You need to write a policy for advocacy. You should choose a community or health organisation and then decide upon the health issue you are advocating for, and the specific population in which this issue occurs.
The health organization preferred for the policy advocacy is the Ministry of Health in Kenya. The Ministry of Health (Kenya) is a government organization which was initially run by the Minister of Health but as a result of devolution (Constitution of Kenya 2010), it is now run by the Cabinet Secretary (CS) of Health who is chosen by the President. The organization aims at providing a clear policy agenda that will facilitate the achievement of better standards of health in a way responsive to the Kenyan populations’ requirements as well as access to enhanced health services with sufficient monetary risk protection (Luoma et al 2010). The Ministry of Health has several departments whose functioning is administered by the Director of Medical Services. These departments help to ensure that the Ministry of Health (Kenya) is functional and effective in its tasks.
The Department of Standard and Quality assurance tackles matters of alternative and traditional drugs, legislation and regulation and quality assurance. The Department of Preventive and Promotive Health is divided into six other areas Family Health, Non-communicable Diseases, Environmental Health, Disease Surveillance and Epidemic response, National Public Health Programs and National Public Health Laboratory and all are independent of the other. Department of Policy, Planning and Health Financing is the pillar of the Ministry of Health from which Kenya accomplishes Health informatics and Healthcare financing, Monitoring and Evaluation, health policy and planning and research development (Noor et al 2009). The Curative and Rehabilitation health services deal with clinical practice and blood transition, divisions of national referral services, emergencies and disaster management and forensic and pathology services. Additionally, Health sector coordination and inter-governmental control department tackle health area international matters and coordination. The Administrative services department manages office tasks like accounts, legal matters, ICT (Information Communication and Technology) as well as HRM (Human Resource Management).
The Ministry of Health in Kenya has several chief functions as outlined in the Kenyan constitution: health regulation, technical assistance to the 47 counties, health policy and national referral facilities and capacity building. Additionally, the Ministry of Health has a mission which involves creating an advanced, responsive and sustainable health care system for the enhanced achievement of better health standards to all Kenyans. Furthermore, the organizations’ vision entails promoting a healthy, industrious and internationally competitive nation and finally the ministry’s goal is achieving equitable, inexpensive, accessible and quality health care services for all Kenyan citizens (Luoma et al 2010).
The Ministry of Health has several core mandates and values. Some of the core mandates include; training of medical personnel, national health referral services, reproductive health policy, health education management quarantine administration and medical services policy, health inspection and other public health services among others. The Ministry is steered by the following core values: communication, professionalism and ethics, transparency and integrity, commitment, teamwork, social justice and equity, partnership and collaboration, innovativeness and creativity, people-centered and customer satisfaction as well as transparency and integrity.
The Ministry of Health focuses on several health priorities in Kenya and has developed specific health programs to help address these priorities. The programs have been employed in two crucial sectors within the Ministry of Health, reproductive health and child health. Some of the programs involved in reproductive health include: prevention and infertility treatment, prevention and management of HIV/AIDS and sexually transmitted diseases, safe maternity, family planning, gender and procreative rights, prevention and management of cancer, deterrence of risky traditional performances that have negative effects to the reproductive well-being of men and women like FGM (female genital mutilation) (Jamison 2006). Those involved in child health include: promoting proper nutrition, to safeguard survival, growth as well as the development of children between 0 to 5 years, promoting children’s rights and protection as well as promoting health in all children in the nation.
Malaria is a severe and potentially deadly disease. It is a disease initiated by parasites of the Plasmodium genus. It is one of the leading causes of death in women and their young ones in Kenya. Kenya is currently ranked 5th position among the African areas affected by malaria. In a population of 45 million individuals in Kenya, 30 million (in every 4 individuals) 3 are likely to get affected with malaria. Amidst them, 16 are likely to be from the highland malaria-prone regions and 8 from the arid and semi-arid areas that have varying malaria epidemiological patterns (Gething et al 2010).
