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------- ItalyKenya-------IntroductionThe health care systems of different countries vary greatly. The development of a system depends upon many factors, such as a country’s history, economic status, culture, beliefs, and values. Italy and Kenya are two countries that are under extremely different circumstances when it comes to these factors. Their health care systems have developed in ways unique to each country, and the practices and structure vary greatly. One example is the manner in which citizens finance and pay for health care; Italy is structured like the Bismarck model, while Kenyan patients pay out-of-pocket. An in depth study will follow which highlights the different factors and outcomes, and the role they play in each country’s health care system. Information will be analyzed based on the tools learned in HPA 401- Comparative Health Systems. Current events will also be presented, along with my recommendations for the health care systems in each country. BackgroundItalyItaly became unified as a country is 1861. The current government consists of a multi-party system in the form of a democratic republic with a parliament. The Prime Minister leads the Council of Ministers who collectively make the executive decisions. The current health care system was founded in 1978 and is nationally run. According to the World Health Organization, Italy’s health care system is ranked as second best in the world, just behind France, the leader. Italy is located in Southern Europe and is known for its boot shaped appearance. It is a peninsula that juts out into the Mediterranean Sea. The country shares its Northern border with France, Switzerland, Austria, and Solvenia.The climate is moderate, but the weather varies greatly if different regions depending on how close they are to the sea or the Alpine mountain barrier. Sicily is an island in the Mediterranean Sea that is isolated from Italy, but it is still part of the country. In Sicily the temperature is much warmer due to being surrounded by the sea and also a lack of mountains. KenyaFor years Kenya was divided by its numerous tribes, but once the presence of the Portuguese explorers appeared, Kenya became divided into colonies. In the early 1900’s Kenya saw an influx of the British and settlers had a great impact on the structure of Kenya. After the reign of the British, Kenya had its first direct election of Africans to the Legislative Council in 1957. A government was formed and the Republic of Kenya was declared in 1964. Kenya is located in East Africa with an Eastern coastline along the Indian Ocean. The immense Lake Victoria brings a presence of water to a small portion on the Western border of the country. Lake Turkana also provides many people with water in the North. Kenya is situated between Somalia and Tanzania and shares portions of the border with Uganda, Sudan, and Ethiopia. Kenya’s climate is tropical with plenty of sunshine year round. The temperature can vary greatly with very hot days and cool nights and mornings. The rainy season is from April to June. The coast is known to be hot and humid, while the inlands tend to be very dry. Tool 1Social, Political, and Cultural InfluencesItalyItalian culture is known to be unique and distinct. Different characteristics and behaviors of the Italian people can be attributed to the late unification of the country in 1861. There are distinct cultural values that can be recognized based on a geographic region in which someone is from. Italy is known for its astounding art and architecture of different ages. The country progressed from the Classical era to the Gothic era, followed by the Renaissance, which led to the current style of art known as Modern. Italy is also recognized for its literature, theatre, and music.With many cities built before modern transportation, much of the roadways tend to be narrow cobblestone alleys. It is very difficult to maneuver automobiles in and out of the winding streets. Because of this most people get around by foot. Walking has always been the most common form of movement, which is one reason why Italian’s are known to be healthy. The culture does not promote laziness and stagnation. Also, Italy is known for its food. There are many dishes that are replicated throughout the world and Italian style dining is mimicked greatly. The diet consists of many carbohydrates, such as pasta and pizza, but the portion size tends to be smaller. Wine is of great importance and is drank with many meals- even during a lunch break from work. Between the exercise from walking up and down steep hills and eating healthy portions of food, Italians stay very skinny and in good health. Recently though, there has been an increase of overweight and obese people. The number rose from 7.0% is 1994 to 9.9% in 2005. Italy, as mentioned in the background section, is led by a Prime Minister who oversees the Council of Ministries. The government is very unstable and has been known to collapse many times in the recent years. The Italian people voice their opinions strongly and they tend to be very different between the North and the South. Protests and demonstrations can be found regularly in the streets of any city, but they tend to remain calm and peaceful. It must also be noted that the Mafia has a strong and corrupt presence in the government.Kenya Due to Kenya’s tribal and colonial history, Kenya’s cultural values differ among geographic areas, like