KHF team attending the workshop
The Health Act 2017 (the ‘Act’) aims to create a unified health system that aligns with the Constitution, by spearheading regulatory changes and coordinating the interrelationship between the national and county government.
The KHF team represented the private sector at a two-day workshop on the implementation of the Health Act 2017 held in Naivasha on 1-2 February 2018. This brought together a diverse and inclusive group of participants to contribute towards work plans for the operationalization of the Act. Participants included stakeholders from the Ministry of Health, Ministry of Agriculture and Irrigation, the Public Service Commission, and the private sector as well as County representatives, regulators, and development partners. The objective was to foster a greater understanding of the Act, encourage dialogue and collaboration and finally, create implementation work-plans on key areas of the Act.
Opening Remarks and Keynote Address
Njeri Mwaura, Senior Health Specialist, IFC/World Bank Group, highlighted that the Act represented a historic moment for Kenya since it tries to bring together all the stakeholders in the health sector and recognized the importance of health for the economy.
Prof. Khama Rogo, Lead Health Specialist, IFC/World Bank Group reminded the attendees that the health sector had been relying on the Public Health Act, which was put together in the 19th century. The professor highlighted that for transformation of the health system to be brought about there was a need for a change in mindsets that accommodated:
- Collaboration between the public and private sector but also collaboration within the public sector itself;
- Recognition of the devolution of health and that ‘our vision of this constitution is that each sector will work only if the center shrinks and the counties expands’
He commended the Act for recognizing the ‘3 Ms’ of health (money, man power and management) that have been problematic and said the Act had the potential to deal with the lack of accountability and lack of efficiency within the sector.
The incoming and outgoing Principal Secretaries, Mr. Peter Tum and Mr. Julius Korir respectively, encouraged the stakeholders present to work effectively towards implementation of the Act. It was recognized that the Act was not perfect but provided a springboard to jump-start the process of transformation.
Overview of the Act
The Head of the Department of Standards, Quality Assurance and Regulation, Dr Annah Wamae OGW described the Act as a ‘mother act’ since it aims to build on and update regulations of the Kenyan health system. She recognized some of the following areas as being particularly significant:
- The right to reproductive health and emergency treatment in line with the Constitution of Kenya 2010;
- Creation of a health information system which will require all healthcare providers to report on national indicators;
- The role of the private sector in achieving universal healthcare through public private partnerships;
- Recognition of E-Health as a mode of service and the need to catch up with the private sector in this regard; and
- The development of health financing that ensures appropriate funding for healthcare.
Dr Wamae explained that a steering committee at national level has been established as well as 9 Technical Working Groups (‘TWGs’) as listed below:
- MOH Organizational Structure and Duties of National Government;
- Kenya Health Professions Oversight Authority ad Traditional Alternative Medicine
- Kenya Blood Transfusion Service and Organ Transplantation
- Legislation and Regulations
- Kenya Food and Drug Authority
- Promotion and Advancement of Public Health/Lactation Stations
- Research and E-Health
- Health Financing
- Human Resources for Health Advisory Council
The steering committee and TWGs shall start working on a prioritized work plan, oversee implementation and create quarterly progress reports.
Panelists, James Mwenda (AG Legal Counsel), Belinda Kamar (IFC Legal Counsel), John Gichuru (MOH Legal Counsel) and Mary Wangai (MOH) who were involved in bringing the Act to fruition, answered questions on areas of concern in the Act. During the discussion, the panel emphasized that the TWGs would work on further regulations to unpack issues in line with the intention of the Act.
- There was a collective concern over the right to emergency medical care. S. 91(b) of the Act requires both public and private sector healthcare providers to provide emergency care services whether there is a compensation mechanism in place or not. The panel recognized the importance of the provision in relation to the Constitution but conceded that compensation mechanisms need to be operationalized urgently for this provision to work.
- Section 86(2)(f) of the Act states that prices for health products shall ‘correspond’ to KMSA market prices. There was concern as to what the process of price setting will entail and how incentives will be given to the private sector. Regulations shall have to clarify this area in an equitable way.
