Why unemployment is a a public health time bomb

Kenya, a developing country, should take keen interest in the WHO review on effects of unemployment and education on public health in Britain, a member of the G10. It states that young people who are not in employment or education in Britain are “a public health time bomb waiting to explode”. ‘Neets’ – or young people not in employment, education or training – were likely to have worse health than their employed counterparts and the Government needed to act to ensure health inequality does not become entrenched, the authors of a report by the organisation claimed.

The review also found that children and women would be better off living in many other European countries, including Eastern European states, than in the UK. “Unemployment may be falling in the UK, but persistent high levels of the number of young people over 18 not in employment, education or training is storing up a public health time bomb waiting to explode,” said Professor Sir Michael Marmont, who chaired the study.

"We are failing too many of our children, women and young people on a grand scale. "I would say to any government that cares about the health of its population: look at the impact of their policies on the lives people are able to lead and, more importantly, at the impact on inequality.

"Health inequality, arising from social and economic inequalities, are socially unjust, unnecessary and avoidable, and it offends against the human right to health." Across the UK there are are 1.09 million 16 to 24-year-olds in the ‘Neet’ category, or 15.1 per cent of the population in that age bracket, according to data published this year.

And death rates for under-fives in the UK - which stand at 5.4 per 1,000 live births and are linked to poverty - are higher than most countries in the east of Europe, the Review of Social Determinants and the Health Divide in the WHO European Region found. Children are more likely to live in poverty in Britain than many other countries in Europe including Iceland, Cyprus and Ireland, it said.

Sir Michael added: "Good quality early years provision must be a priority for all children. But childcare in this country is expensive and many people cannot afford to utilise it or go back to work after having children. "There needs to be a broad range of social policies, including improvements in every child's start to life, adequate social protection that can act as a buffer against low income over the life-course, and provide a minimum standard for healthy living." Female life expectancy in the UK is 83, behind Spain, France and Italy, where it is 85, and Cyprus and Germany, where is it 84.

This review has very serious resonance and semblance to Kenya where a large percentage of the youth are unemployed and lack formal training or education. A recent report by InfroTrack Research stated that only 3% of people in the coast region have at least a University Degree.

Kenya’s life expectancy averages 57 years with under-five mortality standing at 80 per 1000 live births. These damning health indicators may well show that we are more affected by poor investment in employment and training of our youth, doing worse in public health. The fact that the youth are still marginalized in terms of opportunities such as employment means that they stand to be the affected because they can not have the socio-economic power to make the right health choices. There is then every reason for our governments, national and county, to adopt this WHO report. 

The writer is a PHO based in Nairobi (e-mail: chrispory.juma@gmail.com)

Graduate PHO Interns must not be forgotten

The Public Health Officer (PHO), or Bora Afya (in Kiwashili) is the guy who spearheads disease surveillance, hygiene and sanitation, building plans approvals, health education and promotion, community mobilization over all health issues including having a first-hand contact with epidemics where they arise, and enforcing legislations related to environmental health. In essence, the PHO is the custodian and pillar of Kenyans’ health, ensuring that any or many of them are not admitted in hospitals, or fall sick at all; yes, the PHO is the benchmark of preventive health care.

Preventive health care has gained a lot of traction in government as well as in the NGOs sector. However, financing it has never gained the same tracking and most activities geared towards prevention are under-resourced (mortalities due to preventable deaths still high).  Only recently, the government began putting some efforts to support prevention through the community strategy by employing CHEWs (Community Health Extension Workers). However, the CHEWs (lab tech, pharmacy technicians, etc) employed through the ESP program were not directly relevant to Community strategy and had to be reassigned in most districts. To date the biggest undoing of community strategy is lack of funds as it is still donor-funded with many donors having their own priorities.

This brings to fore the whole question of how adequate Public Health Professionals, particularly PHOs, are for the Kenyan Public. The number of PHOs in Kenya is approximately 20,000, with those in government at around 10,000. Majority of those in Government are diploma and certificate holders and only about 200 are graduate degree holders. We are talking of a ratio of 1 PHO for every 2,000 Kenyans.