About 1.5 million women in Kenya become expectant every year. Majority of these women reside in malaria-prone regions. Expectant women, the elderly and children under the age of five are more vulnerable to the serious malaria infections as a result of their low immunity. Expectant women affected with malaria tend to not only become anemic but also risk giving birth to underweight babies. This women also experience other fetal problems like stillbirths, congenital malaria contamination, prematurity or abortion. Pregnant women with malaria have a higher tendency of developing severe malaria. Non-gravid women are less likely to contract malaria as opposed to the expectant women who are 10 times more likely to get malaria (Checchi 2006).
Malaria effectiveness in Kenya varies from one area to another. The risks rise by temperature, rainfall patterns, and altitude. Nyanza and Western areas record the highest rates of malaria cases every year with the prevalence rates of 20-40% and altitude ranges of 0-1300m. The Coast region is another malaria endemic area but the prevalence rates here are less, 5% all year round. The malaria vector life expectancy is less and existence rates in these areas are high due to the favorable climatic environments (O’Meara et al 2008). The highland areas are ranked the second most malaria endemic regions with prevalence rates of 0-20%. The arid areas, as well as semi-arid regions of south and northeastern parts of Kenya, only record malaria cases during the rain seasons with a prevalence not exceeding 5%. During this period the temperatures are generally high with the water pools acting as the breeding regions for malaria-transmitting vectors. High morbidity of endemic malaria outbreaks occurs as a result of low resistant status in these regions during rainy seasons (Seitz and Nyangena 2009).
Kenya lost 46,000 individuals as a result of malaria infections in the year 2013. Reports of World Health Organization (WHO) state that Kenya loses 34,000 children aged below 5 years every year. The four species of malaria-causing vectors; Plasmodium malariae, Plasmodium vivax, Plasmodium falciparum and Plasmodium ovale are transpired in Kenya with Plasmodium falciparum which results to the fatal form of the disease accounting for 98.2% off the malaria infections, whereas P. ovale and P. malariae have a 1.8% occurrence of diverse infections (Muyoma 2012). Malaria is the chief reason of pregnancy complications and can result to early miscarriages. In Kenya, out of three expectant women residing in the Western regions do not use precautionary malaria medicines (Menaca et al 2013). Two among five women in the highland endemic areas do not use ITNs (Insecticide-treated bed nets). Additionally, one among seven women in the malaria rampant regions fails to seek prenatal care.
In the fight of malaria, the Ministry of Health (MoH) Kenya has had several achievements. The National Malaria Control Programme (NCMP) established the National Malaria Strategy (NMS) in 2001. The strategy would run from 2001-2010 and it would emphasize the use of ITNs (insecticide-treated bed nets). Reports indicate that in the late 90s’, there was a reduced infant mortality rate resulting from the use of ITNs. Before 2001 there was an inadequate use of mosquito nets in Kenya but later in 2002, Population Services International (PSI) Kenya with the support from UK sector for International Development to market moderately subsidized the ITNs in Kenya. In 2004, Kenya was given a Global Fund grant to help issue five million (LLINs) long lasting insecticide nets to children below 5 years for free (Zurovac et al 2014).
To help combat the malaria menace in Kenya the government has collaborated with several partners and have developed a 10-year strategy, the Kenya National Malaria Strategy (KNMS), launched on 4th November 2009. The objective of the National Malaria Strategy is to lessen the disease and mortality rates linked with malaria by 30% by the year 2009 and maintain it till 2017. Before the year 2008, it was reported that an additional 50% of the expectant women in most regions were using the ITNs whereas only a small percentage of expectant women in the Rift valley and Central regions were using the ITNs (Gitonga et al 2010).
In accordance with the Ottawa Charter on Health Promotion on malaria in Africa, there are several areas of action that were acknowledged:
The above-stated areas thus prompted the need for a policy of advocacy in several African countries affected by malaria-like Kenya.