- Another question on S86 related to what would happen to the IRA if the private sector would have to report to a new finance oversight mechanism. The panel said the TWG would have to consider whether the Insurance Regulatory Authority (IRA) was the best place for private sector regulation of insurance.
- Part VII of the Act calls for the formation of a single regulatory body for health products and technologies. Since this is very broad, one attendee pointed out that this could even include animal health products. The panelists agreed that further legislation would be required to define the scope of the regulatory body. The panel explained that the intention behind the section was to avoid legal cases where regulatory bodies are fighting over the scope of their mandate.
In order to facilitate further dialogue, there were break out sessions where the attendees were divided into the following TWGs to form draft implementation working plans:
- Research and E-Health;
- Promotion and advancement of public and environmental health;
- Health financing;
- Kenya Food and Drug Authority (KFDA);
- Kenya Health Human Resource Advisory Council (KHHRAC);
- Kenya Health Professions Oversight Authority (KHPOA); and
- Human Organs and Gametes
This exercise allowed the attending experts to give their perspectives on how to best further implementation. The KHF team split up to ensure that private sector representatives contributed to each of these discussions. The summary below outlines some of the issues that were unpacked during this exercise.
The Health Act 2017 has the potential to build a unified national health system. The retreat marked a stride forward towards appropriate implementation of the Act. The KHF team shall continue to contribute to the process of implementation as representatives of the private sector.
Group Work Summary
|Technical Working Group||Key Points|
|Research and E-Health
|Research: The urgent task is to form the National Health Research Committee as stipulated by the Act and create a health research policy. These foundational steps will allow the Committee to create a research agenda.
E health: Part 15 of the Act stipulates that an E-health Act must be passed within 3 years of the assent of the Health Act. The E-health unit at the MOH will be responsible for this. The TWG recognized that collaboration with the ICT unit would be necessary.
|Promotion and advancement of public and environmental health
|This team recognized that there are a number of policies and bills already in place or being processed that can be relied on for implementation of Part 8.
S 71 and S72 require lactation stations to be established in all work places. Regulations dealing with inspections and specifications need to be drafted to put this into practice.
|Health financing||There is a need for further clarifications through regulations and amendments on the following areas:
|Kenya Food and Drug Authority (KFDA)||It was pointed out that the mandate of food safety is with the MOH. The main challenge relates to how this will be coordinated to ensure the regulations adapt to current systems. The first step would be to finalize the KFDA bill and hold stakeholder and parliamentary consultations|
|Kenya Health Human Resource Advisory Council (KHHRAC)||The first step would be to establish the KHHRAC by choosing nominees in line with the Act, appointing a chairperson and appoint a CEO.|
|Kenya Health Professions Oversight Authority (KHPOA) and traditional medicine||It was recognized that the idea of having an oversight authority came from benchmarking South Africa. There is an emphasis on self-regulation with an oversight authority setting minimum standards. The group discussed how gender mainstreaming should be taken into account when choosing representatives.
Traditional medicine: A policy needs to be developed for traditional medicine through stakeholder engagement.
|Human Organs and Gametes
|The team discussed drafting a bill based on key missing parts in the Act:
It was suggested that gametes should not fall in this category because there are distinct complexities that arise when dealing with gametes that should be regulated separately. There were questions as to whether this should be looked at by a new TWG.
The Human Tissue Act Cap 252 would need to be reviewed and used where in line with the Act. There is a working transfusion service but there is a need to set up the same for organs.
On 26th of January 2018, Kenya Healthcare Federation, AMREF and Malteser International organized a successful introductory meeting for the MSP partnership at Radisson Blu, Upperhill, Nairobi. The turnout to the meeting was good and attendees included the H.E. Governor of Isiolo and Chairman of the Council of Governors Health Committees, Dr. Mohammed Kuti, County Executive Committee Health Members from across the country, professional associations, healthcare providers and training institutions.
