Role of Supply Chain towards achieving Universal Health Coverage
Kenya Healthcare Federation supply chain committee held the last committee meeting of the year at Kenya Private Sector Alliance (KEPSA) offices on 22nd November 2018 to confer about Public-Private Partnership (PPP) areas in Supply Chain, Innovations in Health Product Distribution/Supply Chain, Promoting Local Manufacturing and the Role of Supply Chain towards achieving Universal Health Coverage (UHC). Dr. Chris Masila of PractHealth chaired the meeting.
Innovation in healthcare is rapidly growing and can contribute positively to healthcare accessibility. However, Mr. Rolando Satzke CEO, COSMOS Limited, raises a major concern that the patient is not put at the center of the innovations and that the quality of medicine must be maintained to the point of delivery. Further, Dr. Christine Sadia, Chair Kenya Medical Women Association, questioned whether the instructions of the prescription would be clear to the patient at point of delivery.
Dr. Nyalita backed the ideas by adding that most of the innovators focus on the commercial side which raises the question on quality. On the matter Mr. Rolando Satzke concluded by saying “I strongly suggest that all innovations should be patient centrered ensuring that all patients should be able to access quality medication without financial strain.” Dr. Anastasia Nyalita updated the committee on price regulations where she informed them that the Pharmacy and Poisons Board(PPB) is working on the price regulation strategies that was mandated by the Ministry of Health(MoH) and the final report will be ready by the beginning the year 2019. It was good to note that Kenya Healthcare Federation is well represented in the technical working group that is working together with the Pharmacy and Poisons Board.
There was a unanimous agreement by the supply chain committee that it will contribute and support UHC. However, price controls gives less opportunity for profit makers to distribute and resell drugs at a margin to typically unreachable markets, eventually resulting in less impact on patients. This argument links to the importance of patient awareness of and understanding of factors affecting commodity prices. Its important to bring this issue up now when the UHC is being strategized. Countries like Japan Switzerland, Ethiopia and Lesotho are good examples of price regulation models.
The committee has also been discussing the parallel importation Act and Dr. Nyalita updated the committee that the Act by PPB has been finalized and was presented at the Ministerial Stakeholder Forum and will be gazzetted. The Act will look into regulations of parallel importation and Illicit Trade.
On national coding of drugs, Dr. Nyalita updated the attendees on the consensus that was reached where KHF was asked to prepare and present a proposal to the Ministry of Health on coding of pharmaceutical products. In the ninth Ministerial Stakeholder Forum, it was agreed that Kenya should select a global pharmaceutical coding system such as the Anatomical Therapeutic Chemical Classification System(ATC) codes as used by PPB to register medicines. Dr. Daniella Munene was requested to work closely with PPB on this in order to propose a workable coding system for medicines. During the Ministerial Stakeholder Forum, it was agreed that the private sector should share an updated paper on the role of the Private Sector in achieving Universal Health Coverage. The presentation should include bottlenecks that should be addressed to increase coverage and access to quality, affordable healthcare for all.
Universal Health Coverage(UHC) Program Stakeholder Sensitization
The Ministry of Health(MoH) held a Universal Health Coverage(UHC) Program Stakeholder Sensitization meeting to Kenya Healthcare Federation(KHF) at Sarova PanAfric Hotel in Nairobi on 7th November 2018.The meeting was chaired by the Cabinet Secretary, Ministry of Health Mrs. Sicily Kariuki and co – chaired by Dr. Amit N. Thakker ,Chairman ,Kenya Healthcare Federation(KHF) In her opening remarks, Mrs. Kariuki thanked the private health sector team led by their chairman Dr. Amit N. Thakker for honoring the invitation to the meeting at such a short notice. In additional she expressed her gratitude for the fruitful partnership between Kenya Healthcare Federation and Ministry of Health.
The CS stated that the way to deliver UHC is through NHIF on a premium base. “This was the initial thinking. However, with time it has become clear that the UHC dream would not be implemented by 2022 as initially envisaged. This model highlighted challenges like the high cost involved in targeting vulnerable populations. The new approach to this was to balance political and practical implementation. As such, the government with technical advice from experts and in consultation with the county governments so it best fit to provide free healthcare services to its citizens via the county public health facilities.” Said Mrs.Sicily Kariuki, CS Ministry of Health.
The advantages of this new model includes: Strengthen community and public health systems, institutionalize a referral system and Utilize the resources available without causing further strain.The CS informed the inattendance that the pilot phase will still be in 4 counties which include Machakos, Kisumu, Isiolo and Nyeri. For a period of six months before scaling up. This pilot phase will help interrogate the institutional framework to deliver social protection through a health scheme. Some of the requirements prior to implementation includes: A legal and regulatory framework to deliver social protection through a health scheme,strengthen KEMSA to provide commodities and supplies to deliver UHC, a robust monitoring and evaluation framework, Customer care reference in terms of standards and redress mechanisms and a promotive preventive approach will help achieve a more economical viable solution.