Italy, but there is less of a distinct culture in Kenya than there is in Italy. Beliefs and practices vary greatly and there is quite an amount of diversity. The Swahili culture is very notable, and the language of Swahili is widespread throughout Kenya. Another prominent culture is the Massai, whose traditions, clothing, and art are very popular among tourists. Many outsiders believe that the Massai is the largest tribe in Kenya due to the commercial exploitation of their culture, but in reality, they make up a relatively minor portion of the population. In the North, there are distinct pastoralist communities, and the Western and Central areas of Kenya provide a vast amount of unique cultural beliefs and practices. Music plays a very large role in the culture of Kenya, regardless of geographic location. It has deep roots in early African music and tends to be upbeat. Music can be heard being performed for almost any occasion or celebration, and also in downtime just for fun. Currently, some main genres of music that are prevalent are afro-fusion, benga, and folk. With the formation of a government in 1964, there has come much controversy and corruption. The government consists a democratic multi-party representative republic with a president as the head leader. The last general elections were in 2007 and were considered to be flawed and below international standards. Violent protests and riots broke out killing millions and displacing even more people. This had led to a strong presence of slums and many citizens have little access to clean water and no access to health care. The country’s health is poor due to this, and is getting worse with the appearance of life-style based diseases such as high blood pressure and diabetes.Economic InfluencesItaly’s gross domestic product (GDP) is $2.114 trillion with a growth rate of -4.8%. The GDP per capita is $30,300. Italy spends 8.9% of their GDP on health care. The service sector employs the largest part of the labor force at 65.1%. Much of the service sector is based on tourism as Italy is a popular country to visit. Kenya’s GDP is $30.57 billion with a growth rate of 2.0%. The GDP per capita is $1,600. Kenya spends 4.6% of their GDP on health care. Agriculture accounts for the largest portion of the labor force at 75%. Some of the products are tea, sugarcane, corn, and wheat. Italy’s gross national product (GNP) is $1.81 trillion. Kenya’s GNP is $60.9 billion. You can see that there is a large difference between Italy and Kenya when it comes to measuring the GDP and GNP as Kenya is a much poorer country. Although Kenya has considerable less money in its economy than Italy, it is the trade and finance hub of East Africa. Corruption in the government hinders Kenya’s economy and prices of goods remain low. Italy’s HDI is 0.951. Kenya’s HDI is much lower at 0.541. In rank by county, Italy is listed at 18th and Kenya is listed at 147th. The following graphs compare the countries’ HDI’s with others.Italy’s HDI: Kenya’s HDI:As you can see, Italy’s HDI is among the highest compared to OECD countries. Kenya falls in a much lower level compared to many regions of the world, but it is higher than the general HDI for other parts of Africa. This is most likely because Kenya has a high literacy rate among countries in Africa, as they have a standard education system with post graduate degrees offered at institutions beyond the standard level of education that young people rmation on each country’s genuine progress indicators (GPI) is not available.Tool 2Population Structure and Demographic StatisticsItaly, with 58,126,212 people, is a much more populated country than Kenya, in which there is only 39,002,772 people. This shows that Italy is more densely populated considering the fact that Italy is 279,027 square kilometers smaller than Kenya. In comparison to the rest of the world, Italy is ranked as the 23rd most populated country, while Kenya is at 33rd.The following graph shows the age structure for Italy: Age Group (years)Percent of PopulationNumber of MalesNumber of Females0-1413.5%4,056,1563,814,07015-6466.3%19,530,69618,981,08465 and over20.2%4,903,7626,840,444The following graph shows the age structure for Kenya:Age Group (years)Percent of PopulationNumber of MalesNumber of Females0-1442.3%8,300,3938,181,89815-6455.1%10,784,11910,702,99965 and over2.6%470,218563,145Based on the data presented in these charts, the dependency ratio for Italy is 0.508 and for Kenya is 0.815. Even though there is a very small percentage of the population above 65 (2.6%) in Kenya, the large young age structure (42.3%) puts a heavy burden on the working age structure. The percentage of people over age 65 in Kenya is so small because of the lack of accessible and quality health care. Most people do not make it to this age. In Italy, it is the opposite, with the oldest age structure being larger than the young age structure, and therefore they are the ones putting more burden on the working age structure. The median age in Italy is 43.3 years and in Kenya is 18.7. Once again, the difference is so large due to Kenya’s vast young age structure.The total number of males in Italy is 28,490,614 and the total number of females is 29,635,598, which makes the sex ratio equal 0.96. In Kenya, the total number of males is 19,554,730 and the total number of females is 19,448,042. This makes the sex ratio equal 1.01. It is apparent that there are more females than males in Italy, and vice versa in Kenya.The following