The main aim of the National Malaria Strategy (NMS) was to decrease the levels of malaria infections and consequent deaths by 30% by the end of the year 2006 as well as sustaining the improved control levels to the year 2010.To address the malaria issue in Kenya, developing a policy for advocacy which would help the citizens of Kenya in mitigating this threat and improve their wellbeing was essential. In regards to the issue, the purpose of the policy for advocacy was to focus on developing an operational policy that would help the Ministry of Health in Kenya to address the problem of malaria especially in expectant mothers and children below the age of five. Developing an operational policy would play a great role in helping analyze this threat and help reduce the effects of malaria as well as improving the health campaign framework. To accomplish this objective, the Ministry of Health in Kenya developed a set al 2015):
With the implementation of these policies in the Ministry of Health, the Ministry will be able to combat malaria in the nation. Moreover, the policy of advocacy will help provide the community with reliable information on the threats of malaria, malaria causal effects as well as prevention measures. The government will also be able to put advance measures to help reduce the mortality rate resulting from malaria effects on both children below the age of five as well as expectant women who are most prone to malaria. These policies will prompt the organizations collaborating with the Ministry of Health such as schools, non-governmental organizations, both public and private health centers to work effectively so as to help in ensuring that there is improved health care within the country.
Malaria being one of the leading causes of death in Kenya, several prevention measures need to be put in place to avert its effects on the citizens. The Ministry of Health has played a great role in developing malaria treatment policies to aid in the prevention (Mohajan 2014). Initially, the malaria treatment policy used to employ the use of chloroquine back in the year 1998 but as a result of less effectiveness of chloroquine, they introduced treatment with sulphadoxine-pyrimethamine (SP). Since the year 2004, they started using artemisinin-based combination therapies (ACTs) (Nyandigisi et al, 2011). Currently, co-formulated ACTs are the widely preferred malaria treatments for less severe malaria cases in the country. It is also highly recommendable to include a 3-day artemisinin derivative during the ACTs treatment. Additionally, the 1st line treatment for less complicated malaria cases in Kenya was initiated in 2006. The artemether-lumefantrine (AL) tablet contains 20 mg of artemether and 120 mg of lumefantrine.
Creating awareness on the use of free LLINs (long lasting insecticide nets) and IRS (indoor residual house-spraying to help reduce the cases of malaria in malaria-endemic areas and also reduce childhood mortality rates by reducing fetal complications associated with malaria such as stillbirths, abortions, and miscarriages (Snowden 2014). Broadcasting on television stations is another way of creating malaria awareness to the people as this allows a wide coverage of the country.
Encouraging expectant women to seek antenatal care to help facilitate proper pregnancy management practices to help prevent malaria effects before and after childbirth. Moreover, pregnant women should take intermittent preventive treatments-preventive antimalarial drug doses offered at most health facilities across the country.
WHO (World Health Organization) has been offering guidance to the Ministry of Health on policy and strategy matters to aid in the progress of malaria eradication in Kenya (Cotter et al 2013). In 2009, WHO steered the country’s malaria review programme which aided in re-focusing anti-malaria work in the geographical regions that were in entire need of help. WHO offers evidence-based and technical evidence and thus helps modify the strategies of the Ministry of Health.
There is a new preventive measure that is underway but has not been deployed yet, the RTS, S/AS01 malaria vaccine (Rts, S.C.T.P 2015). This vaccine is currently being evaluated as a possible complement to the basic package of WHO-suggested interventions now in use for prevention, treatment, and diagnosis of malaria. Other new preventive tools are being considered. For malaria vector control, novel categories of insecticides for use in the house sprays and bed nets are being established with new methods like bait tools that kill and attract mosquitoes (Raghavendra et al 2011)
In addition to the policies put in place by the Ministry of Health regarding malaria awareness and prevention, there are a few recommendations that can be put in place to aid in the same. Some of them may include:
Abuya, T., Fegan, G., Rowa, Y., Karisa, B., Ochola, S., Mutemi, W. and Marsh, V., 2009.
Impact of ministry of health interventions on private medicine retailer knowledge and practices on anti-malarial treatment in Kenya. The American journal of tropical medicine and hygiene, 80(6), pp.905-913.
Checchi, F., Cox, J., Balkan, S., Tamrat, A., Priotto, G., Alberti, K.P., Zurovac, D. and Guthmann, J.P., 2006.Malaria epidemics and interventions, Kenya, Burundi, southern Sudan, and Ethiopia, 1999–2004. Emerging infectious diseases, 12(10), p.1477
Cotter, C., Sturrock, H.J., Hsiang, M.S., Liu, J., Phillips, A.A., Hwang, J., Gueye, C.S., Fullman, N., Gosling, R.D. and Feachem, R.G., 2013. The changing epidemiology of malaria elimination: new strategies for new challenges. The Lancet, 382(9895), pp.900-911.
