A. Introduction to the country and region  

Kenya is located along the coast of the Indian Ocean in East Africa. Although it is a coastal country, it has many neighbours. It is bordered by Somalia to the east, Ethiopia to the north, Sudan to the north-west, Uganda to the west and Tanzania to the south.  

At the heart of Kenya is Mount Kenya after which it is so named however Kenya boasts of a wide variety of geographical landmarks and diverse terrain. Prominent features include Lake Victoria, the Masai Mara and the Great Rift Valley. It follows that Kenya represents a large number of distinct populations or tribal groups with a diversity of traditions and beliefs. Kenya is divided into eight provinces and over 70 districts.  

In the late 1950's political reform was brought about by the world famous and feared revolutionary Mau-Mau movement led by Jomo Kenyatta. Kenya declared its independence from Britain in 1960 as an African democratic society with Jomo Kenyatta the first African President of Kenya. Despite the turmoil in surrounding countries over the years, Kenya has remarkably enjoyed relative politically stability since independence.  

This year however Kenya's political environment led to a rapid deterioration of stability with elections for President in December 2007. The re-election of President Mwai Kibaki was contested by the opposition with accusations of corruption of election results. This caused a division between the two largest tribal groups within the country leading to wide-spread violence. Both parties have engaged in a reconciliation process that has led to a shared power agreement between the president and opposition leader Raila Odinga, who is set to become the first Kenyan Prime Minister.  

Immediately following the negotiations, peace has returned to Kenya and communities are eagerly in the process of rebuilding Kenya.  

For more specific information link to: http://en.wikipedia.org/wiki/Kenya  

B. Population Health  

What is the general health status of the people?  

Kenya ranks 148 out of 177 countries on the Human Development Index (HDI) as reported by the United Nations Development Programme (UNDP) 2007/2008. The HDI provides a composite measure of three dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment at the primary, secondary and tertiary level) and having a decent standard of living (measured by purchasing power parity, PPP, income). The average life expectancy at birth was estimated at 52 years in 2005, with one third of the population reportedly undernourished.  

80% of the population lives in rural communities where health care access is a challenge for the equitable distribution of health care services.  

C. Health Care System  

Kenya operates with an official health care system that is regulated by the Government Ministry of Health (MOH). The MOH is responsible for the provision of health care to all Kenyans through 150 government hospitals, 460 health centres and 1600 dispensaries. Additionally, non-governmental and private healthcare organizations have allowed the expansion of services since independence. Healthcare in Kenya is based on a fee for service model with government facilities designed to be within reach of the majority of Kenyans. While government hospitals exist throughout the country, access is variable from region to region depending on what organizations have been established.  

Unofficial health care exists in the form of traditional healers which are a common source of health promotion and treatment in Kenya.  

D. Disability and Rehabilitation  

Kenya has an act on disability; The Persons with Disability Act, 2003, which was promulgated into law on 16 June 2004. The act is divided into eight sections, ensuring the coverage of issues relating to that of disabled persons. The act provides for the establishment of the National Council for Persons with Disabilities (NCPD) to be the focal point for all issues relating to persons with disabilities; to implement and ensure the implementation of the rights of persons with disabilities covered in the Act; and to formulate and develop measures and policies designed to ensure that persons with disabilities are educated, employed and participate fully in sporting recreational and cultural activities.  

While legislation is in place to protect and secure the health and safety of people with disabilities, implementation has been criticized by many. (A discussion on the implementation of the act can be seen at www.mshale.com/article.cfm?articleID=1296)  

Until recently, physiotherapy services were primarily limited to public hospitals mostly located in urban areas. The majority of physiotherapists work in government positions.  

The Ministry of Health appoints a “Chief” of physiotherapy which would be comparable to the Canadian College of Physiotherapists. The Chief Physiotherapist is responsible for public health and is the person who deploys therapists into areas to provide services in appointed positions. While he works at the Ministry of Health, he is not the Minister of Health.  

The national association for physiotherapists is called the Kenya Society of Physiotherapists.

Kenya is recognized as a member of the World Confederation for Physical Therapy.  

E. Personal Experience  

Since 2003 I have been actively involved in partnering rehabilitation professionals with a community based rehabilitation programme in rural Kenya. What started as a 2 month academic student placement, has now transformed into an ongoing partnership. In 2005-2006, I returned to Nyanza Province to continue to work with the community in further building the CBR programme.  

My involvement has been through the Kenya Working Group (KWG), a group formed within the framework of the International Centre for Disability and Rehabilitation (ICDR) at the University of Toronto. The KWG aims to bridge the gap in health care in Kenya by providing rehabilitation services to under-serviced areas. We do this through coordinating Canadian volunteers to provide direct service provision to help supplement the services that are already in the community and by providing sponsorship for programmes, such as clients who require equipment (which the programme makes) and necessary surgery as the needs are identified. To learn more about the Kenya Working Group visit www.kenyaworkinggroup.org.  

Our key partner in Kenya is the Disability Service Programme, a community based rehabilitation project in Nyanza Province. Because the programme is grassroots, all of the drive to provide care comes from people living in the community as stake-holders in their health care and funding comes from donations made by friends of the community.  

The Disability Service Programme (DSP) seeks to provide care for 120 000 disabled people living in Nyanza Province Kenya. The DSP is a community-based organization that faces many challenges as human and financial resources that were once available are now receding.  

Physiotherapy skills are an asset to the community and therefore people are eager to seek clinical services.  

The programme is run out of a central clinic on the main road to Homa Bay in which the clinic is open for a couple of days of the week for clients who can come in. On other days the therapists will go out into the community. In some cases these services take the form of pre-arranged clinics where people with disabilities will be told of therapists' arrival and will wait in a central area such as a town hall, under a big tree, on a mat at the police station in the area etc. In other cases these services are school visitations for children who live at these institutions or home visits.  

Because the needs are vast, volunteers work with the clinicians in the area to triage medical needs and identify other services that may be needed. (ie. shunting, surgical requirements, medication management for seizures, vocational training). Therapists perform a great advocacy service and they also think a lot about designing equipment out of locally available materials. The clinic has a technician who makes all of the equipment including wheelchairs, crutches, calipers, splints and anything else we come up with.  

After some time when people who require more intensive therapy have been identified, the programme hosts a “training week”. Most volunteers report that this is the most rewarding portion of the experience because clients come from all over, live at the clinic for a week and the therapists work one on one with children and their caregivers educating and providing intensive treatments for the clients.  

F. Recommendations  

As with travel to any country, it is wise to liaise with the Canadian High Commission to create an awareness of your presence within the country as well as to assist in providing links to projects that may be of interest.