A cadre of PHOs which seems to be forgotten in this Public Health Human Resource circus is the Graduate PHOs Group, which just like any other health cadre, is required to undergo a mandatory 1 year internship to be considered for absorption by the government. The interesting thing about the health care system in Kenya is that it is very much in the hands of the government thus opportunities for health professionals largely depend on government provisions.

Internship is undoubtedly a good professional development platform, more so for those with health backgrounds. But how convenient and motivating is the PHO Graduate Internship? Is there anything that can be done better? Upon completion of studies, graduate PHOs interested in future MOH job considerations are required to choose an internship station of their choice, apply and volunteer there for one year, without any motivation or stipend.

Upon completing this, absorption is not guaranteed. Frustrated graduate PHOs have had to wait for more than 3 years now for a word from the MOH. The most affected are the Environmental Health Graduates. The last time MOH did a meaningful absorption of PHOs was in 2009, where more than 150 PHOs were employed. Many PHO graduates have had to run to NGOs which have Public Health Programs, and have found their skills and experiences relevant and hugely in demand. Others have had to diversify their career paths into unlikely fields such as banking and insurance.

As one of the creamiest professions for university entrants, many people always have huge expectations when they enroll for it. But the loud silence from MOH on the fate of PHO interns, with many of them graduating from Universities each year, always makes them wonder if academic investment in Public Health is worth it, in the absence of many NGOs which have absorbed a number of them.

While we are talking of laws to introduce stipends for unemployed graduates or stipends for best performing form four leavers, what has made it difficult to have stipends for PHO graduates? Is it about our laws, now that the Public Health Act Cap 242 and Public Health Officers/Technicians Act do not mention PHO interns? Can’t we include PHO interns in the PHOs’ Schemes of Service (SOS)?

With health care largely devolved, any hopeful PHO is looking up to the county governments to create more opportunities. This being a service delivery profession, the government continues to be our sole bread-winner and the silence has even wider effects on the growth of the Public Health Profession in the Country.  The Constitution of Kenya, in the Bills of Rights, expressly provides not only the right to health for every Kenyan but also the need for everyone to be treated equally, with an equal right to employment and related benefits. When the government selectively targets one cadre of health workers to be compensated during internship and not the other one, it is a violation of the other’s human rights and propagating professional discrimination in the health sector. As such, by the PHO Interns asking the government to look better into their welfare, it is not a request for a favour but a demand for what is justifiably right.

(The writer is a PHO working as a Program Officer for Water and Livelihoods Network (WALINET). He is the convener of Public Health Officer Interns-Kenya, E-mail: chrispory@walinet.org)

Imported solid wastes adding more salt to injury

The Environmental Management and Coordination Act (EMCA) of 1999 gives rights and confers duties to individuals to safeguard and enhance the environment. It guarantees every Kenyan a clean and healthy environment. These provisions also envisage protection of the environment for the benefit of the present and future generations as also envisioned  in Kenyan Vision 2030 and the constitution 2010.

However, more often than not, urban dwellers have to make do with living amid solid wastes despite the health risks.  Here is where slums and streets are littered with solid wastes and bus parks and ocean/lake shores serve as dumpsites. It is common to come across slum children playing with plastic bags full of feaces that had been thrown away the previous night.

Kenya continues to face a myriad of challenges regarding solid waste management. Budgetary deficiencies, insufficient public awareness, poor enforcement of outdated legislations, less solid waste research and lack of skilled staff in waste management are making us stare in the face of a solid waste management time bomb. Collection systems are inefficient and disposal systems are not environmentally friendly. 30 to 40 per cent of all solid waste generated in urban areas is uncollected and less than 50 per cent of the population is served (Otieno, 2010). He states that up to 80 per cent of collection transport is out of service or in need of repair and argues that if the issue of sustainable solid waste management in Kenya is not considered urgently, all the towns in Kenya will be engulfed in waste. The politics of relocating the Dandora dumpsite, inspite of the obvious environmental health risks it predisposes us to, for instance, has been here with us for decades. Again, one would wonder, where will this dumpsite be rellocated with the current approaches? That remains another discussion for another day!

Nairobi, the most affected by the solid waste menace, produces approximately 3200 tonnes of solid wastes daily. This is enough for people who would want to draw recyclables, instead of resorting to importation as in the case last week of the 20 tonnes from Britain. But this, ashamedly, might just be a tip of the iceberg. Many more are getting in. But one would ask, why bother with the local content while we can not tell the exact amounts of types of solid wastes we produce daily as a nation?