graph shows statistics on Birth and Mortality Rates:ItalyKenyaBirth Rate (births/1,000 population)8.1836.64Fertility Rate (children born/woman)1.314.56Infant Mortality (deaths/1,000 live births)5.5154.70Crude Death Rate (deaths/1,000)10.729.72Life Expectancy at Birth (years)80.2057.82As demonstrated in this chart, it is apparent that the birth rate is much higher in Kenya than in Italy. This is why Kenya has such a larger young age structure. Kenya’s fertility rate is much higher than the average rate of 2.1, whereas Italy’s is considerably lower than that. The difference in life expectancy at birth is contributed to many factors, but a huge one for Kenya is the lack of sufficient health care. Race/Ethnicity/Religious CompositionThe nationality in Italy is Italian, and the ethnic groups that appear are Italian mixed with other nationalities such as German, French, Slovene, Albanian, and Greek. The different ethnic groups vary depending on location in the country. Religion practiced is 90% Roman Catholic. The nationality in Kenya is Kenyan with different ethnic groups arising due to various tribes that have developed. Some of these groups include the Kikuyu, Luhya, Luo, and Kalenjin. Religion is not overwhelmingly dominated by one practice, as seen in Italy. Instead, 45% is protestant, 33% is Roman Catholic, 10% is Muslim, and the remaining 12% consists of indigenous beliefs and other practices. Tool 3As of 2002, the number one cause of death in Italy is ischaemic heart disease at 16% of deaths. This is followed closely by cerebrovascular heart disease at 12% of deaths. Overall, heart disease accounts for 28% of deaths for all ages in Italy. Among other top causes of death in Italy are lung cancer, chronic obstructive pulmonary disease, diabetes, colon cancer, lower respiratory infections, and breast cancer. According to the World Health Organization, in 2002, HIV/AIDS was the leading cause of death in Kenya at 38%. The next closest killer is lower respiratory infections at 10% of deaths for all ages. Communicable diseases such as diahorreal diseases, malaria, and tuberculosis lead to death less than lower respiratory infections separately, but when grouped together, they account for 17% of deaths. Kenya also has some diseases based on life style like Italy, such as ischaemic heart disease and cerebrovascular heart disease, but their prevalence is much lower and they attribute to the causes of death much less. Kenya also has a high degree of risk for major infectious diseases such as Hepatitis A, typhoid fever, and tuberculosis. Making matters worse, they have a lower treatment rate. In Kenya, there are 1.2 million people living with HIV/AIDS with 150,000 deaths from the disease in 2003. The number of people that die in one year in Kenya equals the total number of people that have HIV/AIDS in Italy. 150,000 people are living with it in Italy, and there were only 1,900 deaths in 2007. The age standardized mortality rate for cancer per 100,000 population is about the same in Italy and Kenya. For Italy, this number is 134.0. For Kenya, it is slightly higher at 139.0. Deaths due to non-communicable diseases are seen at a much higher rate at 403 per 100,000 in Italy and 782 per 100,000 in Kenya. In Italy there is a much higher use of tobacco and alcohol than in Kenya. The per capita recorded consumption among adults older than 15 in Italy is 8.02 pure liters of pure alcohol. In Kenya it is only 1.51. Tobacco use among adults older than 15 in Italy is 26.7%, while in Kenya it is 14.1%. Many factors contribute to the higher uses in Italy such as culture, lifestyle, availability, and money available to spend on these activities. The following table shows years of potential life lost due to various factors. Communicable diseasesNon-communicable diseasesInjuriesItaly58629Kenya811195Tool 4According to WHO, the Italian health care system is ranked second among the 191 countries evaluated. So, to no surprise, there are many health care providers such as physicians, operating department practitioners, dentists, physician assistants, nurse practitioners, nurses, pharmacists, therapists, psychologists, chiropractors, physical therapists, optometrists, paramedics, and many more. Italy has a total of 215,000 licensed doctors throughout the country. This equals 37 physicians per 10,000 population, which is one of the highest doctor per capita ratios in the world. There is a total of 419,523 nursing and midwifery personnel in the country which translates to 72 per 10,000 population. Another field that plays a large role in the health care in Italy consists of pharmaceutical personnel. There are 44,000 pharmaceutical personnel countrywide, which equals 8 per 10,000 population. In Kenya, the number of health care providers is much lower even though Kenya is a larger country than Italy. There is approximately the same number of physicians as pharmaceutical personnel at 4,506 and 3,094, respectively. This translates to around 1 per 10,000 population. The number of nursing and midwifery personnel stands at 37,113 or 12 per 10,000 population. As you can see there is a much larger supply of nurses than doctors in Kenya, which leads to a problem. 