The Chairman of KHF Dr. Amit Thakker spoke about the significance of timely interventions in the health sector in light of the strikes of 2017. He stressed the growing importance of the health sector and highlighted that the sector has been positioned to create the second highest number of jobs in Africa in the coming years. The esteemed Governor of Isiolo County, Dr. Mohammed Kuti addressed the attendees and urged them to take steps towards universal healthcare. He said that counties need to start thinking of how they can pre-empt upcoming challenges and pointed towards good relationships between health workers and county managers, technological advancements, better health financing models and appropriate training provisions as the way forward.
Pictured: H.E Dr. Mohammed Kuti: Governor Isiolo County
The introductory MSP meeting was carried out to vote for health specialist cadres that would be strengthened through the MSP partnership. The stakeholders were taken through needs analysis of 10 shortlisted health specialist cadres and then invited to vote for the health specialist professions that would be focused on in the MSP project.
Emergency Care Professionals, Community Health Workers and Health Records and Information Officers were chosen through the voting process to be the focus of the MSP project. The stakeholders were given an opportunity to voice their views on the chosen cadres from their perspective as outlined below.
L-R: Mr. Mohamed Duba: KHPS H.E Dr. Mohammed Kuti: Governor Isiolo County: Dr Murega Kiambu County: Dr Amit Thakker-KHF: Dr Andrew Mulwa: Makueni County, Dr.George Kimathi: AMREF Healthcare.
Emergency Care Professionals
Many stakeholders agreed that this health cadre required immediate attention. Stakeholders shared expert knowledge that strengthened the case to fund capacity building activities for the emergency care professionals.
- The regulatory body in place only covers doctors and nurses. Therefore there is actually no regulatory body for any other emergency care professional groups. In practice, attempts to resolve this have included a system of self-regulation, which has no legal standing. However, because of the advocacy efforts, employers started asking for the certificate despite the lack of a legal requirement.
- The Kenyan Constitution gives every Kenyan a right to emergency medical care. In order to achieve this, there is a need to strengthen emergency care professionals because most emergencies do not occur in hospitals. Therefore the discussion needs to go beyond doctors and nurses.
- Noor, the CEC Health member of Wajir County shared that nurses handle the emergency unit in Wajir, and thus it is important to train specialists for this unit.
- Rukia Abdulkadir from Red Cross expressed the organization’s support of emergency medical services. The Red Cross has been providing a lot of free (CSR) services because of the crisis in the emergency medical care health stream.
- Benjamin Wachira, the Executive Director of Emergency Care Kenya Foundation (EMKF) pointed that out that part of the problem stemmed from the fact that emergency medical care is not taught in medical school. It was pointed out that there is a need to reassess the training provisions in this area.
Community Health Workers
The discussions on community health workers were engaging and gave the CEC Health Members a platform to share perspectives based on the communities they were dealing with in their counties.
- The CEC Health Member from Busia County and the CDNS Homa Bay representative, Dr. Maurice Simiyu and Dr. Daniel Okuku respectively, explained how their counties had allocated funding towards salaries for community health workers. Dr. Simiyu said that Busia County decided to pay community health workers because the referrals that came through this health cadre have been necessary to save lives.
- Some stakeholders pointed out the need to legalize and strengthen training for community health workers. It was highlighted that the Community Health Worker Scheme of Service (2013) was insufficient so long as it was not legally binding, particularly since financial allocations towards community health workers depend on the good will of the Counties.
- Finally, there was a call to shift mindsets towards appreciating the return on investment from preventing the spread of infections and diseases rather than only thinking about how much was spent on community health workers.
Health Records and Information Officers
There was collective agreement that further research needed to be conducted on this area.
- There was an emphasis on the importance of this health cadre to provide data to monitor and evaluate progress and to plan the health agendas of all the counties.
- As one attendee put it, “We are in a digital world – when we are pushing for this training what are we pushing for?”
After the successful discussion, all the attendees were invited to register their interest to be part of the thematic committees for each of the shortlisted cadres that would be involved in shaping the way forward.
The success of the meeting went beyond the specific agenda of the MSP project. The MSP meeting showcased the commitment of relevant stakeholders towards working together on a health agenda focused on universal healthcare provision, strengthening current systems and fostering public-private partnerships within the health sector. The attendees expressed their appreciation of the meeting platform for bringing them together to understand and learn from different perspectives and challenges across the HRH in the health sector.