It was reiterated that new model of implementing UHC was highly supported by the President, Governors and Parliament. The key focus on the new model will lie on offering promotive and preventive health services. “We need to strengthen Public Health Services, Community Health Services,and Health Systems to respond to the needs of the population and a continuum of care to offer basic and specialized services” Said Mrs.Sicily Kariuki, CS Ministry of Health. There was discussion around the funds available to implement the pilot phase of the UHC, Where It was reported that the allocation criteria was equitable based on: County population, equitable share of resources, poverty estimates, outpatient utilization rates, In-patient utilization rates, burden of disease, crude death rates, health facility density and Physical access to health facilities
Dr Amit N. Thakker, Chairman Kenya Healthcare Federation shared the federation’s position, which was in line with the affordable healthcare for all, as declared by H.E President Uhuru Kenyatta on 12th December 2017. He stated the private sector will fully support the UHC model. “Private sector is happy that MOH is accepting the reality around UHC implementation. The suppliers old debt at KEMSA should be paid and going forward, there should be: Prudent management of the funds, commend the stepwise approach safer and more sustainable and strengthen institutional capacity especially at the county level and county facilities. Private sector must operate in a sustainable way, even if the margins are small. They must be willing to give concessions to government on price.” Dr. Amit N. Thakker, Chairman, Kenya Healthcare Federation
Dr. Thakker emphasized on: Strengthening institutional capacity especially Supply chain – quality, Good Manufacturing Product(GMP) 10% preferential rate, KEMSA reforms especially in markups, unregulated parallel imports, counterfeit medicines and pricing regulations, Health services – support for higher levels of care by referral mechanism, preferential prices for public referrals, Financing – support innovative county schemes, support by insurers in claims and fraud management, technology support and Training and academia – HRH capacity, training in classrooms and practices in public sector facility. There was an agreement that KHF will present a position paper to the CS after consulting it’s membership.Major Discussions centred on: Role of private sector healthcare providers? It was agreed that the focus of the pilot phase would be in government facilities, where It was noted that there is a risk of patients overflow that would happen in the immediate period of declaring free health services in the four counties. However, Emergency care fund to cater for the costs incurred by private sector – this will be considered in the special fund that has been set aside to manage referrals of indigent populations for specialized care.
Regulations and reforms: it was noted that NHIF – this is in progress alongside that of KEMSA,on formation of the Kenya Food and Drug Authority – there was an update that discussions are being held in conjunction with the Ministry of Agriculture and relevant stakeholders will be involved, concerning supply chain on reimbursement framework for supply chain commodities, it was highlighted that intensive efforts are being put in place to strengthen KEMSA including their ability to supply commodities outside their framework. In additional to this questions around strengthening pharmaceutical services and assuring quality and addressing governance issues, price controls were discussed. They were deferred to the existing platform that is already handling the same. There were also discussions on provision of quality of healthcare. It was noted That UHC is not just about healthcare financing noting this, the private sector is willing to share best practices on the same.
Biometrics to identify recipients of the pilot phase and also to streamline electronic medical records was tackled this was brought to the attention of the attendees that there is a plan to register populations residing in the four pilot counties in order to contain the demand but also to be able to measure and evaluate progress. It was emphasized that this being a pilot phase, there was a lot of room for lessons learned and better positioning of the private sector in the scale up of UHC to the rest of the 43 counties.
Tenth Health Sector Round up Forum
Kenya Healthcare Federation (KHF) held it’s 10th Health Sector Round up at Radisson Blu Hotel on 10th December 2018.The meeting was graced by Mrs. Sicily Kariuki, Cabinet Secretary, Ministry of Health, Ms. Tessa Mattholie, Chairperson Development Partner of Health (Kenya) and other health sector leaders in Kenya. The event was sponsored by PATH. In her opening remarks, the vice chair, Kenya Healthcare Federation Dr. Elizabeth Wala, welcomed the invited guest and the members of KHF to the tenth health sector round up, which marked major milestones observed especially in advocacy and Public Private Partnership. PATH, a KHF member, has been at the fore front in advocating for access to quality medicine. In her remarks, Ms. Pauline Irungu Country Advocacy and policy manager, PATH, Kenya, called upon the civil societies and the private sector to collaborate and engage the government in advocacy towards accelerating the development of Kenya Food and Drug Regulation Bill. Ms. Pauline informed the inattendance that PATH is currently working with other organizations globally especially SouthAfrica to strengthen the regulatory systems. “For any health system to be fully functional and deliver products and services it must have a strong regulatory system.” Ms. Pauline Irungu Country Advocacy and policy manager, Kenya.
Dr. Amit N. Thakker Chairman, Kenya Healthcare Federation presented the key successes observed by the federation for the year 2018. KHF through it’s advocacy role has held six county stakeholder forum including: Kirinyaga, Makueni, Isiolo, Kisumu, UasinGishu and Mombasa County. Some of the Ministerial Stakeholder Forum KHF has participated in includes: Health ACT 2017,Fastracking and involving the private sector in the process of making Kenya Quality Model for Health (KQMH) the minimum standards certifying tool in Kenya, creating a National Coding on drugs flagged by KHF, carrying a joint inspection and promoting local manufacturers of drugs. KHF has created partnerships with other health stakeholders where it has been in the forefront it giving it’s expertise towards achieving Universal Health Coverage, through conferences which includes: UHC Conference in Makueni and Nyeri, second conference on maternal ,new born and child health,6th Healthcare Management conference by Medic East Africa, 7th East Africa Health Federation Conference(EAHF),Medical Women International Association(MWIA)Conference .KHF has grown its membership by 140% in 2018.
