sector has been especially important in providing health services in rural areas; two thirds of health workers in the country-side are public, compared to only half in cities. Even with this large Ministry of Health presence, there are only 90 health workers per 100,000 population in rural areas, compared with 375 in urban areas.

International Center for Insect Physiology and Ecology (ICIPE)

• R&D Partnership in Bio-Prospecting for Anti-Malarial, Mosquito Repellant & Insecticide Plants. This project is focused on bio-prospecting for East African plants with potential in controlling malaria vectors. A major objective is to develop a nucleus of researchers capable of continuing this work over the long-term.

• A study of Highland Malaria led by Professor Francois Omlin, and funded by Finland. The study has found that about 90 percent of the mosquitoes transmitting malaria are breeding in man-made sites, most often produced by clay excavations for the purpose of brick-making. ICIPE scientists are developing some botanical larvicides from the Neem tree and China Berry. (AllAfrica.com, The Nation (Nairobi), April 28, 2004.)

• ICIPE is also using satellite imagery technology developed by NASA to identify malaria vector hotspots in Kenya and other African nations.

Kenya Medical Research Institute (KEMRI) ( website )

A couple of KEMRI's ongoing research projects include:

• KEMRI’s Centre for Respiratory Diseases Research (CRDR) is conducting studies to improve detection rates for TB, and shorter chemotherapy treatments.
• KEMRI’s Centre for Virus Research (CVR) is studying of the epidemiology, socio- cultural impact, therapy, and vaccine development of and for AIDS. This study is conducted in collaboration with NCID/DASTLR. Five communities in Kenya representing both urban and rural settings have been selected for the development of epidemiological profiles and pathogenetic research into HIV.

Kenyan AIDS Vaccine Initiative (KAVI)

Moi University, College of Health Sciences ( website )

The African Medical and Research Foundation (AMREF) ( website )

Through its Malaria Control Project, AMREF distributes impregnated mosquito nets to reduce transmission of malaria. A second AMREF project in Kenya is the Bungoma District Malaria Initiative. The objectives of this initiative include improving case management for children with malaria, improving home care options, and reducing the number of pregnant women contracting malaria. Finally, AMREF has been tracking the resistance of malaria to various drugs since 1980, providing evidence of the increasing ineffectiveness of chloroquine as a first-line treatment, and encouraging the use of alternatives.

United States Army Medical Research Unit - Kenya (USAMRU-K) ( website )

USAMRU has also conducted preliminary adult clinical trials of a malaria vaccine candidate, MSP-1, and is expected to begin testing the vaccine's safety in children in 2003.

University of Nairobi

This project is intended to identify traditional phytomedicines and establish a research laboratory to carry out pharmacological tests. Partners in this study include Kenyatta University, Makerere University (Uganda), Muhimbili University (Tanzania), the Royal Danish School of Pharmacy, and the Wellcome Trust (UK). Source: MIM

1. Kenya is one of the countries approved to receive support from the Global TB Drug Facility, (GDF) mechanism designed to expand access to, and availability of, high-quality TB drugs by enabling governments and non-governmental organizations (NGOs) to implement effective TB control programmes based on the DOTS strategy.

2. Future priorities of CDC's Global AIDS Program for Kenya, and projects it has initialized, include:
   • Reviewing HIV/AIDS activities in the Kenyan military, and advising the military on HIV/AIDS related policies.
   • Conducting behavioral surveillance surveys in 8 districts.
   • Establishing a pilot initiative using ARV treatment.
   • Becoming further engaged in the VCT and MTCT efforts of NASCOP. In early 2004 CDC
   ... additional information

3. The GFATM has approved a major grant for $81.9 million over two years to fight malaria. The grant agreement has yet to be signed.

   Source: GFATM