Ms.Sarah Omache, the CEC Health Member of Kisii County concluded that it had been productive and enabling to be part of meeting with representation from both the public and private sector and hoped that this would be the first step towards moving the health agenda forward in the best way possible.
L-R: Mr. Benjamin Wachira of EMKF, Yvonne Mathu of Aga Khan University and Denise Jessop of Response Med Speaking during the event.
Yvonne Mathu from Aga Khan University and Dr. Solomon Kilaha from KMTC conveyed their support towards the MSP project and the wider health agenda by detailing their plans for curriculum development in line with the needs of the health sector in the near future.
Moses Lorre from KHPS was elated that one of KHPS’s member associations was picked for capacity building and commended the event organizers for creating an event that built trust between all the relevant stakeholders.
Universal Healthcare in Kenya: is it a pipedream? Will a partnership of public and private sector deliver the promise?
The private health sector leaders converged at Park Inn Hotel on 30thNovember for the Kenya Healthcare Federation annual health round up forum for 2017. A full house attendance included CEOs of hospitals, pharmaceutical firms, insurance and multinational firms, medical equipment, technology and telecommunication companies among other commercial entities that form the backbone of the private health sector in Kenya. Also present were officials from the County governments, Ministry of Health and Development Partners such as USAID, GIZ and World Bank/IFC.
At the event it was evident that this sector has been on a positive growth path over the last decade. However despite growth in demand as more people live longer, this economic system still faces critical challenges.
It is estimated that the health sector will create 178 million new jobs in Africa by 2030 (Ref; Better Business Better World – DAVOS 2016). Of these 28 million new jobs will be in Africa. The sector has outlined its roadmap and has highlighted that risk-pooling and telehealth will be the largest market hotspots in the next decade.
Out-of-pocket healthcare payments push around five percent of households in low-income countries below the poverty line each year. Since the poor pay a disproportionate share of their income in unavoidable health costs, lack of affordable health insurance is also inequitable. Increasing penetration of private, public-private and community insurance schemes can address this problem. As well as spreading health risks across communities, risk pooling often includes organised “contracting” functions that purchase health care on behalf of the individuals covered, which in turn encourages the development of higher-quality private sector providers.
Using sensors that read the vital signs of patients at home can alert nurses and doctors cost effectively to problems before they worsen. Emerging technologies include wearable patches that can diagnose heart conditions, sensors that monitor asthma medication intake and detect poor air quality, and glucose monitors that send diabetics’ data straight to their smartphones. McKinsey Global Institute estimates that remote monitoring could reduce the cost of treating chronic diseases in health systems by 10 to 20 percent by 2025.
Basic mobile internet technologies are already extending access to consultation and diagnosis to remote patients around the world. In Kenya we are well prepared to set up a robust Virtual Care Center that will provide telehealth services across counties and the key urban cities. A community health worker in remote areas will be assist for example an expectant mother through the “HealthAfya call” and help the patient carry out the doctor’s instructions. This kind of a system has helped raise the rate of safe hospital or clinic deliveries by 50 percent in several developing countries.
The private sector, through their Chairman was very clear on the support it will provide in moving towards a full universal health coverage as pledged by H.E Uhuru Kenyatta during his inauguration speech on 28th October in Nairobi. “The journey to achieve universal health coverage in Kenya is intertwined with economic growth. We have to first strengthen several areas within our the health system, both public and private, in order for us to reach full coverage” says Dr Amit N. Thakker “ The next phase will require us to find suitable financing models to expand the risk pooling mechanisms and avoid any monopolies being formed. This will then lead to foster a true PPP in healthcare financing and provision areas which is the only suitable option for Kenya to achieve UHC under the current circumstances” he adds.
Also present as the Chief Guest was Mr Nik Nesbitt, Chairman of the Kenya Private Sector Alliance (KEPSA). Mr Nesbitt provided a clear insight to on the role of KEPSA especially on the institutionalized structures on how to engage effectively with the Government.