In her opening remarks, the Cabinet Secretary for Health Mrs. Sicily Kariuki thanked the Chairman and Board of Directors, Kenya Healthcare Federation, for the invitation, she underlined the forum as an opportunity for networking. She applauded the partnership between KHF and MoH where a lot has been achieved especially through the discussions during the Ministerial Stakeholder Forum (MSF) as they prepare to push the agenda on accessibility of quality and affordable healthcare, during the Presidential Round Table(PRT).The CS reaffirmed the inattendance that the ministry of health is ready to review the levy(s) and charges through regulatory authority particularly on the private sector. “There are issues in the health sector that we (public and private sector) will jointly address which include: Human Resource for Health, Healthcare Financing architecture and Universal Health Coverage.” Said the Cabinet Secretary.
The CS emphasized that the human Resource for health is one of the areas that the sector is doing badly and she called upon the public and private sector to be more innovative and willing to speak to each other she further called upon both sectors willingness to accelerate the speed on training.
The private sector and non-state actors will have a big role in the universal Health Coverage the CS confirmed. “The UHC road map acknowledges the important role played by the primary healthcare and community led interventions they will both play moving onwards. However at the launch of UHC in Kisumu, we have a lot of lessons that we shall pick as a guide moving forward.”
In conclusion the CS called upon the private sector to join hands with H.E president Uhuru Kenyatta in fighting corruption.
Finland explores business opportunities in the Kenya Health Sector
Kenya Healthcare Federation (KHF) held the 5th Bi-Monthly members meeting at the Fairmont Norfolk hotel in Nairobi. The meeting which was held in 2 parts – networking forum with Team Finland, and members meeting, was sponsored by Team Finland who had visited Kenya to discuss business opportunities. Team Finland is a network of public service providers providing internationalization services for companies. The network seeks to provide companies with a smooth service chain from counseling to finance. The main sectors of business focus for the Team Finland delegation were; Education, Energy and Health. The Finland business delegation on health and health education included Perkinelmer Wallac, Vamed Company, Logonet Group, Oulu University of applied sciences and Tampere University of applied science. They were open for partnerships that would help address issues of access and quality of healthcare.
In his opening remarks at the networking forum, Dr. Amit Thakker, KEPSA health sector board and KHF chair stated that the private sector provides 50% of medical services in Kenya. He further added that KHF provides a platform to examine Kenya’s health landscape and identify the type of partnerships that will promote trade and investment in Kenya. Affordable Healthcare for all being one of H.E. President Uhuru Kenyatta’s BIG 4 Agenda, the socio-economic agenda comes at an opportune time in Kenya where the county and national governments are appreciating the inclusion of the private sector. The key opportunities that will require beneficial, cross-cutting resolutions and partnerships include supply chain, local manufacturing and technology These areas offer opportunities for innovations to increase quality and reduce cost of health care.
Dr. Thakker then chaired the members meeting that brought together 50 members. Dr. Elizabeth Wala, KHF Vice Chair, took the members through the KHF strategic plan 2018-2020 which focuses on an increased level of advocacy, public-private partnerships, networking and regional integration. Reflecting on the previous term 2015 – 2017, she noted that there has been remarkable achievements in the membership growth (96%), that KHF has managed to hold fruitful engagements with county health stakeholders, and that through the regular ministerial stakeholders forum (MSF) KHF has managed to get a favorable ruling on the importation of medical equipment and commodities. KHF through the same forum is advocating for policy decisions to promote local pharmaceutical and medical devices manufacturing with the aim of reducing cost of healthcare.
In the strategic plan 2018-2020, the federation through it’s advocacy role will ensure that the under privileged, elderly and marginalized are considered in the national health insurance. KHF will continue to play an advisory role to the Ministry of Health on better health financing models. In line with the BIG 4 Agenda, KHF will ensure that it’s communication and publications will provide expertise on issues affecting the health sector especially where affordability, accessibility and quality of care is concerned. KHF will strengthen it’s partnership with the counties through county health stakeholders engagements to ensure quality is enhanced in health facilities.
Dr. Thakker took the members through the discussion points of the upcoming presidential round table (PRT) which will be focusing on “Closing the gap to the BIG 4 Agenda for Universal Health Coverage.” He informed the members that the private health sector will participate in the following areas: provision of health services, supply chain, technology, innovations and healthcare financing. Some of the key pain points that will be discussed include; high input cost of providing medical care, inefficient use of health infrastructure, shortage of human resources for health, multiple fees, charges and taxes, high cost of medical products and supplies, counterfeits, tax burden, irregular parallel imports, fragmentation of the health sector, poor information sharing, lack of enabling regulation to support innovation in health, delayed NHIF accreditation/ reimbursements, legislated NHIF monopoly, unfavorable laws, lack of overarching regulations for health insurance, sustainability for UHC and ensuring coverage for the poor.
Second International Conference on Maternal, Newborn and Child Health in Africa
Kenya proudly hosted the second international conference on maternal, newborn and child health in Africa themed “Maintaining momentum and focus towards ending preventable maternal and child deaths by 2030 – Sustainable path towards Africa’s Transformation.” The conference was held at the Safari Park Hotel in Nairobi from 29th October to 31st October 2018.This conference that brought together different health stakeholders from across Africa and was opened by the first lady, H.E Mrs. Margret Kenyatta, republic of Kenya.
