The Impact of COVID-19 on Health Care, Education, and Persons With Disabilities in Kenya

Abstract

You have accessSIG 17 Global Issue in Communication Sciences and Related DisordersCommentary17 Dec 2020The Impact of COVID-19 on Health Care, Education, and Persons With Disabilities in Kenya Dolores E. Battle Dolores E. Battle Department of Speech-Language Pathology, SUNY Buffalo State College Google Scholar More articles by this author https://doi.org/10.1044/2020_PERSP-20-00097 SectionsAboutAbstractPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In The COVID-19 global pandemic has impacted the regions of Africa in various ways. This article will address the impact of the virus on various regions of Africa with a special focus on rural and urban Kenya. This article will address the challenges in controlling the spread of the virus in rural and urban areas of Kenya and in providing health care and education in a nation that has limited technology and health care resources. This article will also address the special concerns for care for persons with disabilities (PWD) in preventing the spread of the virus and providing care for infected PWD. The response of the government in addressing the virus will also be addressed. When the virus was first reported in China, many people in Africa did not believe that the virus would reach Africa. They believed that their high level of melanin would protect them. Some believed that herbal medicines would be effective in protecting and treating them from the virus. The Nigerian Health Ministry reported the first case of COVID-19 in Sub-Saharan Africa in Lagos, Nigeria, on February 28, 2020. Prior to that, there had been only two reported cases, one in Algeria and one in Egypt (Farrer, 2020). The Africa Centres for Disease Prevention and Control (Africa CDC) is a specialized technical institution of the African Union that supports member states in their efforts to strengthen health systems and improve surveillance, emergency response, prevention, and control of diseases. On April 29, 2020, Africa CDC (2020) reported 33,500 confirmed cases and 1,400 deaths in 52 countries across the African continent, which has a population of about 1.3 billion. Northern and southern regions of Africa were reported to be the most affected regions. The northern region, which includes Egypt, Algeria, and Morocco, had more than 13,600 cases. The southern region, with South Africa, reported 5,200 cases. The eastern region, including Kenya, Somalia, Djibouti, and Uganda, reported 3,400 cases. The continent's most populous nations in the western region, including Nigeria, Côite d'Ivoire, and Ghana, reported more than 8,400 cases. The central region, including Democratic Republic of the Congo and Cameroon, reported the fewest cases: 3,000 (Africa CDC, 2020). The number of confirmed cases was reported to be increasing rapidly with as much as 40% in 1 week. The data and reports may be more a reflection of the number of cases confirmed through testing than the actual number of COVID-19 cases in the region. Even in the major cities of Kenya, South Africa, Ghana, and Nigeria, the testing for COVID-19 and access to appropriate health care facilities are limited. The director of Africa CDC said that “dozens of nations have ʽvery, very limited’ capacity for testing. The lack of testing could be obscuring a larger danger,” sparking a potential increase in hunger and malaria (Paquette, 2020). Dr. Michael Ryan, Executive Director of the WHO Health Emergencies Programme, predicted to the United Nations Economic Commission that, across Africa, the pandemic would likely kill at least 300,000 persons and would push 29 million into extreme poverty (ChildFund, 2013). Health Care in Kenya With a population of more than 45 million people, Kenya is one of the most populous sovereign nations in East Africa. Despite its breathtaking natural beauty and robust tourist industry, Kenya faces a number of serious social problems including widespread poverty, income inequality, and lack of access to health care. About 20% of the people in Kenya live in rural areas. There are several urban areas such as Nairobi, Mombasa, Kilifi, and Kwale, which are home to nearly 20% of the population. Within Metropolitan Nairobi is Kibera, the largest urban slum in all of Africa. Although the 2.5 million people in Nairobi Kibera live on only 6% of the land, they represent 60% of the population of the city. In urban areas, including Kibera, many Kenyans live in informal settlements where there is a high risk of diseases such as malaria and respiratory diseases. Health care facilities in Kenya are organized across four levels. At the first level, community-based health services provide basic services and identify cases that need to be managed at higher levels of care. Primary care services are provided by community-based nurses through government-run dispensaries that provide outpatient services for common conditions such as common colds and flu, uncomplicated malaria, and skin conditions. More complex cases are referred to public facilities managed by the 47 counties or to private facilities often managed by churches or charities (Kairu, 2019). The highest level of care is provided by national referral hospitals that usually have a full