KHF team attending the workshop
The Health Act 2017 (the ‘Act’) aims to create a unified health system that aligns with the Constitution, by spearheading regulatory changes and coordinating the interrelationship between the national and county government.
The KHF team represented the private sector at a two-day workshop on the implementation of the Health Act 2017 held in Naivasha on 1-2 February 2018. This brought together a diverse and inclusive group of participants to contribute towards work plans for the operationalization of the Act. Participants included stakeholders from the Ministry of Health, Ministry of Agriculture and Irrigation, the Public Service Commission, and the private sector as well as County representatives, regulators, and development partners. The objective was to foster a greater understanding of the Act, encourage dialogue and collaboration and finally, create implementation work-plans on key areas of the Act.
Opening Remarks and Keynote Address
Njeri Mwaura, Senior Health Specialist, IFC/World Bank Group, highlighted that the Act represented a historic moment for Kenya since it tries to bring together all the stakeholders in the health sector and recognized the importance of health for the economy.
Prof. Khama Rogo, Lead Health Specialist, IFC/World Bank Group reminded the attendees that the health sector had been relying on the Public Health Act, which was put together in the 19th century. The professor highlighted that for transformation of the health system to be brought about there was a need for a change in mindsets that accommodated:
- Collaboration between the public and private sector but also collaboration within the public sector itself;
- Recognition of the devolution of health and that ‘our vision of this constitution is that each sector will work only if the center shrinks and the counties expands’
He commended the Act for recognizing the ‘3 Ms’ of health (money, man power and management) that have been problematic and said the Act had the potential to deal with the lack of accountability and lack of efficiency within the sector.
The incoming and outgoing Principal Secretaries, Mr. Peter Tum and Mr. Julius Korir respectively, encouraged the stakeholders present to work effectively towards implementation of the Act. It was recognized that the Act was not perfect but provided a springboard to jump-start the process of transformation.
Overview of the Act
The Head of the Department of Standards, Quality Assurance and Regulation, Dr Annah Wamae OGW described the Act as a ‘mother act’ since it aims to build on and update regulations of the Kenyan health system. She recognized some of the following areas as being particularly significant:
- The right to reproductive health and emergency treatment in line with the Constitution of Kenya 2010;
- Creation of a health information system which will require all healthcare providers to report on national indicators;
- The role of the private sector in achieving universal healthcare through public private partnerships;
- Recognition of E-Health as a mode of service and the need to catch up with the private sector in this regard; and
- The development of health financing that ensures appropriate funding for healthcare.
Dr Wamae explained that a steering committee at national level has been established as well as 9 Technical Working Groups (‘TWGs’) as listed below:
- MOH Organizational Structure and Duties of National Government;
- Kenya Health Professions Oversight Authority ad Traditional Alternative Medicine
- Kenya Blood Transfusion Service and Organ Transplantation
- Legislation and Regulations
- Kenya Food and Drug Authority
- Promotion and Advancement of Public Health/Lactation Stations
- Research and E-Health
- Health Financing
- Human Resources for Health Advisory Council
The steering committee and TWGs shall start working on a prioritized work plan, oversee implementation and create quarterly progress reports.
Panelists, James Mwenda (AG Legal Counsel), Belinda Kamar (IFC Legal Counsel), John Gichuru (MOH Legal Counsel) and Mary Wangai (MOH) who were involved in bringing the Act to fruition, answered questions on areas of concern in the Act. During the discussion, the panel emphasized that the TWGs would work on further regulations to unpack issues in line with the intention of the Act.
- There was a collective concern over the right to emergency medical care. S. 91(b) of the Act requires both public and private sector healthcare providers to provide emergency care services whether there is a compensation mechanism in place or not. The panel recognized the importance of the provision in relation to the Constitution but conceded that compensation mechanisms need to be operationalized urgently for this provision to work.
- Section 86(2)(f) of the Act states that prices for health products shall ‘correspond’ to KMSA market prices. There was concern as to what the process of price setting will entail and how incentives will be given to the private sector. Regulations shall have to clarify this area in an equitable way.
- Another question on S86 related to what would happen to the IRA if the private sector would have to report to a new finance oversight mechanism. The panel said the TWG would have to consider whether the Insurance Regulatory Authority (IRA) was the best place for private sector regulation of insurance.