In her opening remarks, she welcomed delegates and guests from different nationalities and further applauded the ministry of Health and the African Union Commission for the efforts made towards a reduction of Maternal and child mortality. “57% of maternal mortality happens in Africa of which 6,000 happens in Kenya. Kenya demands affordable and safe maternal health services. Let us applaud the role and efforts made by the community health workers and skilled health workers.” H.E Mrs. Margret Kenyatta. She further said that the conference is very timely and looks forward to it’s fruitfulness as Kenya has prioritized affordable health as one of the big four agenda.
“This conference has come at a point where there is a lot of issues happening to the women and children. However, We need to work together to bring out the health Agenda to fruition, this will see the achievement of sustainable development goal and further achieve the transformative goal in Africa.” Her Excellency Amira Elfadil Mohammed, Commissioner for Social Affairs African Union.
The conference was also grace by the Cabinet Secretary for Health Mrs. Sicily Kariuki, Principal Secretary for foreign affairs Mr. Macharia Kamau and first ladys’ from different counties across the country. Call for partnerships was key as discussed and reiterated by majority of the key speakers. This was a call to work together and combine efforts and ideas among the Ministry of Health and associated Ministries, private health sector and Non-Governmental Organizations, so as give a solution not only to lower Maternal and child mortality, but also to end it.
In her remarks, the Cabinet Secretary for health Mrs. Sicily Kariuki, applauded the county governments for their efforts in reducing the maternal and child mortality especially fighting against early child marriage thus encouraging education to girl child. She thanked the first lady Mrs. Margaret Kenyatta for her effort in improving accessibility to maternal health services through beyond zero initiatives. “I urge county governments to continue in improving maternal and child health.We need to intensify efforts to keep girls in school. We are glad that the government has prioritized women, children and adolescent health.” Mrs. Sicily Kariuki Cabinet Secretary for Health.
“ Everything that drives peace between each other, between nations and organizations, is based on how we treat each other.This begins at the family level.We need to invest in good health for the mother and child and this should start at the community level.” Mr. Macharia Kamau, Principal Secretary for Ministry of foreign affairs.
“According to a research carried out in March 2018, majority of Kenyans support devolution in health this is very encouraging and gives hopes of a collaboration towards achieving affordable health. Counties have plans of improving nutrition as one of the solution towards ending maternal mortality, however, there are challenges to achieving this and we must collaborate” Dr. Mohammed Kuti, Governor, Isiolo County.
Dr. Amit N. Thakker, Chairman, Kenya Healthcare Federation represented the private health sector on a panel discussion on ‘What Africa needs to stay on track towards ending preventable maternal ,newborn and child death by 2030.’ “We believe that a woman is at the centre of the family, community and above all at the centre of economic growth in Africa” Dr. Amit N. Thakker, Chairman, Kenya Healthcare Federation. Dr. Thakker further informed the attendees that the private sector will focus on four areas including; Supply chain-this will ensure the support local manufacturers through which there will be a reduction of cost of medicines once implemented. Innovations and Technology – the private sector is ready to provide innovations and technology this has been done in India, Kenya and South Africa ranking third .The challenge facing this is how to get the innovations to the market. Human Resources for Health – there is need to recognize the role of the auxiliary health workers and community health workers, in this the private health sector will also concentrate on capacity building.
“Majority of maternal mortality happens at the health facilities, and less has been done in edu-informing people on the reproductive health a major concentration paid on the uterus. This should be at the core of discussion. Majority of maternal deaths occurs as a result of three delays including; delay in decision to seek care, delay in reaching care and delay in receiving adequate health care. However, in order to address maternal mortality, we need a strong health workforce, sufficient equipment and supplies, order and accountability.” Prof. Khama Rogo, Lead Health Sector Specialist, World Bank.
Ms. Faith Muigai, Director, Kenya Healthcare Federation moderated the panel session on ‘the role of private sector in advancing Reproductive, Maternal,Newborn and Child Health(RMNCH) Agenda’ Kenya Healthcare Federation was well represented in the panel discussion by Dr. Jaqueline Kitulu, director – Kenya Healthcare Federation Ms. Ivy Syovata – Philips East Africa, Dr. Peter Kamunyo, director – Kenya Healthcare Federation and Dr. Walter Obita ,director – Kenya Healthcare Federation. Major areas that were highlighted in the discussions were; Strengthening of the human resource especially in the area of capacity building, map out the distribution of health workers especially the specialists, identify the areas in need of health workers, training the health workers on how to handle equipments, role out financing models that is affordable and that covers the under privileged, training on emergency care should be carried out on the health workers. It was noted that there is less family planning facilities and supplies therefore supporting local manufacturers of drugs will see a reduction on the cost thus making the supplies more affordable.
“We need a central mechanism to map out numbers and distribution of all health workers both public and private .This is the only way that then we can plan as a country to recruit ,train and retain a motivated workforce that can equitably be distributed leveraging on all workers in all sectors to provide the much needed quality healthcare to the public. A health service commission is such a body.” Dr. Jacqueline Kitulu, Director, Kenya Healthcare Federation.
There was a unanimous agreement from different nationalities that the private sector, should partner with the ministry of health in sharing best practices, best innovations and technology and share best evidence based research. “We need to agree on partnerships through this there will be support on innovations and technology. for example maternal death prevention technology that can be used by the midwives. Philips East Africa have come up with mobile obstetrics monitoring , a technology that can be used by community health volunteers once trained.”Ms. Ivy Syovata, Philips East Africa.
