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.
Ninth Ministerial Stakeholder Forum
The Ministry of Health (MOH) held the ninth ministerial stakeholders forum on 23rd October 2018 at the MOH, Afya Annex building. The meeting was chaired by Dr. Jackson Kioko, Director of Medical Services (DMS) and co-chaired by Dr. Amit Thakker, chairman, Kenya Healthcare Federation (KHF). This forum brought together different health stakeholders including Christian Health Associations of Kenya (CHAK), Nursing Council of Kenya, Kenya Medical Practitioners and Dentist Board (KMPDB) and Kenya Private Sector Alliance (KEPSA), to discuss emerging issues in the private health sector, the progress made since the eighth MSF, and the way forward.
In his opening remarks, Dr. Kioko thanked the private health sector team led by their chairman Dr. Thakker for their great efforts in advocacy and strengthening the partnership between the private sector and MOH. The DMS noted that MOH and the counties may not be able to provide 100% of the services therefore are very grateful for the contribution of the private sector. “Both public and private health sector should ensure that quality is at the core of delivering health services. We also need to train the health workers in having a good mind set, right attitude and good etiquette”, said Dr.Kioko. He further added that the human resource norms and standards need to be reviewed because they do not reflect the reality on the ground.
Dr. Thakker in his opening remarks thanked all the attendees for making the time to attend the forum and discuss Kenya’s health agenda. He emphasized that public – private dialogue is a two way engagement and PPP cannot be left to one party alone. Dr. Thakker assured indicated that KHF’s presentation on the role of the private sector will be shared with MOH ahead of Presidential Round Table (PRT). In the previous MSF, there were major issues that were discussed with much progress made including: Health Regulations – control of the cost of healthcare – it was agreed that implementation of the Health ACT 2017, including the Kenya health professional oversight authority will contribute towards control of healthcare costs; Regulation of doctor’s charges – it was suggested that a strong taskforce be formed to assess the doctors fees and procedures e.g. diagnostics, scans, medications, laboratory e.t.c. and give a report that will inform the regulation of the same.
It was agreed in the previous MSF meeting that KHF should be involved in the process of making Kenya quality model for health (KQMH) the minimum standards certifying tool in Kenya. Ms. Faith Muigai, regional director- Pharm Access foundation informed the attendees that AMREF has been an implementing partner and will share an official report soonest. Dr. Kioko reiterated that quality and standards is a vital area to focus on for UHC. “When it comes to matters of quality and standards, we are looking at collaborations”, said Dr. Kioko. Dr. Thakker suggested that the assessment starts with the areas providing low quality, then progress to areas providing high quality. KMPDB announced a joint inspection of health facilities, and requested KHF to send representatives to join the inspection team and give their input, to which KHF obliged.
Healthcare financing is very key in achieving UHC and the private sector is a major contributing partner. Dr.Kioko requested the private sector to present a well structured action plan on the role of the private sector. Dr.Thakker informed the DMS that the role of the private sector has not been clearly defined particularly in healthcare financing, because the role of NHIF vis-a-vis private health insurance is unclear. Dr.Thakker reported that KHF has visited seven counties to assess their healthcare financing needs and existing models. “The urgency of the counties is now. They have already modelled their own schemes and the big question is where does MOH see the role of the county schemes fitting. It is important that a risk pooling structure be clearly defined so that the private sector can engage”, added Dr. Thakker.
Dr. Kioko responded by saying that MOH is supporting the county financing schemes. “Although issues of sustainability and acceptability of the county medical schemes have been raised, we need to look at them positively and allow them to continue, as we look into how we can support them to be more cost effective” Dr. Kioko added. He further explained that the choice of pilot counties for UHC roll out was based on the need to cover the vulnerable first then the less vulnerable, and that the pilot will be a learning phase which will be monitored to determine which partners need to be brought on board.
Commenting on county managed schemes, Mr. Elkana Onguti of MOH however cautioned that too may pools end up in excessive administrative spend. Dr. Thakker then suggested to MOH to implement a regulatory authority that will regulate the schemes.
In matters of supply chain, KHF requested that regulations for appropriate control of parallel imports should be implemented. Dr. Siyoi, CEO, Pharmacy and Poisons Board (PPB) reported that regulations have indeed been drafted and are due to be gazetted in a few days. Ms. Faith Muigai, regional Director, Pharm Access Foundation emphasized that when looking at strengthening quality and standards, supply chain should also be strengthened. Mr. Onguti, reported that a legal framework has identified some gaps in supply chain though the discussions have not been finalized.
On price control of medicines, Dr. Siyoi reported that a task force has been formed that is looking at price reduction strategies, and he will give a report on this once the task force completes their report. The issue of coding of medicines was raised by Dr. Peter Kamunyo, CEO, Medsource Group. Dr.Kioko invited KHF to prepare and present a proposal to MOH on coding. Dr. Daniella Munene, CEO, Pharmaceutical Society of Kenya (PSK), suggested that Kenya should select the global language of ATC codes as used by PPB to register medicines. Dr. Munene will work closely with PPB on this, to propose a workable coding system for medicines.
