As we mark the World Food Day 2019, in line with the Sustainable Development Goals (SDG) 2, that envisions zero hunger, under theme “Our actions are our future. Healthy diets for zero hunger’ we must remember that the future begins today, it is the little routine actions that amount to the great impact that we desire.

Globally the triple burden of malnutrition (undernutrition, micro-nutrient deficiency and Overweight/obesity) continues to bite, coupled with the rise of communicable diseases with nutritional implications that continue to be exacerbated by poor dietary habits.  Further global reports indicate that hunger is on the rise and the absolute number of undernourished people continues to increase.[1]

Failing food systems that speak to the structures and  mechanism of food  production and access continue  to suffice,  Consultative Group for International Agricultural Research (CGIAR) 2019[2],  forwards  five related problems that continue to exert the failing systems including:  Insufficient supply of food from agricultural production to feed the growing world population; Inefficient delivery of foods from farmers to consumers due to market logistical challenges that often lead to  large losses and wastages during transport, handling and storage; Unequitable access to sufficiently healthy and diversified diets, due to highly segmented food markets: Unaffordable opportunities  especially for the poor and Unsustainable food supply due to negative environmental impacts.

As these overarching systematic and process failures continue to pose challenges, solutions need to be sought: for example Information must be unpacked, from this big, large and sometimes abstract idea of ‘ending hunger’, to actual, simple and doable actions from the household, national and global levels to realise zero hunger.  Hunger and nutrition related knowledge levels across the different stakeholders must be built to help wield a force toward the realization of this global vision.

 Going forward we must see the smaller and the global pictures and establish deliberate and concerted efforts to improve the health outcomes at each level: For example, well-nourished mothers have healthier babies with stronger immune systems, and thus at the household maternal child nutrition must be prioritised, exclusive breastfeeding and optimal complimentary feeding must be emphasised.  

The link between investment in nutrition and development need to be communicated clearly: Proper nutrition early in life could mean a 46% more in lifetime earnings, could save 3.1 million children per year, could increase a developing country’s GDP by 16.5 percent, ending nutrition related child mortality could increase a workforce by 9.4 percent and every dollar invested in hunger prevention has a return between USD15 and USD 139 in benefit[3]. In Kenya 53% of child deaths can be averted through investment in nutrition and 3.2 Trillion shillings saved in the next 20 years.[4] Specific actions at household level to global level to actualise this, must be relayed clearly.

Ending hunger must move from mere rhetoric to action, information must be broken down for every stakeholder to understand what they can do towards the cause. It must be owned from the household level, translate to policy and must wield political good will and resources to actualise it. Stakeholder’s coordination to end hunger must be strengthened, with the understanding that ending hunger is everybody’s responsibility.

By Wachira Charity

Communication Officer

[1] Food and Agriculture Organization of the United Nations 2019: The State of Food Security and Nutrition

    in  the World 2019

[2] Consultative Group for International Agricultural Research, 2019-https://a4nh.cgiar.org/2019/02/01/repairing-food-systems-failures-policies-innovations-and-partnerships/

[3] Food and Agricultural Association: https://www.greeningtheblue.org/event/world-food-day

[4] Nutrition Profiles 2010

BY: KANCO

Depression is the most common illness worldwide. Kenya was ranked at position four in Africa with 1.9 million people who have the condition (WHO Report, 2014).According to the Kenya Mental Health Policy (2015-2030), mental disorder cases in Kenya continue to rise rapidly. Estimates point that 20-25 percent of outpatients seeking primary healthcare present symptoms of mental illness at any one time, while government statistics indicate that at least 1 in every 4 Kenyans suffer from a mental illness at one point in their lives.

In recent times, we are waking up to many shocking incidences ranging from people including school children committing suicide, others murdering their loved ones. Although not all these cases are attributed to depression and other mental related disorders, a good number have been confirmed to result from this.  In almost equal stride, many people including prominent personalities have come out sharing their mental health challenges. Some have shared how despite having been top performers in their jobs, they abandoned their jobs or terminated due to non-performance arising from lost interest. Others turning to alcohol and substance abuse as others cut relationships with their close family members.  Despite the doom and gloom associated with mental illness and those who have embraced it not only get well but set a precedent for others that the condition can be managed. .