This calls for the need for sustainable, economically and ecologically practical solutions to integrated solid waste management.  These simple and well known three bottom-line prerequisites need to guide us in the development of a solid waste management strategy that would protect our land and turn the solid waste management sector into a viable economy. This would call for the revision of the EMCA Act to be realistic with the changed face of the solid wastes sectors such as a viably inclusive private-public partnership in the major towns. This would facilitate a fruitful implementation of NEMA’s Waste Management Regulations 2006 which are yet to yield convincing fruits. It would also guide county governments on waste management. If this is not happening alongside other sector alignments, then where are headed to? 

The writer is a Public Health Officer practicing in Nairobi(Chrispory.juma@gmail.com)

How can young people end corruption in Kenya?

With Kenya ranked as one of the most corrupt in Africa and the youth accounting for more than 60% of her population, the fight against corruption can be well won if the youth actively participate in interventions against corruption or initiate innovations to help fight the vice. We must help effect Transparency International’s vision of a world in which governments, politics, business, civil societies and the daily lives of people are free of corruption.

We, young people, are undoubtedly the biggest victims of corruption. Youth unemployment is one of Kenya’s biggest headaches yet World Bank Reports show that more than 250,000 job are lost to corruption annually. Bribery, tribalism and nepotism shroud the job market such that competence and merit have been thrown to the bin. This in turn means that we remain poor and resort to retrogressive malpractices such as drug-abuse, moral degradation, violence and apathy that continue to affect our economic growth over time. The need for the youth to be involved in the fight against corruption can therefore not be over-emphasized. What then must young people do to end corruption?

We must provide servant leadership, at all levels. With our athleticism and energy, we must strive to influence the society to believe in us as the best agents of change and capable leaders. We must therefore lead by example while respecting existing authorities. In a society where politics is money-driven, we can use our numbers to propel ourselves into political offices and once there, we must be of integrity to serve as examples to others. Many youths now look up to Duncan Gutuanja (youngest county representative) and Kinoti Gatobu (youngest MP) to be shining leaders. The nation can never trust us with leadership when, in positions of power, we are the ring-leaders of corrupt deals and moral corruption. We need to be the luminaries of reforms and social accountability, providing leadership in condemning corruption loudest and reporting any cases to the relevant authorities, which we must always keep on check and ensure they serve the interests of citizens.

Young people must end total dependency on the government for jobs and wealth creation opportunities by coming up with initiatives that do not only help them, but create opportunities for others. To be prosperous in these wealth creation initiatives, we can seek mentorship from successful businesspeople who have always inspired generations over-time, such as Manu Chandaria and Chris Kirubi. The government provides loans to the youth. How many of us belong to youth groups that can apply for these loans? How many youth groups pay back their loans so that others can also benefit. If we can manage these funds well to have sustainable sources of income for ourselves, the government will be encourage to pump more into youth funds and we shall be politically and economically independent.

Corruption can not hold us back as we watch. In the words of Benjamin Disraeli, ‘We live in an age when to be young and to be indifferent can be no longer synonymous. We must prepare for the coming hour. The claims of the Future are represented by suffering millions; and the Youth of a Nation are the trustees of Posterity.’ I believe that with servant leadership and strive for economic independence, we’ll immensely contribute to securing a corruption-free future for our beloved country Kenya.

The writer is a Public Health Officer practicing in Nairobi (chrispory@gmail.com)

Public Health Officers Act good for the profession

This year saw the enactment of the Public Health Officers (Training, Registration and Licensing) Act which makes provision for the professionalism,  training, registration and licensing of Public Health Officers and Public Health Technicians. The Act establishes the Public Health Officers and Technicians Council whose purpose is to exercise general supervision and control over the training, practice and employment of Public Health Officers and Technicians in Kenya and advice the government and Ministry of Health on matters of Public Health Governance.

The success, order, prominence and impetus of any professional body is hinged on a strong regulatory council and the powers given to this council signals a promise of a brighter future to the legitimacy, position and contribution of Public Health professionals in health care provision, management and policy dialogues in  Kenya. This Act puts the Public Health Profession at par with other council or board-regulated health professions in the country such as Medicine, Nursing and Medical Technology.