Gething, P.W., Patil, A.P., Smith, D.L., Guerra, C.A., Elyazar, I.R., Johnston, G.L., Tatem, A.J. and Hay, S.I., 2011. A new world malaria map: Plasmodium falciparum endemicity in 2010. Malaria journal, 10(1), p.378.
Gitonga, C.W., Karanja, P.N., Kihara, J., Mwanje, M., Juma, E., Snow, R.W., Noor, A.M. and Brooker, S., 2010. Implementing school malaria surveys in Kenya: towards a national surveillance system. Malaria journal, 9(1), p.306.
Jamison D.T., Breman, J.G., Measham, A.R., Alleyne, G., Claeson, M., Evans, D.B., Jha, P., Mills, A. and Musgrove, P. eds., 2006. Disease control priorities in developing countries. World Bank Publications.
Luoma, M., Doherty, J., Muchiri, S., Barasa, T., Hofler, K., Maniscalco, L., Ouma, C., Kirika, R. and Maundu, J., 2010. Kenya health system assessment 2010. institutions.
McCollum, R., Otiso, L., Mireku, M., Theobald, S., de Koning, K., Hussein, S. and Taegtmeyer, M., 2015. Exploring perceptions of community health policy in Kenya and identifying implications for policy change. Health policy and planning, 31(1), pp.10-20.
Menaca, A., Pell, C., Manda-Taylor, L., Chatio, S., Afrah, N.A., Were, F., Hodgson, A., Ouma, P., Kalilani, L., Tagbor, H. and Pool, R., 2013. Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study. Malaria journal, 12(1), p.257.
Mohajan, H., 2014. Improvement of health sector in Kenya.
MUYOMA, O.B., 2012. MAIN MALARIA VECTOR DISTRIBUTION AND CURRENT STATUS OF INSECTICIDE RESISTANCE IN KENYA (Doctoral dissertation, University of Nairobi).
Noor, A.M., Alegana, V.A., Gething, P.W. and Snow, R.W., 2009. A spatial national health facility database for public health sector planning in Kenya in 2008. International Journal of Health Geographics, 8(1), p.13.
Nyandigisi, A., Memusi, D., Mbithi, A., Ang’wa, N., Shieshia, M., Muturi, A., Sudoi, R., Githinji, S., Juma, E. and Zurovac, D., 2011. Malaria case-management following change of policy to universal parasitological diagnosis and targeted artemisinin-based combination therapy in Kenya. PLoS One, 6(9), p.e24781.
O’Meara, W.P., Bejon, P., Mwangi, T.W., Okiro, E.A., Peshu, N., Snow, R.W., Newton, C.R. and Marsh, K., 2008. Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya. The lancet, 372(9649), pp.1555-1562.
Opiyo, P., Mukabana, W.R., Kiche, I., Mathenge, E., Killeen, G.F. and Fillinger, U., 2007. An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Malaria Journal, 6(1), p.48.
Raghavendra, K., Barik, T.K., Reddy, B.N., Sharma, P. and Dash, A.P., 2011. Malaria vector control: from past to future. Parasitology research, 108(4), pp.757-779.
Rts, S.C.T.P., 2015. Efficacy and safety of RTS, S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. The Lancet, 386(9988), pp.31-45.
Seitz, J. and Nyangena, W., 2009. Economic impact of climate change in the East African community (EAC). Final Report, GTZ Project “Support to the Integration Process in the EAC Region. Arusha, Tanzania.
Snowden, F.M., 2014. The Global Challenge of Malaria: Past Lessons and Future Prospects. World Scientific.
World Health Organization, 2002. The importance of pharmacovigilance.
Zurovac, D., Githinji, S., Memusi, D., Kigen, S., Machini, B., Muturi, A., Otieno, G., Snow, R.W. and Nyandigisi, A., 2014. Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya. PLoS One, 9(3), p.e92782
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