Basing the discussion on best practice and successes observed in Zambia, Malawi and Liberia a major solution that was discussed in a parallel session on strengthening community plat forms for primary health care, was ‘Trust’ primary health care has been successful in the three countries through the efforts by the community health workers. They are trusted with health advocacy, communication and sensitization, they are trusted with handling health technology and medical equipments such as blood pressure machines.
Kenya Healthcare Federation(KHF) contrives on enhancing the eHealth Policy
The ICT and mobile health committee held it’s quarterly meeting on 9th October 2018 at KHF Board Room to discuss the ministry of health(MoH) eHealth policy document being discussed as the key agenda.On eHealth policy, document that is being reviewed by the committee. From the document, the issues of data exchange is addressed mainly under “health infrastructure” and not under “health information,” the Policy does not specify or make a proposition about which of the 10 different ‘orientations’ of the eHealth policy is most relevant to the private sector, and where the industry is expected/invited to be involved and provide support, Kenya Health Architecture; It is not quite clear who the target users of the document are, with regards to the private sector, a challenge in the private sector is the issue that emerging technology often remains unregulated (e.g. MyDawa experience).
The Health Information Interagency Committee (ICC) is the highest committee in charge of coordinating health information related issues at the Ministry of Health and involving partners. For private sector players (health service providers, medical insurance providers, IT providers and others), more specific and strict regulation “with teeth” may be required. The policy documents presented appear relatively vague and high-level, and as such do not provide clear guidance or binding rules for the private sector, The engagement of the government with the private sector (with regards to health information and data exchange) should be more systematic; communication with individual companies – who do not have a mandate to share information with others – or with the top-level leadership of KHF alone may not lead to the desired outcome of a broad-level dissemination of messages and a two-way communication with broad representation from the various private health sub-sectors.
There is an interest of private sector players to participate/provide input in the development of indicators in the national health information systems, so that issues that affect the private sector more can also be captured and reported. The current practice appears to be that indicators for the national health information system are discussed by the government and international partners without involvement of private sector.
The committee is also reviewing two documents namely: Standards and guidelines for mHEALTH, the WHO classification of digital health systems (2018) and the standards and guidelines for Electronic Medical Record Systems in Kenya (2010).The committee has also formed a PPP subcommittee who held their first meeting on 6th September 2018 at HUAWEI Technologies to outline PPP issues within ICT health sector. This subcommittee has also met Mr. Anthony Okoth, Chair of KHF’s main PPP committee to align the KHF’s PPP agenda for onward presentation to Ministerial Stakeholder Forum and Presidential Round Table.
Setting the pace for affordability of quality medicines
Med source Group Limited Kenya, was launched on 11th October 2018 at Villa Rosa Kempinsky Hotel in Westlands. This is the first organization of its kind in Kenya – ‘a group purchasing organization’ dedicated to improve the availability and affordability of quality medicines and related supplies for the people of Kenya as well as assist members to build sustainable businesses and provide services they can use to grow and prosper. MedSource Group leverages the combined purchasing power of it’s members to negotiate favorable contract pricing from suppliers and offers members access to a broad catalogue of quality products from prequalified distributors and manufacturers.
This launch brought together different leaders from the pharmaceutical industry representing both public and private sector who saluted the entrance of Medsource group into the market, as a much needed solution to various problems ailing the health sector. Dr. Fred Siyoi, Chief Pharmacist and registrar -Pharmacy and poisons Board, welcomed Medsource group to the market. He reiterated that “The presence of Medsource group will contribute to the achievement of Universal Health Coverage through reducing the cost of medication. The government welcomes the important role played by all health stakeholders and Medsource Group’s role cannot be overemphasized.
According to the sustainable development goals 2030 set by the United Nations, goal 3 states that; ensure healthy lives and promote well being of all at all times. Many nations worldwide are making efforts to achieve this for example in Kenya this falls under the big four agenda set by his excellency president Uhuru Kenyatta for his second term. Affordability of quality medicine is one of the challenges faced towards enhancing access to affordable and quality care. “Even as the world is making great strides at improving health outcomes, even in low – resource countries, access to medicines continues to be a challenge. MedSource Group also presents an innovative way for Management Science for Health, to create private – sector opportunities to help deliver quality health services and products to more people. We are happy to add this novel approach to the range of other work that we have done over the years and we hope this venture in Kenya is just the beginning of similar work throughout Africa” Marian W. Wentworth, CEO Management Science for Health.
“The MedSource Group platform will be valuable to stakeholders such as pharmacies, hospitals/clinics, distributors, manufacturers and especially patients. Our main focus is and will always be to improve accessibility and availability of affordable, quality medicines and laboratory and health supplies for healthcare providers and people from all walks of life.” Dr. Douglas Keene, MedSource Group Chairman and Management Science for Health vice president for the pharmaceuticals and health.
Dr. Peter Kamunyo, Medsource Group CEO, expressed his optimism that the organization will fill the gaps in the availability and affordability of quality assured life- saving medicines, including those used to manage non – communicable diseases. “Many families are struggling to continuously provide medication, especially to handle non – communicable diseases such as cancer, hypertension and diabetes among others. Through Medsource Group, healthcare providers will be able to procure the medicines their clients need at more affordable prices.” Dr. Peter Kamunyo, Medsource Group CEO.
The organization’s membership is open to pharmacies of all sizes, hospitals & hospital groups, institutions, in-house clinics, dispensaries, clinical laboratories, and health networks. Based in Nairobi, it is a fully owned subsidiary of Management Sciences for Health (MSH), a global nonprofit organization based in the United States.
