Challenges facing the Healthcare Facilities in Kenya
Crescent Tech Limited held a breakfast meeting at Parkinn Hotel in Westlands on 22nd November 2018, to discuss key challenges facing the healthcare facilities in Kenya. Some of the key issues highlighted were: Limited access to health care facilities, lack of adequate personnel and expertise to address the medical needs, poor Infrastructure where most facilities do not have the proper facilities to handle the medical challenges, ironically the facilities that are highly equipped with specialized equipment do not have effective processes and personnel in place to execute the tasks, access to medical records and Healthcare Financing.
The breakfast meeting was organized by Crescent Tech Limited and Napier Healthcare who partnered so as to address these issues of access to healthcare services and also to offer solutions that will provide a seamless access to records and efficient delivery of services to even the most rural area in the country.
For a healthcare facility to deliver quality healthcare, it should be well equipped with the right equipment and tools, quality medications, should be accredited, should have qualified and experienced staffs. In Kenya, the healthcare sector is facing some setbacks in: supply chain, the facilities are understaffed, healthcare financing and innovations & technology. Once this set backs are looked into, the delivery of quality healthcare will go a notch higher.
In his opening statement, Dr. Percy narrated a direct experience of how the above mentioned challenges impacted and eventually led to the loss of their C.E.O, the late Mr. Kennedy Mbwaya, who was in urgent need of medical attention while in Eldoret for a business meeting. Thereafter, the ambulances services arrived late, and it was a challenge identifying a center that could perform an endoscopy. When that was established, an appointment was required to be made so as to access the services of a specialist. This whole process greatly affected the speed at which his life could have been saved.
According to Dr. Amit N. Thakker, Chairman Kenya Healthcare Federation, the new constitution that brought forth the two arms of government, National and devolved governments gave capital to projects aimed towards the BIG 4 agenda, healthcare being one of them, through the Constituency Development Fund(CDF).Under financing of the health sector, our government has reduced its funding and this has posed as a challenge in the health sector. Over 80% of the country’s population is dependent on this funding for their healthcare needs. A very small percentage of Kenyans have access to private insurance and can afford to pay for their own healthcare expenses. This is less than 20% of the Kenyan population.
“Kenya has undergone quite some positive disruptive changes in governance and through the devolution of some services from the national government to the county government. As expected, this transition has encountered its challenges. In as much as we consider our country as having highly skilled specialized staff, we still do not have available workers to provide for healthcare services to the larger population. The people who mostly need these services, still have challenges accessing the services of specialized health workers to assist them. There is an urgent need to address this human resource and staffing issue through a proper policy in place that will boost the public health sector.” Dr. Amit N. Thakker, Chairman Kenya Healthcare Federation.
Recommendations towards solving the challenges as discussed in the meeting were: The general challenge of leadership and governance has trickled down to the health care sector. Allocation of resources has been hampered by poor governance and the lack of accountability in the use of the resources allocated to the healthcare sector therefore, the Government should accelerate discussions and implementation of public-private partnership initiatives for creation of sustainable models for healthcare financing to achieve Universal Health Coverage.
“Since Africa is emerging as an economic hub, it is notable that there is a great need to embrace technology in the key sectors like health care. Napier healthcare comes in handy with relevant solutions for the healthcare sector as it has technology that was designed by a team of doctors based in Singapore. Singapore is a proper case study for Kenya as both countries were colonies of Britain and in 1979 both economies were at par. Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014. The Economist Intelligence Unit placed Singapore second out of 166 countries for health-care outcomes.” Enrico Lim, Regional Alliance Director, Napier Healthcare
New plans on achieving Universal Health Coverage
Kenya Healthcare Federation(KHF) Healthcare Financing committee held it’s last quarterly meeting at KHF offices on 7th December 2018 the meeting was chaired by the committee chair Dr. Njoki Fernandes. The key agenda for the discussions were: Universal Health Coverage, Doctor’s price guidelines and NHIF amendment Bill. Dr. Walter Obita, director representative for the committee updated the committee on the discussion around Universal Health Coverage that has been going on at the ministerial level and the last engagement between the Ministry of Health led by the cabinet secretary Mrs. Sicily Kariuki and the private Health Sector.
Healthcare Financing Committee has been leading all the discussions around Universal Health Coverage where the committee has also been engaging with the government at the technical working committees(TWCs) set by the national government. Dr. Obita has been representing KHF healthcare financing committee in the TWCs.