“It’s very important for your companies and organisations to effectively voice your concerns and find solutions through KHF at the regular Ministerial Stakeholder forum (MSF).At this you get a chance to resolve matters that can be dealt with at the Ministry of Health level” he went on to add “should you find that the matter continues to affect your industry negatively, that’s when you escalate the matter to KEPSA for the Presidential Round Table (PRT) that is held twice a year”
L-R: Dr. Ardo Ba (President, FOASPS), Hon. Abdouliaye Diouf Sarr (Minister of Health & Social Action Senegal, Dr. Amit Thakker (Chairman, Africa Healthcare Federation) showing a true sign of public private partnerships during the official opening ceremony.
Africa Health Business Symposium has hit a new milestone this year – it was the first time that the continent was united in West Africa with public sector, private sector and development partner representatives from 51 countries across the globe, Moreover, this conference was a historic partnership effort between the Ministry of Health Senegal, the Private Health Federation of Senegal (ASPS) and Africa Health Business Ltd, leading the path towards the joint objective of achieving SDG3 and transforming the healthcare landscape in our continent.
New relationships were made and old ones renewed as members met in Dakar for the 3 days of knowledge sharing events. The good news is that there is a willingness and demand for the state and non state partners in the healthcare ecosystem to come together to collectively take responsibility of meeting the healthcare challenges. Our diverse and dynamic group of speakers and panelists provided in-depth insight, as well as, actionable activities through practical tools of engagement models, methods and mechanisms.
Key outcomes of AHBSII:
- Establishment of an honest and true dialogue model process between Ministries of Health that were present and the private sector stakeholders
- Setting a common ground: all parties agreed that Public Private Partnerships are non-negotiable in achieving healthcare goals in the continent
- Leadership: all stakeholders agreed to take responsibility in driving towards effective partnerships for tangible positive impact in healthcare outcomes
- Accountability: we will be tracking the progress on impact and improved health outcomes.This progress will be presented at AHBS III
The lesson is clear – to have a significant impact in healthcare, we must work together. It was an absolute pleasure to host you at AHBS II. We sincerely thank you for your continued support and active participation in our initiative. We hope to see you in South Africa for the 3rd Africa Health Business Symposium next October!
L-R: Clare Omatseye (FOASPS), Zola Mtshiya (Board of Healthcare Funders), Magriet Deetlefs Raxworthy (Nutricia) and Dr. Ardo Ba (FOASPS) during the AHBS III handover ceremony to our event partners in South Africa.
Dr Jacqueline Kitulu, National Chair Kenya Medical Association and Director Kenya Healthcare Federation (KHF) attended the annual World Medical Association (WMA) General Assembly in Chicago from 11th to 14th October 2017. The event which was open to all constituent members of the World Medical Association, associate members, and observers and to other individuals by special invitation brought together delegates from more than 50 national medical associations.
The World Medical Association (WMA) is an international organization representing physicians, founded on 17 September 1947, when physicians from 27 different countries met at the First General Assembly of the WMA in Paris. The organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behaviour and care by physicians, at all times.
Among the issues discussed during this year’s conference were Hunger strikes where the assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.
A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
Against a background of armed conflicts in many parts of the world, the Assembly issued a strongly worded statement reminding governments of the human consequence of warfare. It says that armed conflict should always be a last resort and physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions to start or continue armed conflict.
A call for ethical codes for recruiting health professionals was agreed in a bid to reduce inappropriate recruitment activities by states. The Assembly approved a new policy to combat the problems of a global maldistribution of health care workers. It said that ethical recruitment codes were needed for both governments and commercial recruitment agencies to ensure that countries did not actively recruit from other states.
Guidance to physicians on dealing with child abuse were agreed. In a new policy document, the WMA says that child abuse in all its forms, including exploitation of children in the labor market, is a world health problem and that physicians have a unique and special role in identifying and helping abused children and their families.
Dr Jacqueline Kitulu was nominated to the credentials committee to represent Africa region to assess who can vote, numbers and also to count votes for the presidential elections which took place on Saturday 14th October 2017. Dr. Yoshitake Yokosuka, President of the Japan Medical Association, was installed as President of the WMA for 2017/2018.
