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.
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.
HEALTHCARE FINANCING COMMITTEE CONTRIVES ON DELIVERING UNIVERSAL HEALTH COVERAGE
The healthcare financing committee held a dinner meeting on 31st May 2018, at Pride Inn Hotel to strategize on how to deliver UHC from the Private health sector perspective. The committee strategy is also under the BAF project that was granted to KHF for advocacy. The dinner meeting being chaired by Dr. Walter Obita, took three hours and was very intense and informative. In his opening remarks, he highlighted that the committee has been tasked to lead universal health coverage within KHF.
Dr. Obita reminded the attendees that Universal healthcare basically looks at quality healthcare, accessibility and reduction of out of pocket expenses while accessing health services. He further reiterated that KHF fully supports UHC which is part of H.E President Uhuru Kenyatta’s BIG 4 Agenda number 4, Affordable Healthcare. KHF’s approach is to have both private and public health providers to be able to offer this care because there will be cross – referrals and the patients should be able to access this care. There was a suggestion on an engagement on risk pooling mechanisms to ensure agreement on the type of what mixed methods that can be used in order to reduce exposure on both public and private insurance insurance companies.
One of the agendas floated was to have the private Insurers be the first to insure claims for the patients to access care followed by National Hospital Insurance Fund(NHIF). KHF agreed that there should be a benefit package that should be used by the patients when they seek care. This provides an opportunity for the private insurance companies to assess the gaps within NHIF so as to develop a benefit package that addresses these gaps. There was also a suggestion that we should have a health benefits regulatory body that can provide an oversight for both NHIF and private insurers. This will provide an enabling environment for both public and private insurance, increase accountability and have transparency.
This intitiative will enable innovations to look into health financing that can be introduced in the counties, and enable citizens to access healthcare at an affordable rates. For example Makueni County Healthcover where each house hold is supposed to pay Ksh.500.00 to access care with no additional cost. The benefit package should also concentrate on primary healthcare.
Dr. Amit Thakker – KHF Chairman highlighted that KHF has started County Stakeholder forum which is under the BAF project and is focusing on healthcare financing towards achieving UHC. So far KHF has covered two counties successfully and has a plan to cover seven counties. There was an agreement that NHIF should be advised to pay first key focus on the poor in the society.
The meeting was well attended by Amref healthcare, Fountain Healthcare, Carepay, Business Advocacy Fund, Access Afya, Association of professional coders, Health store east Africa, The Nairobi Hospital, Jubilee Insurance and KHF secretariat.
Human Resource for Health Committee holds It’s second meeting
The human resource committee held it’s second committee meeting for the year 2018, on 29th May 2018 at Kenya Healthcare Federation (KHF) offices, from 8:00am to 9:00am.The meeting was chaired by Mr. Ken Auma – Committee chair. In his opening remarks, he informed the attendees that there has been a directive for the Cuban doctors to be deployed where they will work in the country for a period of one year. This was information was relayed by the permanent secretary for health, Mr. Peter Tum during the ministerial stakeholder forum.
He further advised the committee that KHF should identify the true needs of human resource for health so that in future and through strong public-private partnership (PPP), the government acts in the interest of it’s citizen.
Mr. Auma reminded the committee about the upcoming Emergency Care Technician symposium that will be held on 28th – 29th June 2018 at Safari Park Hotel Nairobi. He further advised the committees that there is need to address the following: what is their strategy in terms of growth, do they have a structured approach of engagement, how many are they and what is the capacity?
Mr. Auma updated the members on the Community Health Extension Workers (CHEW) curriculum which is a MOH initiative under the Community Health and Development Unit in collaboration with Kenya Medical Training College (KMTC). The CHEWs are medics with diverse medical backgrounds (engineers, nutritionists, labs, etc.) and there is a need to harmonize their knowledge, so they can deliver healthcare at the community level.
The CHEW curriculum is completed and signed by the Kenya Medical Training College (KMTC) Director. It has also been pre-tested by 70 CHEWs from 17 counties.
Currently, there are many health records information officers (HRIOS) and they have an association but not fully recognized and there is need to recognize them. There are two upcoming conferences on health records. They include a one-day conference in September at The Nairobi Hospital and a one-week conference organized by the Health Records Association. The venue for the second meeting will be communicated later.