- Part VII of the Act calls for the formation of a single regulatory body for health products and technologies. Since this is very broad, one attendee pointed out that this could even include animal health products. The panelists agreed that further legislation would be required to define the scope of the regulatory body. The panel explained that the intention behind the section was to avoid legal cases where regulatory bodies are fighting over the scope of their mandate.
In order to facilitate further dialogue, there were break out sessions where the attendees were divided into the following TWGs to form draft implementation working plans:
- Research and E-Health;
- Promotion and advancement of public and environmental health;
- Health financing;
- Kenya Food and Drug Authority (KFDA);
- Kenya Health Human Resource Advisory Council (KHHRAC);
- Kenya Health Professions Oversight Authority (KHPOA); and
- Human Organs and Gametes
This exercise allowed the attending experts to give their perspectives on how to best further implementation. The KHF team split up to ensure that private sector representatives contributed to each of these discussions. The summary below outlines some of the issues that were unpacked during this exercise.
The Health Act 2017 has the potential to build a unified national health system. The retreat marked a stride forward towards appropriate implementation of the Act. The KHF team shall continue to contribute to the process of implementation as representatives of the private sector.
Group Work Summary
|Technical Working Group||Key Points|
|Research and E-Health
|Research: The urgent task is to form the National Health Research Committee as stipulated by the Act and create a health research policy. These foundational steps will allow the Committee to create a research agenda.
E health: Part 15 of the Act stipulates that an E-health Act must be passed within 3 years of the assent of the Health Act. The E-health unit at the MOH will be responsible for this. The TWG recognized that collaboration with the ICT unit would be necessary.
|Promotion and advancement of public and environmental health
|This team recognized that there are a number of policies and bills already in place or being processed that can be relied on for implementation of Part 8.
S 71 and S72 require lactation stations to be established in all work places. Regulations dealing with inspections and specifications need to be drafted to put this into practice.
|Health financing||There is a need for further clarifications through regulations and amendments on the following areas:
|Kenya Food and Drug Authority (KFDA)||It was pointed out that the mandate of food safety is with the MOH. The main challenge relates to how this will be coordinated to ensure the regulations adapt to current systems. The first step would be to finalize the KFDA bill and hold stakeholder and parliamentary consultations|
|Kenya Health Human Resource Advisory Council (KHHRAC)||The first step would be to establish the KHHRAC by choosing nominees in line with the Act, appointing a chairperson and appoint a CEO.|
|Kenya Health Professions Oversight Authority (KHPOA) and traditional medicine||It was recognized that the idea of having an oversight authority came from benchmarking South Africa. There is an emphasis on self-regulation with an oversight authority setting minimum standards. The group discussed how gender mainstreaming should be taken into account when choosing representatives.
Traditional medicine: A policy needs to be developed for traditional medicine through stakeholder engagement.
|Human Organs and Gametes
|The team discussed drafting a bill based on key missing parts in the Act:
It was suggested that gametes should not fall in this category because there are distinct complexities that arise when dealing with gametes that should be regulated separately. There were questions as to whether this should be looked at by a new TWG.
The Human Tissue Act Cap 252 would need to be reviewed and used where in line with the Act. There is a working transfusion service but there is a need to set up the same for organs.
On 26th of January 2018, Kenya Healthcare Federation, AMREF and Malteser International organized a successful introductory meeting for the MSP partnership at Radisson Blu, Upperhill, Nairobi. The turnout to the meeting was good and attendees included the H.E. Governor of Isiolo and Chairman of the Council of Governors Health Committees, Dr. Mohammed Kuti, County Executive Committee Health Members from across the country, professional associations, healthcare providers and training institutions.
The Chairman of KHF Dr. Amit Thakker spoke about the significance of timely interventions in the health sector in light of the strikes of 2017. He stressed the growing importance of the health sector and highlighted that the sector has been positioned to create the second highest number of jobs in Africa in the coming years. The esteemed Governor of Isiolo County, Dr. Mohammed Kuti addressed the attendees and urged them to take steps towards universal healthcare. He said that counties need to start thinking of how they can pre-empt upcoming challenges and pointed towards good relationships between health workers and county managers, technological advancements, better health financing models and appropriate training provisions as the way forward.
Pictured: H.E Dr. Mohammed Kuti: Governor Isiolo County
The introductory MSP meeting was carried out to vote for health specialist cadres that would be strengthened through the MSP partnership. The stakeholders were taken through needs analysis of 10 shortlisted health specialist cadres and then invited to vote for the health specialist professions that would be focused on in the MSP project.