Key membership benefits, in addition to the MedSource electronic platform to access price agreements, order and pay for their quality-assured medical supplies directly to the distributors includes; training support for business skills, pharmacy practices, and inventory management, facilitating access to credit, IT solutions and data analytics for improved integration and tracking of business transactions including purchasing and inventory management.
Ninth Ministerial Stakeholder Forum
The Ministry of Health (MOH) held the ninth ministerial stakeholders forum on 23rd October 2018 at the MOH, Afya Annex building. The meeting was chaired by Dr. Jackson Kioko, Director of Medical Services (DMS) and co-chaired by Dr. Amit Thakker, chairman, Kenya Healthcare Federation (KHF). This forum brought together different health stakeholders including Christian Health Associations of Kenya (CHAK), Nursing Council of Kenya, Kenya Medical Practitioners and Dentist Board (KMPDB) and Kenya Private Sector Alliance (KEPSA), to discuss emerging issues in the private health sector, the progress made since the eighth MSF, and the way forward.
In his opening remarks, Dr. Kioko thanked the private health sector team led by their chairman Dr. Thakker for their great efforts in advocacy and strengthening the partnership between the private sector and MOH. The DMS noted that MOH and the counties may not be able to provide 100% of the services therefore are very grateful for the contribution of the private sector. “Both public and private health sector should ensure that quality is at the core of delivering health services. We also need to train the health workers in having a good mind set, right attitude and good etiquette”, said Dr.Kioko. He further added that the human resource norms and standards need to be reviewed because they do not reflect the reality on the ground.
Dr. Thakker in his opening remarks thanked all the attendees for making the time to attend the forum and discuss Kenya’s health agenda. He emphasized that public – private dialogue is a two way engagement and PPP cannot be left to one party alone. Dr. Thakker assured indicated that KHF’s presentation on the role of the private sector will be shared with MOH ahead of Presidential Round Table (PRT). In the previous MSF, there were major issues that were discussed with much progress made including: Health Regulations – control of the cost of healthcare – it was agreed that implementation of the Health ACT 2017, including the Kenya health professional oversight authority will contribute towards control of healthcare costs; Regulation of doctor’s charges – it was suggested that a strong taskforce be formed to assess the doctors fees and procedures e.g. diagnostics, scans, medications, laboratory e.t.c. and give a report that will inform the regulation of the same.
It was agreed in the previous MSF meeting that KHF should be involved in the process of making Kenya quality model for health (KQMH) the minimum standards certifying tool in Kenya. Ms. Faith Muigai, regional director- Pharm Access foundation informed the attendees that AMREF has been an implementing partner and will share an official report soonest. Dr. Kioko reiterated that quality and standards is a vital area to focus on for UHC. “When it comes to matters of quality and standards, we are looking at collaborations”, said Dr. Kioko. Dr. Thakker suggested that the assessment starts with the areas providing low quality, then progress to areas providing high quality. KMPDB announced a joint inspection of health facilities, and requested KHF to send representatives to join the inspection team and give their input, to which KHF obliged.
Healthcare financing is very key in achieving UHC and the private sector is a major contributing partner. Dr.Kioko requested the private sector to present a well structured action plan on the role of the private sector. Dr.Thakker informed the DMS that the role of the private sector has not been clearly defined particularly in healthcare financing, because the role of NHIF vis-a-vis private health insurance is unclear. Dr.Thakker reported that KHF has visited seven counties to assess their healthcare financing needs and existing models. “The urgency of the counties is now. They have already modelled their own schemes and the big question is where does MOH see the role of the county schemes fitting. It is important that a risk pooling structure be clearly defined so that the private sector can engage”, added Dr. Thakker.
Dr. Kioko responded by saying that MOH is supporting the county financing schemes. “Although issues of sustainability and acceptability of the county medical schemes have been raised, we need to look at them positively and allow them to continue, as we look into how we can support them to be more cost effective” Dr. Kioko added. He further explained that the choice of pilot counties for UHC roll out was based on the need to cover the vulnerable first then the less vulnerable, and that the pilot will be a learning phase which will be monitored to determine which partners need to be brought on board.
Commenting on county managed schemes, Mr. Elkana Onguti of MOH however cautioned that too may pools end up in excessive administrative spend. Dr. Thakker then suggested to MOH to implement a regulatory authority that will regulate the schemes.
In matters of supply chain, KHF requested that regulations for appropriate control of parallel imports should be implemented. Dr. Siyoi, CEO, Pharmacy and Poisons Board (PPB) reported that regulations have indeed been drafted and are due to be gazetted in a few days. Ms. Faith Muigai, regional Director, Pharm Access Foundation emphasized that when looking at strengthening quality and standards, supply chain should also be strengthened. Mr. Onguti, reported that a legal framework has identified some gaps in supply chain though the discussions have not been finalized.
On price control of medicines, Dr. Siyoi reported that a task force has been formed that is looking at price reduction strategies, and he will give a report on this once the task force completes their report. The issue of coding of medicines was raised by Dr. Peter Kamunyo, CEO, Medsource Group. Dr.Kioko invited KHF to prepare and present a proposal to MOH on coding. Dr. Daniella Munene, CEO, Pharmaceutical Society of Kenya (PSK), suggested that Kenya should select the global language of ATC codes as used by PPB to register medicines. Dr. Munene will work closely with PPB on this, to propose a workable coding system for medicines.