12 nurses/midwifery personnel per 10,000 is actually considered a surplus in Kenya because there are not enough health care facilities. There is actually more educated personnel than the system can handle, but it is still very true that there needs to be more. The problem lies in the number and capabilities of the facilities. As far as dentistry goes, there is less than 1 dentistry personnel per 10,000 population in Kenya. In Italy it is higher at 6 dentistry personnel per 10,000 population, but this is still not a strong number from an American’s point of view. Consider the United States- there is 16 dentistry personnel per 10,000 population. In Italy there are 33 medical schools. Students attend medical school for 6 years. A 6 month internship must be completed at a university clinic with at the National Health Service. Once these two stipulations are met, a student must then take a state examination. With successful completion of the state examination a student then receives a professional authorization to become a doctor. To become a specialist, a doctor then must go to a technical college for at least 2 years. In Kenya, there are only three medical schools. Education consists of two years of basic science study and three years of clinical experience. A bachelor’s degree is then awarded and must be followed by one year internship. A master’s degree may be obtained by attending post graduate school for three to four years. This period usually consists of specialty training, and a doctor may become a specialist upon completion of this and an additional two years of supervised clinical work. Tool 5ItalyHospitals in Italy are either private or public. There is a difference in how the care is delivered but it generally believed that the quality of treatment provided at both types of hospitals is the same. Private hospitals tend to be owned by the Catholic Church and are more often than not specialty hospitals, rather than a full service hospital. There is also a fair amount of respected university hospitals. The best hospitals are believed to be found in northern and central Italy. There are both private and public clinics. A public clinic means it is open to anyone, but more specifically those covered under the National Health Insurance. Private insurance is available in Italy, which is what the private clinics usually require. Recently, a number of private clinics have opened their facilities to all people as well, but in most cases long waits will be found. To be referred or admitted to a clinic or hospital, a consultation with a doctor must first occur. You are generally referred to a hospital within your province, but you may request the service be performed in a different hospital or city. Public hospitals usually offer wards with three to six beds in each one. Meals are provided for free, but all other accommodations are up to the patient. You will need your own clothes, toiletries, and towels. This is where the difference of care is observed between public and private hospitals. Private hospitals, on the other hand, are known to have standards comparable to those of a luxury hotel. Private rooms are provided with an extra bed for relatives. There is air conditioning and a television. Also, visiting hours are not restricted as they are in public hospitals. KenyaIn Kenya the health care system is structured similarly in the manner that a referral system be used to send patients to higher institutions of care. The lowest level of care in a facility begins with government dispensaries and private clinics. The dispensaries are run by enrolled and registered nurses who supervised by a nursing officer at the corresponding health center. Private clinics can only be run by those with ten years experience of clinical care. Both of these facilities offer basic outpatient care with the possibility of some diagnostic and laboratory equipment being available. The next level of care is received at health centers, which are medium sized facilities that cover an area of approximately 80,000 people. The staff usually consists of a health administration officer, a public health officer, a health information officer, a clinical officer, nurses, medical and pharmaceutical technologists, and a nutritionist. There are inpatient and outpatient wards, laboratories, a pharmacy, minor surgical facilities, and a maternal ward, among others. Sub-district hospitals are next up on the chain of health care facilities. They are very similar to health centers, but they have a full surgery unit. Nursing homes tend to deliver the same level of care. Going up the chain, there are district, then national hospitals. Tool 6ItalyItaly’s health care system is based on the Bismark Model. This model originated from Prussian Chancellor Otto van Bismarck, who was the leader of the welfare state movement in Germany during the unification of the 1800’s. The system, which mirrors the options for the working people of America, pays through insurers. It is financed through employers and employees with money being deducted from wages. The money is placed in pools known as “sickness funds.”The “sickness funds” must cover everyone which is a way in which it differs from America. Also, health insurance plans in Italy are non-profit entities. The health care coverage is public but hospitals and other facilities are private. The Bismarck Model consists of a multi-payer system, but there are strict controls, which lead to great cost efficiency and quality. There may be a co-payment for a patient upon a visit to the doctor, but it does not create a financial burden from medical expenses. Equal access is available for all citizens.KenyaKenya’s system for financing medical treatment creates much more of a burden for the citizens and is not at all cost