From the UHC discussions in the ministry of health ,the current position shows that the government is not going to use the social insurance schemes to roll out UHC. Hence it plans on directly procuring or paying for commodities through Kenya Medical Supplies Authority( KEMSA).The counties will therefore have to roll down the payments made to KEMSA by directly making orders to KEMSA where KEMSA will make the deliveries. Inadditional,the government is going to allocate some resources to the public health activities,community health activities and 80% will be used for commodities and supplies to KEMSA.
The counties have been tasked with a role in ensuring that all other health systems are built through allocation of finances to each of the activities which include:Human Resource recruitment, deployment and management, Strengthening of governance structures and management of data, information and technologies .
Dr. Fernandes brought to the attention of members the NHIF amendement Bill with a major focus on section 2a) part II which states that there shall be paid into the fund the employer contributions matching employee’s contribution, Part III. such monies as may be appropriated by the National Assembly out of the Consolidated Fund, for persons certified by the Board to be unable to pay the contributions, Part iv. Gifts, grants or donations, Part v. Funds from the National Government, County Governments or employers for the administration of employee benefits and section five ,Part vi ,to administer employee benefits on behalf of the national government, the county governments and employers in respect of their employees. KHF’s recommendations included: should discuss this bill with the parliamentary Health Committee, Lobby in, Federation of Kenya Employer(FKE) and KEPSA and Healthcare Financing Committee to be involved in all the discussions.
There was a parliamentary directive that the Doctor’s rate should be taken back to 2006 price guidelines that were abandoned two years ago with the adoption of the current rates. The National Assembly’s Health committee further requested the Cabinet Secretary, Ministry of Health, Mrs. Sicily Kariuki to replace the existing Medical Practitioners and Dentists Rules 2016 with the second edition of the Professional Fees Rules and Guidelines of 2006, which prescribe cheaper rates for various medical services and procedures.
KHF’s recommendations as a way forward for the doctor’s price guidelines include: KHF should get more involved in costing and also learn from the successes of other countries and professionals, KHF should engage more health experts especially health economist to join in the discussion to guide in making more sound decision, Healthcare Financing should be more engaged in the discussions so as to deter NHIF from charging high rates ,the medical board should consider setting up maximum rates instead of minimum and there should be maximum margins set for pharmaceuticals and supplies which will also bring about price regulations.
Other issue as discussed was the quality of care which has been compromised and the public is not well informed on where to seek care from. Therefore the committee suggested that there should be edu-information and sensitization done to the public on who to go for care. There should also be regulations on healthcare providers at all levels in which they should have the right qualifications and experience.
The committee agreed on the focus areas for the year 2019 as: NHIF Amendment Bill, Doctor’s Price Regulations, Pricing Quality and Regulations ( this will focus on care services and medications) and engaging the media in Agenda setting.
Medical Exellence Japan(MEJ) prepares for the first Public –Private Mission(PPM)
The Medical Exellence Japan(MEJ) team visited Kenya from 26th November to 1st December 2018 in preparation for the first Public –Private Mission that will be held in Nairobi, in the month of February 2019.The MEJ shall conduct the mission in partnership with Kenya Healthcare Federation.The main aim of the pre-visit by the MEJ team was to invite Kenya to participate in their programs and collaborations. Some of the companies and organizations that were visited include: Ministry of Health, Kenyatta National Hospital, The Nairobi Hospital, M P Shah Hospital, Council of Governors, Moi Teaching and Referral Hospital, Fountain Healthcare Eldoret Hospital and Mediheal Hospital & Fertility Center. In preparation to the PPM, one of the areas the team was focusing on was getting to know the impression or specific opinions on Japanese products and services and the impression on PPM.in an interview with Dr. Joan Osoro, AD, Medical Services & Research ,Nairobi Hospital she applauded the Japanese brands in medical equipment and products “ Quality-wise, we know Japan and its brand reputations. Japan should consider what would be the strong/appealing points to introduce their equipment or services to our hospital. This is a good idea. We would like to hear more options from Japanese companies.” Dr. Joan Osoro, AD, Medical Services & Research, Nairobi Hospital.
Ms. Doris Kimbui, Nursing Officer in charge of resource mobilization and Mr. Kennedy Mbogo Liaison Officer from Kenyatta National Hospital welcomed the Japanese team by applauding the idea of PPM, From Ms. Doris and Mr. Kennedy view the Japanese equipment and products are of high and excellent quality, however they welcomed the team to the hospital in the month of February Where they requested them to have only ten delegation.