complement of medical services such as surgery, pediatrics, obstetrics, general medicine, and gynecology. A majority of Kenya's population receives health care services from the public sector. Since over 78% of the population live in rural areas and 52% live in poverty, access to health care for complex cases such as COVID-19 is limited. Persons have to travel long distances to reach local or regional health care facilities. Most of the community and primary care centers in Kenya lack medication and do not have access to some of the vital equipment used to treat respiratory conditions such as the ventilators that are necessary to treat COVID-19. In addition, the cost of testing for COVID-19 provided by the national hospitals was prohibitive for low-income persons. The cost of each test at Nairobi Hospital was approximately SH10,000 per test (about $93.00). Only 20% of the population have health insurance, meaning 35 million Kenyans are without adequate health care coverage. COVID-19 in Kenya As of this writing (April 29), there were 374 reported cases of COVID-19 in Kenya with 14 deaths (ChildFund, 2013; U.S. Embassy in Kenya, 2020). The identification and treatment of COVID-19 in Kenya, as in many parts of Africa, is particularly challenging because of the social conditions in the country. The social determinants of health play as important a role in a person's health as genetics or medical treatment. They include economic stability, physical environment, education, food community, social context, and health care systems. Many of the recommended practices to control the spread of COVID-19, including isolation or quarantine, social distancing, and handwashing, present particular challenges for persons living in poverty. In rural areas, many Kenyans live in single-room homes in isolated settlements where there is a high risk of diseases such as malaria and respiratory diseases. Persons living in the densely populated urban areas of the cities, such as Kibera in Metropolitan Nairobi, find it difficult, if not impossible, to maintain social distance. Although some professionals are able to work from home, many people earn a living by doing casual jobs or working in the markets, earning as little as $1–$3 per day. People usually go to the market for food each day since they have limited space or facility to store food and needed supplies. Lacking personal transportation, people use public transportation or buses to get to work or to search for food. Kenya's Response to COVID-19 In Kenya, leaders, businesses, and communities took quick and decisive action to minimize the economic and social impact of the pandemic and control the spread of the virus including early social distancing and movement restrictions. Ministry of Health Chief Administrative Secretary Dr. Mercy Mwangangi directed all villagers to set up handwashing stations at their homes using a bucket with a tap and to provide sanitizers. Public gatherings were banned; funerals were limited to 15 people; and communal worship at churches, mosques, and temples was prohibited. Nonessential workers were required to work from home, and restaurants were restricted to serving only to-go food. Markets, bars, and clubs were closed, and public transport vehicles such as “tuk-tuks” and “matatus” were required to leave seats empty between passengers. All passenger and drivers were to wear protective face masks. A curfew was established from 7 p.m. to 5 a.m. daily. The Kenyan government created strict screening points at all locations of entry to the country to detect COVID-19 including roads, airports, buses, and train stations, especially into and out of the Nairobi metropolitan area as well as Kilifi, Mombasa, and Kwale counties. Kenya planned to hire more than 500 doctors and 5,000 skilled health care workers with special training in infectious diseases. As the number of COVID-19 cases rose, the government increased prevention and treatment measures. Private health care facilities were encouraged to share all COVID-19 test results based on the Public Health Act and international health regulations. There was a limited supply of personal protective equipment (PPE) and respirators to treat the most serious respiratory conditions. Businesses and manufacturing companies were encouraged to design equipment and to use 3D printing technology to produce PPEs and parts for medical devices to address the expected medical equipment deficit in the country (Wadekar, 2020). President Kenyatta encouraged businesses to explore local solutions to address the need for equipment to treat those affected by the virus. Toyota Kenya developed a bridge mechanical ventilator as an emergency use resuscitator system to support patients with COVID-19 respiratory failure. The ventilator was designed to enable rapid, large-scale development and deployment at a cost of SH100,000 per unit ($925; Mutinda, 2020). COVID-19 and Schools Kenya's national education system is structured on a model with 8 years of compulsory education including preschool and primary education, followed by secondary education or vocational/technical school. While more affluent students attend private boarding schools, most urban students in Kenya commute daily to day schools. They use public transportation, making them