Why Mental health Matters

The Kenya Mental Health Policy (2015-2030) states “Mental health is a key determinant of overall health and socio-economic development. It influences individual and community outcomes such as healthier lifestyles, better physical health, improved recovery from illness, fewer limitations in daily living, higher education attainment, greater productivity, employment and earnings, better relationships with adults and with children, more social cohesion and engagement and improved quality of life,”

Challenges facing Mental Health Management and Treatment in Kenya

Low Awareness: One of the biggest challenges is low awareness of mental disorders, particularly, the symptoms of this condition among the persons suffering from the condition and community at large.  The fact that the symptoms affect emotions, thoughts and behaviors make it difficult to understand and accept. This has largely led to conformity of norms, where mental  illness continue to be marred by myths and misconceptions including being a curse, witch craft, spiritual problem etc. instead of a disease that can be treated and managed if  and when addressed appropriately. More often the affected person(s) resort to isolation and don’t seek medical help.

Cost and Management of treating mental illness in Kenya: In Kenya, mental health is underfunded and there is no separate budget for mental health. The country has approximately 100 psychiatrists for a population of 45 million (ratio 1:450,000).  In addition, clinical psychologists and medical social workers who are central to the management and treatment of mental illness are very few.  They are relatively inaccessible to the majority who need mental health services due to geographical distance as majority are based in the urban areas with high consultation fees. This forces most of those suffering to seek private treatment which is very costly and those who cannot afford are force to deal with their conditions themselves without professional assistance (WHO Mental Atlas, 2014). According to the Office of the Auditor-General (OAG), the referral system in place cannot work for provision on mental healthcare services since most of this staff are unavailable in almost all institutions in level 1 to 4 of the referral systems while others are thinly distributed between level 5 and 6 facilities. Mathari Hospital, is the only affordable public facility and the only public hospital in the country offering specialized psychiatric services and training.

Ongoing Mental Health Interventions in Kenya

The Kenya Mental Health Policy (2015-2030) provides a framework on interventions for securing mental health systems reforms in Kenya. This policy seeks to address the systemic challenges, emerging trends and mitigate the burden of mental health problems and disorders. It aims at ensuring people have access to comprehensive, integrated and high quality, promotive, preventive, curative and rehabilitative mental health care services at all levels of healthcare and strengthen mental health systems especially from the community level.

To realize the above and with the aim of bridging this human resource gap, Ministry of Health (MOH) – has been training community health volunteers (CHVs) on how to address common mental health problems so they can effectively offer assistance to people suffering from the same. The training focuses on a novel cost-effective method for treating common mental illnesses – such as depression, anxiety and chronic stress – known as Problem Management Plus (PM+) which has been approved by the World Health Organization (WHO). This is in the view that effective mental health interventions must be cognizant of the diversities in our environment. The  WHO states  ‘Presenting mental health care services in culturally-sensitive ways may be essential to increasing access to and usage of mental health care services, as local beliefs about mental health often differ from the Western biomedical perspective on mental illness. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route. Governments should move away from large mental institutions and towards community health care, and integrate mental health care into primary health care and the general health care system.

In view of the above, it will be important for all health stakeholders to take up mental health as a serious health issue. They need to undertake intensive awareness campaigns on the condition, prevention, early symptoms and management and treatment services. The Government should also allocate more funding to mental health services and train health workers at all levels to manage and treat mental Health Challenges. At the community level, grassroots advocacy present both opportunity for empowerment towards demystifying stigma and influencing policy through ground up advocacy to effectively address the challenge.

References

• https://www.theelephant.info/reflections/2019/05/03/am-i-going-mad-a-reflection-on-mental-health-in-kenya/ -The Elephant – Speaking truth to power
• World Health Organization. WHO’s mental health Atlas. J Nutr Educ. 2014. http://www.who.int/mental_health/evidence/atlas/mental_health_atlas_2014/en/
• https://ijmhs.biomedcentral.com/articles/10.1186/s13033-018-0234-y
• WHO Report. https://www.pressreader.com
• Office of the Auditor General (OAG). Performance Audit Report on Provision of mental health care services in Kenya. 2017

April 2nd, 2019

Wachira Charity, Communications Officer

26th March 2019 will remain a historic day for the Harm Reduction fraternity and stakeholders in the greater Eastern Africa region and globally . It is the day that the EAC council of Ministers  approved the East African Community Regional Policy on Alcohol, Drugs and Substance use!  a major and bold step to cementing harm reduction for people who use drugs in the region.

