columnBy Lee Pyne-Mercier
Great progress has been made in improving the quality and coverage of Kenya's health system in recent years.
The scale-up of HIV services has been particularly dramatic. Half a million people are now on anti-retroviral therapy, and are living longer, healthier and more productive lives.
These people are dependent on daily medication to keep them alive. The lifelong nature of anti-retroviral treatment means that HIV patients are particularly vulnerable during natural and man-made disasters, such as the Haitian earthquake, the Japanese tsunami and political violence in the DR Congo.
Interruption of HIV therapy can result in drug resistance, illness, and death.
The dispute following the December 27,2007, elections caused substantial disruption in essential health services.
HIV patients in clinics across Kenya experienced a significant increase in interruption of their treatment. Several studies conducted after the elections by Kenyan and international research teams documented the scale of the problem, and identified lessons that can help HIV patients avoid any disruption during future disasters. These lessons are equally applicable to patients with other chronic conditions requiring ongoing care.
Clinics should develop contingency plans describing how they will continue to provide services in an unpredictable and unstable environment.
This should include communicating with patients, ensuring a consistent supply of medicines, ensuring safety of staff and patients, preparing for trauma care and communicating with the Health ministry and other facilities.
Clinics need to pay particular attention to patients who travel long distances to seek care. After the 2007 elections, individuals traveling for three or more hours to seek treatment were much more likely to have a treatment interruption.
Providers should give extra attention to these patients, and should ensure that all patients are aware of alternatives for accessing care.
While women are always a vulnerable group, men may be more likely to experience HIV treatment interruption during periods of social unrest. Providers should work with the men to ensure they have made plans for accessing care during and after the elections.
All patients should be provided with 'patient passports' including a summary of their current treatment regimens, side effects and phone numbers wherethey can call for advice in case they need to seek care elsewhere.
Providers should consider dispensing additional medicines before the elections to allow patients a greater flexibility on when they should next visit the clinic, particularly for those who live far away.
Clinic management should conduct daily situation assessments and adjust service levels to accommodate variations in volume, with more staff available on-call for days when patients come.
The period following the 2007 election was characterised by levels of violence that fluctuated on a daily basis. The number of patients attending clinic was extremely variable by day and largely driven by political events. Patients visited clinics in large numbers on quiet days and on days before major protests were planned.
The most important way to promote the health and well-being of patients in need of HIV care and other chronic diseases will be a free and fair elections. It is up to all Kenyans, and particularly politicians, to ensure the conditions for a peaceful election are established and to respect the will of the people of Kenya.
A peaceful March 4 elections will demonstrate the final realisation of democracy in Kenya and pave the way for a prosperous and healthy future.
Lee Pyne-Mercier works for a non-profit organization in Seattle, Washington, and has conducted research on the impact of conflict on health in Africa.