Kenya AIB

• Only 30% have acess to medicines, many die from preventable diseases
• Shortage of healthcare professionals as they emigrate or work for private companies - 1 doctor per 10 000
• Shortage of infrastructure - Hospital:Population = 1:60 000
• Only 25% of Kenyans have access to medical facility within 8km
• Cultural traditions - many HIV/AIDs patients cared for at home
• Lack of political will - transport and logistics are not the main focus of international pressure (MDGS)
• Poor infrastructure - only 14% of Kenya's roads are paved
• 40% of national transport budget was unspent in 2006
• Most people can't afford retroviral drugs
• Healthcare is expensive - not free at the point of delivery
• Poor road conditions = breakdown of vehicles = need for riders
• 70% of population live more than 2km away from a paved road

• IMR: 40.7 per 1000 (under 1)
• Total External Debt - $13.5 billion
• Over 60% live in rural locations, but only 14% road networks paved (not suitable for normal cars)
• Healthcare delivery vehicles out of use for want of US$3 part
• Riders for Health became an NGo in 1996 - works in the Gambia, Zimbabwe, Nigeria, Kenya, Malawi, Zambia and Lesotho
• Kenyan program began 2002, 8 staff manage 77 vehicles
• Works with African Infectious Disease Clinics
• Grassroots iniatives - healthworkers from community based organisations provided with transport
• 2011- opened International Academy for Vehicle
• Before - 60 people reached a week by a rider, now 450 reached a week per rider
• Travel time cut from 4 hours to 1
• Can travel up to 80km away rather than 20km away
• Society for Women with Aids - stigmitization reduced - MDG 3 & 6

• Most of South-West is over 1000m
• Central region 200-1000m
• Coastal region under 200m
• High rainfall in areas of higher relief due to relief ranfall
• High rainfall in Mombasa due to tropical storms
• Areas of higher precipitation suitable for crop growth, allows a continuous growing season
• Areas of high population density developed around cropland 
• No cropland in national park and no people
• Coast quite densely populated
• Poverty in main cities - areas with high population density
• Areas in North Kenya have high population density but lower poverty
• Should we concentrate medicines in area of greatest poverty? Dense population -> infectious disease

• Mountainous terrain makes access difficult - areas of high relief
• High precipitation = more mass movement of land
• High preciptation = malaria = hours lost, high IMR
• National parks prevent corridor of development from capital
• Large country with many small villages requires large road network but only 14% are paved
• Low precipitation areas are unsuitable for cropland
• Low precipitation = uneven water distribution = cost of irrigation

• Inequality of healthcare provision due to poor infrastructure
• Over 60% live in rural locations, only 14% road networks paved - unsuitable for normal cars so hard to deliver healthcare
• Allows better access to education = improved hygeine = reduces spread of disease
• Better road systems could encourage urbanisation 
• Better access to pregnant women - reduce the IMR and maternal mortality rate
• Resources can be distributed according to need not population size
• Cost-benefit analysis?

Social 

• more people with HIV go public and receive treatment
• treatment improves quality of life
• more hospitals - decrease in incidence of poor health
• less absences from school - better education - more opportunities

Economic

• Less absence from work

Environmental

• Farms could fall into disrepair and lead to desertification

• Most effective
• Those at bottom know what they need
• More tailored to specific needs - different needs in different places
• Might not have infrastructure to support it - appropriate technology? - How do Bikers get petrol?
• Top Down - needed to distribute medical supplies to whole country - not efficient to have an effective system for only one area

• Kenya has roads, only 14% are paved but bikes are suited to dirt roads
• One bike per doctor - need more bikes, could fit 4 in one car before
• People can be trained to ride/repair/maintain the bikes
• Can't carry as much medicine

• Seen improvements on a small scale in the areas they operate - 20 000 more people reached
• Inappropriate distribution of supplies + loss of workers currently
• Start with demand at the bottom - requires some kind of database, work with supply and demand
• Would require efficient IT system - high set up costs - would Riders fund this? The governemnt can't afford it.
• If they miss the deadline day, do they wait another month?
• Riders may not be sustainable - funded by donations - not guaranteed income
• Kenya could follow a riders style system, introducing tax to pay for the improvements

MDGS

• 2005 - unlikely to achieve goals due to lack of resources - poor transport, healthworkers, supplies, ICT, poor communications etc
• Set a policy for the next 10-12 years to work towards goals - all public investment toward it

• Strengthening Service Delivery Systems - human resources, infrastructure and management capacity
• 500 hospitals, 611 health centres, 3310 subcentres/dispensaries
• Each health centre serves 6887 people. Hospital:People =1:60 000
• Only 25% of Kenyans have access to health serices within 8km
• Urban population only 20% but spending there is 70% - easiest to distribute money there
• Low quality of care - lack of supplies plus poorly accessible
• 10% of govs annual budget for healthcare spent on drugs - antiretroviral drugs
• Low utilisation of healthcare due to high cost - not free at point of delivery- rural population isolated

• Money available 2005-2007 should focus on improving human capacity -
• 42% personnel - training teachers, healthworkers, agricultural extension workers
• 39% operations and maintenance - teaching materials, anti-malaria drugs, mosquito nets
• 19% costs for building infrastructure to increase capacity of economy

• Medium Term - 2007 - 2015 - sustaining additional human capital and investing in infrastructure - major trunk roads, rural access roads, education and healthcare buildings