Annual Africa Health Business Symposium 2018 focuses on achieving Universal Health Coverage (UHC) in Africa
Africa has recorded a high increase in health expenditure over the last two decades with an associated increase in out-of-pocket expenditure for primary healthcare services. Access to quality healthcare plays a key role in achieving sustainable development goals (SDGs) and boosting economic growth. Integration of UHC as a goal in the national health strategies of African countries is becoming increasingly critical as the continent continues to bear the highest disease burden, an increasing population and lack of a strong health workforce to meet healthcare demands.
Africa Health Business Limited held the 3rd Africa Health Business Symposium dubbed AHBSIII at Hyatt Regency Hotel in Johannesburg , South Africa from 8th – 9th October 2018. The two day conference was themed “Achieving UHC in Africa: Stronger Together.” The conference brought together more than 300 delegates from over 50 countries, majority being African. A major expectation for the attendees was learning from various countries’ experiences in implementing UHC and the various policies and financing mechanisms required for UHC to be achieved.
The South Africa minister for health Dr. Pakishe Aaron Motsoaledi opened the conference by welcoming the attendees to South Africa. He further thanked the AHBS team for choosing South Africa to be the host country for the third annual Africa Health Business Symposium. In his opening remarks, he said “The concept of achieving Universal Health Coverage by 2022 is important. We should aim at reducing the burden on health systems in Africa”.
H.E. Amira Elfadil Commissioner for Social Affairs, African Union, said the public sector must work in unity with the private sector and commit to improving health outcomes for all, not just the middle, upper – middle and elite classes that the private sector mainly serves. “Universal Health Coverage, will help us narrow gross inequalities among people who require access to quality healthcare and affordable medicines.”
“Implementing Universal Health Coverage is only possible when we train local skills and bring in the right medical equipment. The private sector is well positioned to launch such initiatives through Public – Private Partnerships or tailored agreements” Dr. Mohamed El Sahili, CEO Medland Health Services.
Dr. Amit N. Thakker, emphasised that quality should be the foundation and basis of UHC. “Quality is the right treatment for the right person at the right time. The private sector has the opportunity to provide care more cost- effectively”, said Dr. Thakker, the chairman of Kenya Healthcare Federation (KHF).
There was an emphasis on strengthening public-private partnerships for achieving UHC. Intra Health CEO, Mr. Pape Gaye, emphasised that leveraging PPP in Africa can help achieve UHC especially establishing the right human resource capacity.
Key pointers discussed as a way forward were: PPPs, human resources for health, as well as quality and affordable medicines. There was unanimous agreement that African governments should consider working through PPPs to strengthen health literacy and health systems to increase access to quality health services and improve on financial protection schemes.
UHC can be achieved through learning from experiences of countries that have successfully implemented or are in the processes of successful implementation of UHC. Learning and adopting evolving innovations will give better ideas of effective healthcare models that are tailored to each country’s needs. Diversified approaches will create the road map to significantly expand the number of people covered by risk pooling arrangements, with substantial benefits to health care, optimizing resource use, maximizing results and “leaving no one behind.”
Dr. Toda Takao, Vice President, human security and global health – Japan International Cooperation Agency (JICA) – spoke of his own country’s post-World War II experience in implementing UHC. He said that it was the key economic driver to the country’s recovery from devastation by the conflict. Takao emphasized these three points: UHC is a nation-building issue, UHC is a pre-condition to economic growth and UHC must involve all stakeholders in the process or it will neither be achieved nor sustained.
Kenya Healthcare Federation was proud to partner with Africa Health Business Limited (a KHF Member) in making the event a success. KHF was represented the chairman Dr. Amit Thakker and two directors namely: Dr. Daniella Munene and Dr. Anastacia Nyalita. There were other KHF members who attended and exhibited at the event, including Corvus Health, IntraHealth International, Amref Health, General Electric and PharmaAccess Foundation. In his closing remarks, Dr. Thakker applauded the conference as remarkable, fruitful and very informative. “We celebrate three key successes borne out of the symposium: Meaningful interaction and engagement with dignitaries, tangible progress on unification of the private sector in South Africa under a federation with good will from the Department of Health, and a commitment from the private health sector to support African Union to achieve Agenda 63.
Many delegates visited a General Electric (GE) medical innovation center that features the latest high-tech ultra sound scanners, infant incubators and other ultra modern medical equipment. GE considers this center as part of a solution toward African development by fostering home-grown solutions. This includes an education and training center where expert healthcare providers train rural, community-level healthcare workers who are usually mostly untrained in the use of new technological advancements. There was unanimous agreement that the next AHBS (AHBSIV) will be held in Ethiopia.
The forth Speakers round table
Kenya Private Sector Alliance(KEPSA) held the forth speakers round table meeting at Leisure Lodge, Diani, Ukunda, on the 5th October 2018.The Speaker’s Roundtable (SRT) happened between the National Assembly and the Kenya Private Sector Alliance (KEPSA) and is one of the high level Public – Private Dialogue(PPDs) that was formed and formalized under the 10th Parliament. In her opening remarks, Ms. Carole Kariuki, KEPSA CEO, thanked the speaker and members of the National Assembly for the engagement with the private sector. She noted that KEPSA makes efforts to meet parliamentarians once elected, to enable them understand the private sector and continue engaging through parliamentary departmental committees to provide input into key policies and legislations.