efficient. There is not equal access for all, and no guarantee of quality. The system consists of out-of-pocket payments from the patients. There is no health insurance available, and patients incur all the costs. Rich people are better off, but the majority of the country cannot afford health care, let alone the means to travel to the few and far beyond facilities. Much care is administered by a local village healer with treatments based on Voodoo and herbal remedies. For those who manage to make it to a doctor once (most never visit one in their lifetime), it is difficult to continue health care for long-term ailments because of financial restrictions. A patient may begin to take medicine, but with established pharmacies being hard to find and funding non-existent, many do not continue their regimen. These problems mirror those of the unemployed citizens in the United States. In the NewsItalyA natural disaster made headlines in Italy on April 6, 2009. The biggest earthquake in Italy since 1980 struck the central area of the country killing hundreds of people. Rescue workers searched for living people for weeks and medical teams exhausted their resources helping the injured. Approximately 50,000 people were displaced and left homeless. Entire towns were destroyed. The Abruzzo region suffered greatly, and the 13th century mountain of L’Aquila experience the most deaths and damage. To this day, the cities are still being rebuilt and people are piecing their lives back together. Many have serious injuries they are still suffering with from rage of the earthquake. Luckily, for these victims of an unpreventable disaster, Italy offers health care to all. They do not need to worry about losing their insurance from the loss of a job or due to the financial burden created by starting their lives over from scratch. “An Italian military carabinieri walks on debris past destroyed buildings, after an earthquake in downtown Aquila, April 6, 2009.”?REUTERS/Alessandro Bianchi KenyaAs previously mentioned, Kenya has recently gone through mass riots and violence has afflicted the government due to the controversial election. It is believed that Mwai Kibati, the previous president, used his power to rig the tallying of votes and make himself win again. There are many indicators that point to the true winner of popular vote was his rival, Riala Odinga. In July 2008, the United States government became involved with the counting process and revealed that Odinga was the true victor with a 6% margin. The consequences of the resulting riots affected Kenya greatly, and still do to this day. There are millions of people living in slums with little access to clean water. Conditions are unsanitary. Many people do not even have a roof over their head, especially the thousands of children orphaned due to the violence. Kenya’s government does not know how to fix this problem, and this segment of the population is often overlooked and ignored. It is not surprising that there is no health care available to any of these people, and it does not seem that there will be any in the near future. The first step to be taken should be providing suitable living space and the means for a proper diet, but most people in Kenya are struggling to do this for themselves, which forecasts a grim future for the victims of the riots. RecommendationsItalyI feel that Italy is heading in the correct direction with its health care initiatives. The Bismarck Model assures access and quality for all citizens, and it is done in a cost effective manner. Italy could improve the number of beds available to patients. With the money they are saving through the National Health Insurance, they could invest more into expanding their facilities. Also, they can use that money to assure that all health care workers are compensated a bit more for their hard work and dedication.KenyaKenya’s health care system faces a multitude of problem. First, get the displaced people out of the slums and provide them with housing and food. This will greatly improve the health of millions. Next, a health insurance program must be set up. The option that seems to be the best would be the Bismarck Model, as seen in Italy. If the insurance is private, only the rich will have access to it, and it will still exclude the majority of the population. The government needs to take action on this. ReferencesAbout Kenya. (1999). Retrieved March 14, 2010, from Italian Quake. (2009, April 6). Retrieved April 13, 2010, from Database Search. (n.d.). Retrieved March 30, 2010, from [Indicator].[RF].MembersHealth Care in Kenya. (2008, August 24). Retrieved March 30, 2010, from Services/Health Insurance in Italy. (n.d.). Retrieved April 4, 2010, from Development Report 2009- Italy. (n.d.). Retrieved March 22, 2010, from Development Report 2009- Kenya. (n.d.). Retrieved March 22, 2010, from Republic. (n.d.). Retrieved April 4, 2010, from . (n.d.). Retrieved March 16, 2010, from . (n.d.). Retrieved March 16, 2010, from : The Big Picture on Health. (n.d.). Retrieved March 22, 2010, from Climate. (n.d.). Retrieved March 14, 2010, from and Climate Italy. (n.d.). Retrieved March 14, 2010, from Country Fact Sheet 2006- Italy. (n.d.). Retrieved March 16, 2010, from Country Fact Sheet 2006- Kenya. (n.d.). Retrieved March 16, 2010, from of Kenya. (2003, February 25). Retrieved March 14, 2010, from , T. R. (2009).?The Healing of America. New York: Penguin Press. ................
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