Policy Advocacy for Malaria Prevention in Kenya

The Ministry of Health in Kenya has developed a policy for advocacy to combat malaria, especially in expectant mothers and children below the age of five. The policy aims 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. The policy includes upgrading epidemic awareness and response, providing personal protection, cross-cutting approaches, providing free fever treatment, and more. Read more on Desklib.

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CONTEMPORARY HEALTH ISSUES AND POLICIES
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Health Organization
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

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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

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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.
Background of the Health Issue
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).

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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.

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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).
Aims and Objectives
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:
1. Creating supportive surroundings, since there is an administrative principle for the
nations across the world to take good care of one another as well as the natural surroundings.

Contemporary Health Issues and Policies 7
2. Building healthy public policy, for collaborative action leads to harmless and better
goods as well as services.
3. Developing individual skills, since wellbeing campaigns support an individual as
well as their social growth by offering information, health education and developing life skills at
home, school as well as the community surroundings.
4. Support community action, empowering the community via health information
access promotes health in the community by helping in decision-making strategies.
5. Re-familiarize health care services, for health promotion responsibility is collective
among health practitioners, community, individuals, government as well as the health
organizations.
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

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campaign framework. To accomplish this objective, the Ministry of Health in Kenya developed a
set al 2015):
• Upgrading the epidemic awareness and response.
• Providing personal protection to individuals prone to malaria particularly young
children and expectant women via improved access to ITN (insecticide treatment bed nets) and
IRS (indoor residual house-spraying) services.
• Application of cross-cutting approaches like Health Systems Strengthening (HSS),
Education and Commission (IEC) for Behavior Change Communication (BCC), information and
adequate monitoring and assessment.
• Providing expectant women access to at least two free doses of sulphadoxine-
pyrimethamine (SP) or two doses of Intermittent Prophylactic Treatment (IPT).
• Providing free fever treatment for children below 5 years with artemisinin
combination treatment (ACT) and enhanced lab diagnosis at the mission and government
facilities.
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

Contemporary Health Issues and Policies 9
public and private health centers to work effectively so as to help in ensuring that there is
improved health care within the country.
Health Promotion
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.

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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)
Recommendations
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:

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• The Ministry of Health under the Promotive and Preventive health department can
coordinate with other shareholders to offer continued health training, consistent advocacy, and
sensitization to the Kenyan citizens (Abuya et al 2009). For instance, the county government
always plays a crucial role in the community development with the help of the Ministry of
Health it can hold seminars to sensitize people on good environmental hygiene to help prevent
the occurrence of breeding sites for malaria-transmitting vectors. For instance, people can be
mobilized to drain any stagnant waters near their homes, clearing bushes and generally
maintaining proper environmental conditions that have positive effects on preventing malaria.
• The Ministry of Health can collaborate with the Ministry of Education and develop
programmes that can be run in schools with the help of educated youths to help educate children
and the community on prevention measures on malaria (Opiyo et al 2007).
• The Ministry of Health should put extra effort on the provision of LLINs (long lasting
insecticide treated nets) expectant mothers and children below 5 years being the first priority.
• Moreover, with health practitioners being the most appropriate avenue through which
individuals can get adequate health information from, the Ministry of Health can sensitize health
workers in all health facilities across the country to disseminate this information to the
community (Abuya et al 2009).
• The government should organize programs that target knowledge, attitude and
practices of people (KAP) to educate people on the positive effects of using mosquito nets since
some people have different ideologies on nets (Opiyo et al 2007). Some individuals don’t use the
nets claiming they are too stuffy because of the insecticides sprayed on them, others are just lazy

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to use the nets, and others use them in their kitchen gardens to act as fences whereas others are
just ignorant.
• The Ministry of Health can also start a mobile clinic program that will help in
provision of preventive treatments-antimalarial drugs especially in the remote areas where there
are only a few hospitals to increase the number of expectant women who receive this kind of
treatments to help them prevent fetal complications brought about by malaria and also help
reduce the mortality rates of expectant women in the country (Checchi 2006).
• The Ministry of Health can create a platform that gives offers novel information
regarding not only malaria but also other diseases that affect the nation to the public to ensure
that they are always well informed about the disease since most people tend to lack enough
knowledge on some of these health matters due to lack of reliable information sources (World
Health Organization 2002).

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