Ms. Kariuki further noted the government’s focus on the Big 4 Agenda and emphasized on the need to work together to achieve the ambitious plan in the shortest time possible. She called for a change in tact and a need to re imagine Kenya through legislative partnership. She added that to spur manufacturing competitiveness, some of the underlying impediments that need to be resolved include; reducing energy costs, curbing proliferation of illicit trade and cheap imports, removal of IDF (Import Declaration Form Levy) and RDF (Railway Development Levy) on industrial input and machinery as well as enhancing prompt payments to suppliers. Through partnership with the National Assembly, she expressed optimism of achievement of the Big 4 Agenda.
The Speakers’ Round Table, under the leadership of the Speaker Hon. Justin Muturi, had some key areas of focus ranging from policy to revenue management to engagement with the private sector engagement. To note a few, the agenda included outlining recommendations and strategy for the conclusion of the list of policies, laws and regulations in the areas of revenue generation, debt management and effective taxation. They also sought to enhance the quality of policy and governance to facilitate a conducive business environment to create jobs and wealth in order to bring inclusive prosperity. Further, the Speakers’ Roundtable aimed to increase uptake and adoption by parliament of key private sector recommendations on the legislative agenda as identified by private sector and to increase coordination between the legislature and private sector on legislative agenda needed to drive the Big Four development agenda and to unlock private sector investments.
The National Assembly Speaker Hon. Justin Muturi applauded the crucial role played by the private sector in the economy as the engine of growth, creating jobs, paying taxes and providing essential goods and services. He said that interactive planning and decision making processes would be needed to support the private sector participation in development and foster partnerships strategies that combine skills, resources and ideas to stimulate the economy, enabling it to respond innovatively to national and global economic changes.
The speaker noted KEPSA’s continued provision of a unified voice for the private sector and maintaining focused efforts to create impact on wealth creation and social economic development. On the other hand, the SRT would provide an opportunity to highlight the key issues affecting public and private relationship and give the National Assembly a chance to identify areas of intervention to create an enabling environment for private sector development and increased investment. It would also act to enhance oversight of the executive to ensure all budgetary proposals are scrutinized and implemented as approved with ensure integrity, ethical values and the rule of law as well as promoting action-based best practices like corporate social responsibility, conservation and protection through prudent use of the country’s natural resources
During the breakout sessions, there were major discussions on universal health coverage (UHC) conducted by Hon. Sabina Chege, the chairperson of the Health Parliamentary Departmental Committee. Kenya Healthcare Federation was represented by Mr. Anthony Jaccodul, Vice Chair of the Health Regulations, Quality and Standards Committee. In his remarks he said that provision of universal health care in Kenya will not only accelerate progress towards vision 2030, but will also lead to realization of Sustainable Development Goal 3 of ensuring healthy lives and promotion of well- being for all the ages. There is therefore need for a whole systems’ approach in the delivery of UHC Mr. Jaccodul also presented KHF’s position statement on which includes; UHC should be implemented and monitored basing on quality indicators that can be measured by accredited Health Standards for Quality, Facilities to adopt both nationally and international accepted patient safety and quality standards e.g. Kenya Quality Model for Health (KQMH), Safecare, Joint Commission International (JCI),The sole government agency handling quality that is KENAS needs to be brought on board to ensure quality of care conversation does not get lost, KENAS would accredit conformity assessment bodies to implement various standards available in the industry, This would also provide a space for continuous quality Improvement, National Hospital Insurance Fund(NHIF)restructuring regulations to various sections of the Health Act 2017 should be drafted and guidelines adopted to ensure this moves in tandem with UHC.
The discussions were rich, informed, and resulted in several recommendations. There is need for a holistic approach to Universal Health Coverage. In addition to financing , we should focus on human capital, better health infrastructure, value chain efficiency, lower cost of medical equipment, standards for health services delivery and enhanced access to quality healthcare, policy on harmonization of pricing of health services to be developed and a review of work schedules in public hospitals to tackle the problem of shortages. There would also be need to evaluate of the Managed Equipment Service Program by the MOH to establish reasons why some of the critical equipment are lying idle and that the NHIF coverage in schools should be standardized to cover all students in both public and private schools including issuance of the NHIF card. The Hospital referral system should be strengthened to the lower tier county run hospitals to reduce burden on Kenyatta National Hospital and Moi Teaching and Referral Hospital. It’s important to strengthen the private sector for curative healthcare while public sector focus on preventive and promote health services. A health summit for all the health leaders including the Health Parliamentary Departmental Committee, Governors, County Executive Members and the private sector was proposed.
The legislative recommended the fast tracking of the Health Laws Amendment Bill 2018 ,by the house business Committee to the committee of the whole house. This bill will promote local manufacturing of pharmaceuticals and medical equipment to tackle influx of illicit trade in Kenya. National Hospital Insurance Fund (NHIF) Bill to be brought to Parliament soonest so as to address governance issues i.e. separate accreditation and financing role of NHIF, Issues of quality management should be assigned to Kenya National Accreditation Service (KENAS) to accredit healthcare facilities and Ministry of Health MOH to oversight policy, Ministry of Health to fully operationalize the Health Act, Review Insurance Regulatory Act to increase uptake of private insurance in addition to the National Hospital Insurance Fund (NHIF) and Finance Committee to review the public finance management Act to ensure that health finances are ring-fenced exclusively for health services only and avert diversion.