Emergency Care Professionals, Community Health Workers and Health Records and Information Officers were chosen through the voting process to be the focus of the MSP project. The stakeholders were given an opportunity to voice their views on the chosen cadres from their perspective as outlined below.
L-R: Mr. Mohamed Duba: KHPS H.E Dr. Mohammed Kuti: Governor Isiolo County: Dr Murega Kiambu County: Dr Amit Thakker-KHF: Dr Andrew Mulwa: Makueni County, Dr.George Kimathi: AMREF Healthcare.
Emergency Care Professionals
Many stakeholders agreed that this health cadre required immediate attention. Stakeholders shared expert knowledge that strengthened the case to fund capacity building activities for the emergency care professionals.
- The regulatory body in place only covers doctors and nurses. Therefore there is actually no regulatory body for any other emergency care professional groups. In practice, attempts to resolve this have included a system of self-regulation, which has no legal standing. However, because of the advocacy efforts, employers started asking for the certificate despite the lack of a legal requirement.
- The Kenyan Constitution gives every Kenyan a right to emergency medical care. In order to achieve this, there is a need to strengthen emergency care professionals because most emergencies do not occur in hospitals. Therefore the discussion needs to go beyond doctors and nurses.
- Noor, the CEC Health member of Wajir County shared that nurses handle the emergency unit in Wajir, and thus it is important to train specialists for this unit.
- Rukia Abdulkadir from Red Cross expressed the organization’s support of emergency medical services. The Red Cross has been providing a lot of free (CSR) services because of the crisis in the emergency medical care health stream.
- Benjamin Wachira, the Executive Director of Emergency Care Kenya Foundation (EMKF) pointed that out that part of the problem stemmed from the fact that emergency medical care is not taught in medical school. It was pointed out that there is a need to reassess the training provisions in this area.
Community Health Workers
The discussions on community health workers were engaging and gave the CEC Health Members a platform to share perspectives based on the communities they were dealing with in their counties.
- The CEC Health Member from Busia County and the CDNS Homa Bay representative, Dr. Maurice Simiyu and Dr. Daniel Okuku respectively, explained how their counties had allocated funding towards salaries for community health workers. Dr. Simiyu said that Busia County decided to pay community health workers because the referrals that came through this health cadre have been necessary to save lives.
- Some stakeholders pointed out the need to legalize and strengthen training for community health workers. It was highlighted that the Community Health Worker Scheme of Service (2013) was insufficient so long as it was not legally binding, particularly since financial allocations towards community health workers depend on the good will of the Counties.
- Finally, there was a call to shift mindsets towards appreciating the return on investment from preventing the spread of infections and diseases rather than only thinking about how much was spent on community health workers.
Health Records and Information Officers
There was collective agreement that further research needed to be conducted on this area.
- There was an emphasis on the importance of this health cadre to provide data to monitor and evaluate progress and to plan the health agendas of all the counties.
- As one attendee put it, “We are in a digital world – when we are pushing for this training what are we pushing for?”
After the successful discussion, all the attendees were invited to register their interest to be part of the thematic committees for each of the shortlisted cadres that would be involved in shaping the way forward.
The success of the meeting went beyond the specific agenda of the MSP project. The MSP meeting showcased the commitment of relevant stakeholders towards working together on a health agenda focused on universal healthcare provision, strengthening current systems and fostering public-private partnerships within the health sector. The attendees expressed their appreciation of the meeting platform for bringing them together to understand and learn from different perspectives and challenges across the HRH in the health sector.
Ms.Sarah Omache, the CEC Health Member of Kisii County concluded that it had been productive and enabling to be part of meeting with representation from both the public and private sector and hoped that this would be the first step towards moving the health agenda forward in the best way possible.
L-R: Mr. Benjamin Wachira of EMKF, Yvonne Mathu of Aga Khan University and Denise Jessop of Response Med Speaking during the event.
Yvonne Mathu from Aga Khan University and Dr. Solomon Kilaha from KMTC conveyed their support towards the MSP project and the wider health agenda by detailing their plans for curriculum development in line with the needs of the health sector in the near future.
Moses Lorre from KHPS was elated that one of KHPS’s member associations was picked for capacity building and commended the event organizers for creating an event that built trust between all the relevant stakeholders.