Three years ago, KANCO with the support of the Global Fund through the Regional HIV and Harm Reduction Project, embarked on a journey to introduce and cement harm reduction in the greater Eastern Africa region. Armed with three objectives:  to improve the policy environment, the service delivery environment as well as generate evidence to inform harm reduction interventions in the region.

Confronting scepticism, prohibitive policy environment and limited information on harm reduction characterised the terrain at the start of the task ahead. Using a public health approach as an entry point, KANCO and the implementing partners formed partnerships of like-minded institutions, to help gather evidence and create the momentum for engagement.

This was against the background that, East Africa is home to about 150 million people, 260,000 among them being people who inject drugs. This constitutes about a fifth of the population of people who use drugs in Africa and growing, thus could not be ignored. This is majorly because of the role of the Eastern Africa region as a transit route as well as the growing use of drugs for recreation. Consequently this has fuelled the growth of the HIV epidemic standing at about 18%, arising from the sharing of injecting equipment and related sexual behaviour, with recent data from studies conducted in Tanzania and Kenya indicating that most of the people who inject drugs acquire HIV before the age of 25.

Harm reduction entails addressing the health, social and economic consequences faced by people who use drugs. At the heart of the intention was the understanding that policy legislation was the only sure way of cementing any gains made in the region.

Subsequently KANCO in partnership with the East African Community Secretariat and regional Harm Reduction partners embarked on developing a policy that would safeguard the gains made and create room for sustainability of harm reduction interventions. They sought to address 5 broad key policy areas: Data collection to inform Harm Reduction, Developing national harm reduction policies, Delivering interventions to people who use drugs, strengthening the capacity of PWUDs across EAC as well as creation of a supportive legal environment.

The EAC Regional Policy on Alcohol, Drugs and Other Substance

In 2016, KANCO  working with the EAC Secretariat with support from the Global Fund under the HIV and Harm Reduction Regional Project for Eastern Africa, and the EAC Partner States commenced the process of developing the Policy. The International Drug Policy Consortium (IDPC) provided the initial technical support in the formulation of the draft EAC Regional Policy on Prevention, Management, and Control of Alcohol, Drug and Other Substance Use.

The policy was developed through a consultative process where it navigated various stages both at regional and national levels. This includes the literature review and data collection involved in drafting a comprehensive situational analysis; the formulation of the draft policy document; country consultations; experts’ meetings and peer review consideration and validation of the final draft. Numerous parties and individuals including Experts from the EAC Partner States, Experts from regional and international organizational including KANCO, IDPC, OSIEA, UNODC, UNAIDS, WHO, and the technical experts from the EAC Secretariat HIV and AIDS unit contributed to the development of this policy.

The EAC Regional Policy on Alcohol, Drugs and Other Substance use recognizes that alcohol, drugs and other substances use or consumption is associated with related problems arising from the complex relationship between the individual consumer of alcohol, drugs and other substances and the broader cultural, political, social, economic and physical environment. Therefore, this policy provides broad framework within which all stakeholders in the region will contribute to the reduction of the negative consequences caused by Alcohol, drugs, and other substances used in the EAC region with specific emphasis on comprehensive prevention, control and management of the harmful effects of alcohol and drug use including provision for strategies for the rehabilitation of persons with alcohol, drugs and other substance use disorders.

With the aims of the policy anchored on; prevention of the youth from initiating alcohol and drug use; control the production supply and distribution of illicit and licit alcohol as well as narcotic drugs in the region, and management of alcohol and drug related harmful effects including, Harm reduction for those that are already dependent on drugs. This policy also promotes and protects the health and well-being of the citizens of the East African Community.

Although the policy is not an end in itself it provides a platform for sensitization, advocacy and access to services, reaffirming the health and human rights of the people who use drugs. The call to the member countries stakeholders is to adopt, sensitize and promote its understanding for effective application to bridge the service gap for people who use drugs in the region. KANCO and stakeholders remain optimistic that the policy opens a new frontier to chart the harm reduction discussion.