Moreover, the chairman informed the committee that the Ministry of Health has a database on all enrolled professionals but there is need to classify different human resource for health professionals for example classifying Clinicians who have done health information in the health system. Therefore there is need for KHF to push the Ministry to ensure live documents on human resource information. There is need to involve the Health Records Professional Associations in the data collection and storage process.
There was a suggestion that KHF should come up with an awarding system for the external partners, whom KHF works with like the Counties thereafter do more appreciation first to its members then later awards.
There was a uniform agreement that that KHF should not sit back and assume all will go well whenever there are critical issues, KHF should come up with appropriate strategies towards such healthcare matters. Dr. Christine Sadia added that KHF needs to do SWOT of good balance and take a strong stand on arising matter in the health sector.
Enterprise Ireland Seminar
Enterprise Ireland held a seminar and networking event 11th June 2018 in Dublin, Ireland. The seminar focused on East Africa as one of the fastest growing regions of Sub Sahara Africa, which has growing middle class currently estimated at 10%. It’s in this region that three of the top ten fastest growing economies in the world are based.
The aim of the seminar was to give Irish companies an overview of the market opportunities in East Africa, provide practical information regarding the mechanics of exporting to the region, review how to partner with East Africa based companies and to focus on the sectors that are most attractive for Irish exports.
After the seminar, the companies were expected to give views on whether it’s a suitable market for them and how to progress it to the next stage with support from Enterprise Ireland.
“Africa will not be developed by foreign aid alone, but by doing business with a social conscious which create sustainable impact.” Dr. Ian Clarke – Chairman International Medical Group & Clarke Group Limited.
Dr. Ian Clarke however, noted that, there should be ready opportunities in education and training since 400,000 graduates travel from Africa to the rest of the world for education. Additionally,
Kenya, Botswana and South Africa have the highest financial inclusion in Africa, but the rest of Africa is improving because of good technology.
Dr. Amit Thakker – Chairman, Kenya Healthcare Federation, presented opportunities for the Irish private sector in East Africa. He informed the attendees that the Irish population is 10% of the Kenyan population yet $18 billion is spent on healthcare in a year in Ireland, compared to the $3 billion spent on healthcare annually in Kenya. In terms of spending per capita, Kenya spends $70 per person on healthcare whereas Ireland spends $3800 per person. Therefore, Irish companies would have to tailor their services and products to the needs of the East Africa in terms of balancing quality with affordability in order to penetrate the East African markets effectively.
Dr. Thakker highlighted some opportunities for the private sector, based on their financial viability and the size of potential deals. These opportinuties include: service delivery and diagnostics, human resources for health training, information and communication technology, enablers, health financing ,pharmaceuticals and medical devices & equipment.
There was a consensus reached that success requires, a real commitment of time and resources inorder to form meaningful partnership or entice the right stakeholders.
The seminar was well attended with the key presenters including: Ms. Angela Ndambuki – CEO Kenya National Chamber of Commerce and Industry, Dr. Ian Clarke – Chairman International Medical Group & Clarke Group Limited, Mr. Samuel Makome – chief operations officer, Kenya Commercial Bank, Dr. Amit Thakker, Chairman Kenya Healthcare Federation, Mr. George Mokogi managing –Director- carrier services division – Telkom Kenya Limited and Mr. Stanley Muia – senior program manager of commercial & business strategy – Adrian Kenya Limited.
5TH Annual Devolution Conference 2018
The 5th Annual Devolution Conference – 2018 took place at Kakamega High School in Kakamega County from 23rd to 27th April 2018.The conference was hosted by the Council of Governors in partnership with the Ministry of Devolution and Arid & Semi-Arid Land(ASAL), the Senate, the County Assemblies Forum and other stakeholders .The conference brought together 6,000 people from different sectors such as; Health, Trade, Agriculture, Urban Planning & Infrastructure, Private Sector, National and County Government representatives and Members of the Public.
