Covid-19 and the Kenyan health system: a collaborative ethnographic study

In May 2023, the WHO declared an end to the global public health emergency for Covid-19, more than three years after the WHO declared COVID-19 to be a pandemic. Covid-19 remains a public health threat, and is still highly infectious, but death rates decreased, and the pressure on once-overwhelmed health systems correspondingly eased. While the development and distribution of vaccines has largely been a success story, the vaccine roll-out, like other forms of care and intervention mobilized during the pandemic, was also marred by lack of equity, solidarity, and coordination. Although the pandemic is officially over, it leaves deep scars – on people’s bodies, health, and livelihoods, on health systems, national economies, and politics, and on trust in health systems and in government. One branch of our research focuses on the effects of anti-epidemic interventions on access to and delivery of care. Thus, research conducted by the project team in Nairobi, Kisumu and rural western Kenya explored: - the impact of anti-epidemic measures on healthcare delivery and access to healthcare, focusing on maternal health and the experiences of health workers and pregnant women during the covid pandemic (Wangamati/Nyambedha/Geissler). - the roll-out of Covid-19 vaccinations, how Covid-19 vaccination campaigns unfolded on the ground, the fears and rumours circulating around vaccinations, and the stigma and coercion experienced during vaccination campaigns (Yusuf). - experiences of community health workers and community health work during the covid-19 pandemic, and how anti-epidemic measures impacted them (Muinde/Yusuf/Wangamati). - the experiences of people living with HIV during the Covid-19, particularly concerning stigmatization and access to/delivery of care (Yusuf/Haaland). - experiences of cancer patients during Covid-19, in terms of access to care and quality of care (Prince). As our research was conducted during the long transition from pandemic emergency to post-pandemic life, we also explore the legacies, effects, afterlives and remains of the covid-19 pandemic and anti-epidemic interventions. Here our research has focused on the afterlives of epidemic interventions and the repurposing of tools and infrastructures, including questions of what is remembered and how (Muinde). Another strand of our research attends to pandemic legacies shaping ‘local biologies’, focusing on the experiences of people with HIV and other chronic conditions (Haaland/Prince). A third strand concerns the memories and reflections of health workers involved in the anti-covid response as they look back at the impact of the pandemic and of anti-epidemic interventions on people’s lives, health, on health services and the health system.

The project addresses the response of African health systems (HSs) to the Covid-19 pandemic, focusing on Kenya as case study. Covid-19 reaches Kenya at a critical juncture in its HS evolution. Recent decades brought considerable achievements and experimentation with new HS solutions. These include comprehensive HIV/AIDS care, a coordinated Community Health System, a maternal health financing programme reducing maternal mortality, improvements in chronic disease management, innovative digital health solutions increasing access to health care, and novel reporting and surveillance systems. Universal Health Coverage (UHC), piloted in 2019, was to be scaled-up nationwide in April 2020. Our project asks what happens to these HS achievements, innovations and experiments under the impact of Covid-19, i.e. the epidemic itself and anti-epidemic counter-measures. We are interested in the damages to health, life and livelihoods and challenges to the HS, as well as in the productive effects triggered by Covid-19, such as adaptations and innovation of technologies, infrastructures, procedures and collaborations. Similar to HIV/AIDS, the new epidemic is a change-agent, which will shape the Kenyan HS for the foreseeable future, and beyond the limits of infectious disease control. We will use an in-depth, holistic and integrated approach, employing collaborative multi-sited ethnography in rural and urban sites in western Kenya. Eight researchers from Norway, Kenya and UK trained in anthropology, epidemiology and public health will work across five different HS domains – maternal and community health, chronic disease, data and surveillance and Universal Health Coverage – to document effects of Covid-19, chart adaptations and innovations, and explore how Covid-19 is shaping relations between HS and communities. We aim to inform HS strengthening policies and contribute to global policy conversations on how Covid-19 impacts routes towards the Sustainable Development Goals in Africa.