During a visit to the council of governors(COG) office, Hon. Meshack Ndolo, Senior Health System Advisor informed the MEJ team that the devolved government system in Kenya has significantly increased county level decision-space on diverse tasks. COG takes its leadership to organize and run each committees for providing solutions to diverse issues. “As for the Health committee, H.E. Mohammed Kuti; the Governor of the Isiolo County is the Chairman. Emerging issues are Human Resources and Capacity Building in the healthcare field. To get to know more about our ongoing projects, please visit our site. Quality-wise, we know Japan and its brand reputations and it has excelled.” Hon. Meshack Ndolo, Senior Health System Advisor, Council of Governors.
Mr. Reyaz Shariff, Director of Operations and Dr. Vishal R. Patel, Assistant Medical Director, In charge ICU,welcomed the MEJ team to M P Shah Hospital.During an interview,the M.P Shah officials informed the Japanese team that M P Shah hospital operates under the umbrella of the Social Service League which is a non-racial, non-religious, non-political charitable institution and cares for the patient along with it’s policy and it’s the ‘one-stop healthcare provider in East and Central Africa.’
“In terms of a patient-nurse ratio, our hospitals provides “1 patient : 1 nurse” service, while other hospitals are “3 patients : 1 nurse. We opened a new hospital in Village Market, near the trademark hotel recently. We are about to open the MRI center, too. This is a good idea. We understand that you want to enhance the presence of Japanese products in Kenya, which is significant. However, how would you do it? You should think deeply and logically about how would you enter the market and how would you set up the specific strategies. However, we also recognize Japanese companies are trying to work on providing after care services. To minimize a down time of the devices is critical. Speaking of GE and Phillips, their backup/follow up services are fairly good. Japanese (companies) should consider the reason why we need to buy your products. You must tell us your story”. Dr. Vishal R. Patel, Assistant Medical Director, M P Shah Hospital.
Prof. Lukoye Atwoli, Associate Professor of Psychiatry, Moi Teaching and Referral Hospital who welcomed the MEJ team to Moi Teaching and Referral Hospital informed them that the hospital is currently working on a new project of expanding and establishing the largest hospital in the western region. “As for the teaching side; Moi Teaching University is composed of approximately 1,200 students from not only Kenya but also many other regions, such as Tanzania, Rwanda, Somali land, and Lesotho etc. Our two facilities; University side and Hospital side are well combined as one. In terms of the care program, our counterpart is USAID. This is a five-year program, quality-wise, we know Japan and its brand reputations which score a high mark. Japanese (companies) should consider the reason why we need to buy your products. You must tell us your story”. Prof. Lukoye Atwoli, Associate Professor of Psychiatry, Moi Teaching and Referral Hospital.
Dr. Andrew Wandera, Consultant Surgeon, Fountain Healthcare welcomed the MEJ team to Fountain Healthcare, by noting that it was the very first time to welcome the people from Japan. He applauded the Japanese products as excellent “Speaking of quality, the Japanese and its products are good, but we hardly see the Japanese products here. This is a good idea. We understand that you want to enhance the presence of Japanese products in Kenya, which is significant. We don’t think Japan’s presence is strong here in Kenya except TOYOTA, We would like to know how to use a simple device more effectively to diagnose diseases. We maybe need high-end types of equipment in the future, but it’s not now. Acquiring more knowledge from a company who sold the device to us, and letting technicians more professional are the crucial things for us”. Dr. Andrew Wandera, Consultant Surgeon, Fountain Healthcare.
Mr. Miten V. Lodhia, Finance Director and Dr. Neelesh Aggarwal Director from Eldoret Hospital Pharmaceutical limited informed the MEJ team that they run hospitals and a distributing company; Eldoret Hospital Pharmaceuticals Ltd, in Kenya where they also supply medicines to the Moi Teaching and Referral Hospital as well as the other hospitals in the regions.
“We understand that you are going to hold the PPM in Nairobi. However, you need to explain to us why we should have your companies and devices here in Kenya. Quality-wise, we know Japan and its brand reputations, but the word “Quality” is not belonging to you anymore, is belonging to any companies all over the world. You may need to consider and set up a good narrative to provide your products to us. You may need to convince us in a good way.” Dr. Neelesh Aggarwal Director, Eldoret Hospital Pharmaceutical limited.
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.