highly susceptible to the virus not only in school but also while commuting. This also poses the risk of spreading the virus to local communities. Nearly 70% of the school children in Kenya live in rural areas where there is a shortage of well-funded schools, trained teachers, and books and supplies. Students often have to walk several kilometers to reach the schools, which are often small with large class sizes. To reduce the spread of the virus, the Government of Kenya closed all schools and universities on March 16, 2020, until further notice. Schools were expected to implement online instruction using technology and the Internet. Teachers were advised to prepare work for the students to do at home. However, the lack of broadband Internet and the cost of Wi-Fi in some remote areas limited the amount of e-learning available to students. Although Kenya is an ICT hub, known as the Silicon Savannah for its innovations in technology, it is not immune to the digital divide. As in many countries, the digital divide limits the access of e-learning to children in remote areas of those living in poverty. The cost to access the Internet for families is often more than a day's wage. Many low-income people, especially those living in the rural areas, have limited access not only to the Internet but also to hardware such as mobile devices, laptops, or computers. Parents also may not have had training in the use of the devices or the Internet for instruction. Although the literacy rate in Kenya is at 78.7%, parents do not have sufficient education to assist their children at home (MacroTrends, 2020). Although many families in Kenya have mobile phones, most do not have smartphones with Internet access. A Pew Research Center report conducted in the spring of 2019 provided data on the digital divide on use of smartphones in 34 countries. Only 36% of Kenyans reported owning a smartphone, 40% reported owning only a mobile phone, and 24% reported owning neither a smartphone nor a mobile phone. Whereas in most of the countries reporting, there was more use of the Internet by the younger persons aged 18–29 years, in Kenya, there was little use of smartphones by the younger persons (Schumacher & Kent, 2020). In addition, electricity and Internet are often sporadic, limiting the consistent use of the resources for learning. Travel to an Internet café for the Internet or to charge mobile phones during the COVID-19 crisis was limited due to the closing of many nonessential businesses and restrictions on travel. The cost of Internet is often prohibitive for lower income families. Wi-Fi and data providers were asked to bundle Internet costs to reduce costs for students. Some Internet providers made free Internet service available for 60 days during the outbreak to households where there is a K–12 student or a university student, but if families did not have the hardware of computers, tablets, or smartphones, they were not able to access the learning. PWD in COVID-19 An estimated 10% of the population in Kenya has a disability. This may be an underestimate. Because of cultural perceptions and taboos, families conceal PWD from public view. Among the identified PWD are those with mobility impairments (26.2%), those with auditory impairments (12.4%), those with speech impairments (10.6%), and those with cognitive impairments (8.2%). More than 67% of the PWD in Kenya live in poverty versus 52% of the total population living in poverty (Global Disability Rights Now!, n.d.). Article 54 of the Constitution of Kenya particularly targets PWD and provides that PWD have a right to access educational institutions and facilities that are integrated into society to the extent compatible with their interests and needs (National Council for Law Reporting with the Authority of the Attorney General, 2010). The right to education is explicitly provided for in Article 53(b) of the Kenya Constitution 2010, which guarantees the right to free and compulsory basic education for every child (Kenya Law Reform Commission, 2020). Children with disabilities face barriers to accessing a quality, inclusive education in Kenya under the best of circumstances. Special needs education is provided in special schools, integrated units, or inclusive settings in regular schools. However, only 38% of children with a disability are enrolled in primary education. Only 19% of the disabled population (vs. 49.9% of the total population) is enrolled in secondary education. This is due to a number of factors including sociocultural factors, poverty, lack of awareness, stigmatization, and negative attitudes. In addition, there are few teachers for children with disabilities, special facilities, or adapted materials or other resources to provide the necessary education for children with disabilities. PWD and COVID-19 Disability alone may not be related to higher risk for getting COVID-19 or having severe illness. However, some PWD are at a higher risk of infection or severe illness because of their underlying medical conditions that render them more susceptible to the virus. Many are among the most vulnerable to infection, chronic lung disease, serious heart condition, or weakened immune system or weakened respiratory functions. Some PWD are less likely to understand the need for safety