Some of immense powers it gives the Public Health Officers and Technicians Council include; Prescription of courses of instruction for Public Health Officers and Public Health Technicians, and specifying their minimum qualifications; Consider and approve the qualification of Public Health Officers and Technicians for purposes of registration; Licence and regulate the practice of registered Public Health Officers and Technicians; Establish, regulate and maintain a professional code of conduct for all Public Health Officers and Technicians.

Section 37 provides for the establishment of the Disciplinary Committee which shall be responsible for instilling discipline, decorum and decency within the profession. This committee actually has powers to suspend, withdraw or cancel the practicing certificate of a professional found to have violated the code of conduct. This will go a long way in restoring the integrity of a profession which at times has been associated with corruption in course of duty of its members.

The Public Health profession shall no longer be a field for any other Dick and Harry. One will have to undergo specific examinations for certification to practice in Kenya or anywhere else. Let us ready to expect even specific dress-codes we are required to put on while on duty. It is our hope that this Act will streamline employment of Public Health Professionals, most particularly employment and internships of Public Health (Environmental Health) Graduates.

One unexploited area that this Act gives life and cognisance is Private Practice by Public Health Officers and Technicians. It states that one is qualified for practice as long as he/she is a Kenyan citizen, registered as a PHO/T, holds a valid practicing certificate and annual licence, has served as a PHO/T under supervision for a period of not less than five years and is deemed to have professionally qualified with a certificate, diploma or degree.

The Council, in its constitution, provides for a representative of the Association of Public Health Officers, Kenya (APHOK). This reverberates into the need for strengthening of the professional body which protects the rights and welfare of all the Public Health Officers/Technicians in Kenya. This strengthening, in the eyes of an intern, must involve providing avenues for interns to actively participate in APHOK’s activities, including involvement in elections.

This Act will no doubt play a bigger part in restoring the stature of Public Health Officers/Technicians as key players in the pursuit of realizing holistic health for all Kenyans. We are awaiting the constitution of this council with abated breathe.

The writer is a Public Health Graduate practising in Nairobi (Chrispory.juma@gmail.com)

We must continue to uphold Musa Juma’s Legacy

Today marks the death of Musa Juma two years ago. The sorrows that greeted the news of his death still hovers over the hearts of his legion of fans, including me. Kenya had lost one of its greatest and iconic benga and rhumba musicians.

We owe it all to the man who revolutionized our music, giving it the lyrical and instrumental touch similar to the conglose lingala. With his fusion of Franco’s guitar skills, Okatch’s attractive voice and Collella’s tempting tunes, he gave our music a new image. He proved it that vernacular music, in this case benga, could infact unite people, as every Kenyan, from whichever background enjoyed and continues to enjoy his music. People from all walks of life could attend his live shows. He entertained many people of different nationalities, from Botswana to U.S.A.

He inspired and continues to inspire many musicians. Bands like Bana Sungusia, BV Band, Madjona Rhumba, Banamela and Patron Musica have learnt a lot from him and his brand remains their musical benchmarks.

As we commemorate his death with his legendary spirit still hovering over us, his fans, the question remains if we continue to uphold what he stood for. This was a crooner who advocated for peace, love, reconciliation, integrity, discipline and environmental management; the thematic issues around which his music revolved. We can honour him by upholding these values. Just as he used his gift to promote a better society, we can also use our various abilities to create a better society.

He commanded respect amongst his peers and fans and led his band, Limpopo International, with exemplary discipline and adorable flamboyance. Perhaps present-day musicians have lessons to learn from this.

We must credit his younger sister, Millie Fedha, for managing to liven his legacy by maintaining Limpopo Band, though now metamorphosized to Super Limpopo International Band. Even with major band members like Damas, Azile, Salim, Vaska, Tumbas, Jose, Sande and John gone to other bands like Banamela, she has managed to bring up a young and talented band that continue to make the late Musa Juma (I am sure) and every of his fans proud. Watching them sing is nostalgic and acoustic. Keep up Millie, we support you.

I still believe there are more things we can do to honour our music icon. Think of a memorial event like a tournament, or a special awards ceremony to honour benga artists named after him. We love you MJ, your legacy lives on, we continue to immortalize you. 

The writer is a social commentator living in Nairobi