KHF was on the 20th September 2017 represented by the Chairman Dr Amit Thakker at the 72nd Regular Session of the UN General Assembly (UNGA 72). The meeting which convened at UN Headquarters in New York had the general debate opened on 19 September 2017 and focused on the theme, ‘focusing on People: Striving for Peace and a Decent Life for all on a Sustainable Planet’.
In Line with PSHP Kenya project that is managed by KHF and UNFPA, the session on 20th September 2017 at the Every Woman Every Child Hub deliberated on what it takes to deliver on an integrated agenda for women, children and adolescents to achieve healthier, more prosperous and peaceful societies. The session which was moderated by Ms. Tikhala Itaye: President Afri YAN was attended by H.E Ms. Ana Helena Chacon Echeverria: Vice president of Costa Rica, Mr. Michel Sidibe: Executive Director UNAIDS, H.E Hala Bsaisu Lattouf: Minister of Social Development Jordan, Mr. Elhadj As Sy: Secretary – General IFRC, Mr. Wade Warren: Acting Deputy Administrator USAID and Dr Amit Thakker, Chairman Kenya Healthcare Federation. Dr Amit on behalf of PSHP- Kenya announced a new private sector member, Unilever and a new masterplan during this event.
Kenya Healthcare Federation was represented by the Chairman Dr Amit Thakker in this year’s German-African Healthcare Symposium that took place on the 18th October 2017 in Ellington Hotel, Nürnberger Berlin. The symposium is an official side-event of the 2017 World Health Summit and brought together high-level experts from Africa, Germany and Europe to discuss and shed light with an economic perspective to the results of the G20 Healthcare Conference, which took place in May 2017.
The event which is in particular directed to medium sized enterprises was organized by Afrika-Verein Veranstaltungs (AVV) and German Healthcare Partnership (GmbH). Dr Amit Thakker was privileged to join the health security panel alongside Prof. Dr Thomas Büttner: Member of the Board of Trustees of the German Fund for World Population, Dr Anthony Nsiah-Asare: Director General Ghana Health Service and Judith Helfmann-Hundack, Afrika-Verein der deutschen Wirtschaft (AV). The session touched on spread of disease, prevention & detection and coordinated response for a public health emergency.
Kenya Healthcare Federation has in the recent past engaged the Ministry of Health (MoH) Council of Governors (CoG) and the Kenya National Union of Nurses (KNUN) and relevant officials in a mid to end the nurses strike Stalemate.
In a meeting with KHF Director Ms. Winnie Shena and Human Resource Committee Chair Mr. Kennedy Auma, Mr. Meshack Ndolo CoG Health representative stated that they have held several discussions with KNUN to try and end the stalemate to no avail. The strike however remain illegal as stated by the court and the CoG is still committed to fresh talks to end the 4 months standoff. Mr. Ndolo urged the county leaders to individually own up the stalemate by seeking other Interventions undertaken by some counties like Nandi, Bomet, Uasin Gishu and partly Kimabu who have gone back to work not based on the CBA.
The genesis of the standoff was when the CoG was tasked by the Salary and Remuneration Commission (SRC) to demonstrate affordability and sustainability of the CBA. Nurses want the implementation of the CBA, including uniform allowance of KES 50,000 / pa. The SRC required that the CBA be pegged on job evaluation done, an exercise that KNUN obtained a court order for nurses not to participate. The 1st report on job evaluations done by SRC was rejected as it termed nurses unskilled creating a second ember to the standoff. The CoG has since organized a re –evaluation with all the relevant stakeholders including NCK, MTRH and KNH and the feedback from SRC was received by CoG.
Ministry of Health Head of Department of Policy, Planning and Health Financing Dr. Peter Kimuu (right) and Kenya Healthcare Federation Chairman, Dr. Amit N. Thakker, display a copy of the signed “One Monitoring and Evaluation Framework in the country at the Intercontinental Hotel.
MBA Students from Colombia University visiting Kenya and KHF to prepare a business case for telemedicine in Lamu under the PSHP Kenya partnership.