precautions against the virus such as to engage in handwashing and sanitizing. Because of the need for physical care and direct support from family members or others, persons with visual, auditory, and mobility impairments are less able to engage in social distancing or isolation. They may not be able to avoid coming into close contact with others who may be infected, such as direct support providers and family members. They may not be able to communicate their symptoms of the illness to others (Centers for Disease Control and Prevention, 2020). COVID-19 could be more catastrophic for PWD who live in settlements where people live in close proximity and who often lack basic services and face severe obstacles of access to basic services such as water for handwashing, sanitizers, and medical care (United Disabled Persons of Kenya, 2020). Children with disabilities are largely excluded from education during the COVID-19 pandemic in Kenya since online instruction is not made accessible to them. Teachers are not able to provide special education or other services through adapted accessible materials or to use telehealth communication strategies where Internet is not available. Many parents are not able to assist their children because they do not have the required skills necessary. With the schools closed, parents are required to provide constant physical support and care at home, further restricting their ability to care for other members of the family or to work outside of the home. Travel to facilities to obtain necessary support or rehabilitation services is also problematic because of the need for social distancing on public transportation. Conclusions The Government of Kenya adopted three pillars for responding to COVID-19. They were (a) prevention and social distancing through the support of research for testing protocols by the Kenya Medical Research Institute;(b) financial stabilization through providing free sanitizers for distribution to the public, PPE, and other supplies supported by over 1 billion shilling from the Kenyan COVID-19 Emergency Response Fund; and (c) state-funded World Bank initiatives to provide financial support for vulnerable persons such as those living in poverty and the elderly, including SH500 million for PWD and those caring for vulnerable persons. With the advocacy and support of United Disabled Persons of Kenya and the Association of Speech and Language Therapists Kenya, the needs of PWD in Kenya will continue to be addressed to ensure access to opportunities, inclusion and protection, and treatment from the pandemic (Murumba, 2020). References Africa Centres for Disease Control and Prevention. (2020). 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FactTank.https://www.pewresearch.org/fact-tank/2020/04/02/8-charts-on-internet-use-around-the-world-as-countries-grapple-with-covid-19/ Google Scholar United Disabled Persons of Kenya. (2020). COVID-19. https://www.udpkenya.or.ke/covid-19/ Google Scholar U.S. Embassy in Kenya. (2020, September15). COVID-19 information. https://ke.usembassy.gov/covid-19-information/ Google Scholar Wadekar, N. (2020, April15). Kenya's 3D printing community is making Covid-19 equipment to fill a deficit as caseloads rise. Quartz Africa. https://qz.com/africa/1838608/kenyas-3d-printing-community-making-covid-19-equipment/ Google Scholar Author Notes Disclosures Financial: Dolores E. Battle has no relevant financial interests to disclose. Nonfinancial: Dolores E. Battle has no relevant nonfinancial interests to disclose. Correspondence to Dolores E. Battle: [email protected] Editor-in-Chief: Patrick Finn Editor: Carolyn Higdon Publisher Note: This article is part of the Forum: Implications of COVID-19 on Global Speech, Language, and Hearing Services. Additional Resources FiguresReferencesRelatedDetailsCited by PLOS Global Public Health2:12 (e0001348)21 Dec 2022Identifying the impact of COVID-19 on health systems and lessons for future emergency preparedness: A stakeholder analysis in KenyaDosila Ogira, Ipchita Bharali, Joseph Onyango, Wenhui Mao, Kaci Kennedy McDade, Gilbert Kokwaro, Gavin Yamey and Veena Sriram Higher Education Research & Development41:7 (2247-2261)10 Nov 2022Perceptions on the implications of the COVID-19 pandemic on university students’ wellbeing in Kenya – a thematic analysis approachGladys Mutinda and Zhimin Liu International Journal of Scientific Research and Management10:01 (2095-2108)14 Jan 2022A comparative study of social inequalities in education as an effect of Covid-19 pandemic: A case of schools in Saudi Arabia and KenyaJames Siambi PLOS ONE16:12 (e0260486)15 Dec 2021Rapid health impact assessment of COVID-19 on families with children with disabilities living in low-income communities in Lusaka, ZambiaMary O. Hearst, Lauren Hughey, Jamie Magoon, Elizabeth Mubukwanu, Mulemba Ndonji, Esther Ngulube, Zeina Makhoul and Maria Berghs Volume 5Issue 6December 2020Pages: 1793-1796 HistoryReceived: Apr 28, 2020Accepted: Aug 27, 2020 Published online: Oct 21, 2020 Published in issue: Dec 17, 2020 Get Permissions Add to your Mendeley library Metrics Topicsasha-topicsasha-sigsasha-article-typesleader-topicsspecial-collectionsCopyright & PermissionsCopyright © 2020 American Speech-Language-Hearing AssociationPDF downloadLoading ...