The Conference also focused on the president’s Big four Agenda where there were break out session to
Discuss more on Health, Trade, Agriculture and Urban Planning & Infrastructure where there was impactful contribution from the members of the Public, and Private Sector. All sessions were chaired by the Cabinet Secretaries (CS) or Principal Secretaries (PS) from the various Sectors. In attendance was the CS Ministry of Trade, Industries and Cooperatives Mr. Adan Mohamed, CS Ministry of Energy Mr. Charles Keter, PS Housing and Urban Development Mr. Charles Mwaura, the PS Crop Development, Dr. Richard Lesiyampe, PS Irrigation Fred Sigor, the PS ASAL Mr. Michael Powon, the PS Devolution Mr. Nelson Marwa, the Chief Administrative Secretary Ministry of Health Dr. Rashid Aman and the PS Health Mr. Peter Tum among many others.
There were plenary sessions which Portrayed strong political will, to ensure that the Big 4 National Agenda is achieved and to demonstrate the political commitment to Devolution. Deputy President, William Ruto emphasized the importance of the Big 4 Development Agenda which will transform Kenya. The Big 4 agenda will also help deepen Devolution and benefit all Kenyans. He reiterated that partnership will be very key in achieving the big 4 Agenda.
The President in his speech emphasized that Health is very key in the big four Agenda “We aim, by 2022, to give every family in the Republic access to Affordable Healthcare. Again, this is no small task and it will require a reimagining of the status quo. In defining this aspiration, I recognize that County governments are at the closest point of inflection when it comes to the provision of Health services at the grassroots.
There will be the hard work of financing this dream and restructuring all the institutions critical to its success. We will have to improve the quality of our facilities and manage the cost and quality of drugs; we will also have to train and recruit more Doctors and Nurses. Equally, all of us will have to work together to fit existing programmes into the new plan. Still, the work will be well worth it. A win in Healthcare today is a decisive win for generations to come.”
The PS for Health Peter Tum expressed an overarching vision of affordable Healthcare as captured in the Kenya Health Policy 2014 – 2030. He emphasized that the Ministry of Health has scaled up their interventions in order to be able to achieve the goals set out in the policy. Already, such interventions have led to reductions in maternal deaths. He briefly reminded the attendees that the Universal Healthcare Coverage pilot program would be held in 4 Counties, namely, Nyeri, Kisumu, Machakos and Isiolo. The lessons from this will determine the way forward in relation to the Universal Healthcare Coverage Agenda.
Prof. Khama Rogo from the World Bank stated that for interventions to be successful, the difference must be made at County Level. For instance, we should allow training for Human Resources for Health to be implemented at county level. He emphasised that Universal Healthcare Coverage will be achieved when we capitalise Devolution.
Kenya Healthcare Federation (KHF) represented the private Health sector through the attendance of Dr. Amit Thakker – Chairman, Dr. Jacqueline Kitulu – Director, Ms. Faith Muigai – Director, and Dr. Peter Kamunyo – Director.
There was a session on ‘Critical Enablers for Optimizing Health Sector Performance’ where Dr. Amit Thakker – Chairman – KHF was part of ‘’ panel in this session. In his remarks, he highlighted that the private sector contributes a lot in the Healthcare and will continue to advance the Health Sector in Financing; Innovations such as Telemedicine; Stakeholder engagement and Healthcare service delivery. Sanda Ojiambo from Safaricom added that the Big 4 agenda provides great opportunities for transforming Business.
There were booths where the attendees displayed their products and services. Moreover the KHF members who showcased the organization’s products and services at the booths were; Management Science for Health, Pharm Access Foundation, AMREF and Philips.
The Devolution Conference was well attended and gave all the relevant stakeholders a platform to engage on important issues in relation to key sectors. KHF was able to engage with Government officials and showcase the importance of private sector contributions to the Kenyan Health sector.
The Deputy President Willam Ruto closed the meeting by appreciating the attendees for their unified effort towards Devolution. “I would like to pay tribute to all of you for your devotion to the success of Devolution. Rest assured, you have a strong supporter of Devolution in this Administration. Let us all define our leadership through service, work, and delivery. The magic of Devolution, after all, is in service delivery. That is what Kenya needs; that is what our people need. By the time this leadership term is over, we will be celebrating 60 years of self-rule. We are the ones with the power to ensure that we have something to show for that time.”
Communique KHF 2018(Click to Download)
Communique – Kenya Health Forum 2018(Click to Download)