Second Universal Health Coverage Conference in Nyeri
Kenya Vision 2030 delivery secretariat in partnership with Ministry of Health (MoH), Kenya Healthcare Federation (KHF), Amref Health Africa, Kenya Cardiac Society, Council of Governors, NCD Alliance Kenya, Kenyatta University and Nyeri county health department organized the second Universal Health Coverage Conference held at Green Hills Hotel, Nyeri County from 11th – 12th September 2018. The conference sought to address the non – communicable disease (NCD) challenge to the country and was appropriately themed “Universal Health Coverage for Sustainable Development – Transformative Solutions to Halt and Reverse the Non-Communicable Disease Epidemic”
The conference was graced by several dignitaries: Her Excellency Dr. Carol Karugu, Deputy Governor, Nyeri County; His Excellency Prof. Peter Anyang’ Nyong’o, Governor, Kisumu County; His Excellency Prof. Kivutha Kibwana, Governor, Makueni County; Dr. Julius Muia EBS, Principal Secretary, State Department for Planning; Dr. Racheal Kamau, CEC Health, Nyeri County.
Rev. Samuel Njenga of the Presbyterian Church of East Africa opened the conference with prayer and thereafter giving a brief address. He said that the church has a vital role to play in advocating for and sensitizing the people about good health.
Dr. Kamau welcomed participants and thanked the organizers for choosing Nyeri County to host the conference, adding that she looked forward to fruitful deliberations. “Nyeri County is facing a high burden of NCDs. We need to change our ways of practice and take up the challenge” she remarked. Thereafter Dr. Kibachio Mwangi, the Head of NCD unit at MoH highlighted the key objectives of the conference which were: Understand the NCDs challenge; outline the role of private sector in addressing NCDs; outline the role of consumer organizations in protecting the public from sale of harmful products; and outline the role of government, civil society and the youth in addressing NCDs. Dr. Mwangi emphamphised that NCDs are not purely a health agenda, but require a multi-sectoral approach incorporating sectors such as transport, education and agriculture particularly in prevention measures.
“We should put health first; unfortunately what are addressing is a result of our choices such as what we eat. Good health plays an important role in boosting the economy, reducing poverty, increasing education and boosting investment” Dr. Julius Muia said in his address to the conference.Preventive measures against NCDs took center stage in the deliberations. It was appreciated that more focus needs to move to prevention as we continue in disease management interventions.
The consensus on the way forward included creating awareness, education of the public and preventive measures against NCDs, adoption of a multi-sectoral approach, utilizing Public- Private Partnerships and supporting local pharmaceutical manufacturers to make medicines affordable and strengthening the supply chain. “Managing NCDs is very expensive. If we truly want to make UHC achievable, we need to address the issue of cost. If we reduce costs we’ll be able to expand the care. The biggest PPP opportunity in cost reduction is in supply chain”, said Dr. Peter Kamunyo, Director, Kenya Healthcare Federation.
Further, there was consensus that community health volunteers (CHVs) should be officially entrenched in the health system. It was recognized that CHVs play a very critical role in NCD public sensitization. It was agreed that NHIF be strengthened, that it should cover preventive health checks and that it should ensure that the poor and vulnerable are covered. The country should strategize on addressing the poor availability, lack of affordability and inadequate resources as barriers to UHC. Young people should be informed and sensitized on NCDs so they can act as role models to their peers in NCDs prevention. NCD education should be incorporated in the school curriculum.
A patient representative at the conference made an appeal to the health sector to address survivorship of NCDs, a phase of management that insurance doesn’t cover. She highlighted that cancer patients are usually deserted by friends and family after diagnosis due to the burden of their disease on their loved ones. “We are left alone. It’s time for medics to inform us how we can survive after diagnosis of an NCD like cancer. This way trauma can reduce and a patient can accept the situation, love on themselves and even achieve their goals. The price of medications is usually very high and almost unaffordable. Patients get financially drained while trying to get medication”, said Elizabeth, a cancer survivor of nine years.
Professor Nyong’o called on stakeholders to identify areas of inequity in health care, and strategize on how to fill the gaps. “Counties don’t have a strong primary healthcare system, the aim of UHC is to strengthen primary healthcare” said Dr. Karugu, while Prof. Kibwana called upon all pilot counties to learn from each other as a way achieving UHC uniformly, further adding that CHVs will play a big role in rolling out UHC, particularly in educating communities.
The conference was well attended attracting 400 delegates drawn from both public and private health sectors. There was representation from national government, county governments, World Bank, the United Nations office in Kenya, Non-governmental organizations and youth organizations. KHF was represented by the chairman, Dr. Amit Thakker, directors Dr. Peter Kamunyo and Dr. Daniella Munene, Dr. Joy Mugambi, deputy Secretary General, Kenya Medical Association (all panelists), as well as several KHF members who attended as delegates. A number of KHF member organizations sponsored the event.
Strengthening Health Workforce in Kenya
The KHF Human Resource for Health (HRH) Committee held a breakfast meeting at KHF offices on 16th of August 2018 to discuss on the committee progress in advocating for adequate human resources in the health sector, recruitment and retention of human capital and how to get the neglected cadres recognized.
The meeting was chaired by the committee’s vice Chair, Dr. Joyce Sitonik. The committee has had several engagements with the Ministry of Health (MoH) to discuss on how to get the neglected cadres recognized. In last year’s meetings with MoH, the primary agenda for the committee was to identify the neglected specialized cadres and those that need more attention in terms of regulation and standardization in order to bring them to a good quality assurance level. Thereafter, a partnership formed between Amref Health Africa, Kenya Healthcare Federation and Malteser International to strategize on how these cadres can be strengthened.
The Identified cadres were, health records and information officers, emergency care professionals and community health workers. The discussions have been very fruitful, with outputs such as the current effort by emergency medical technicians to form a professional association.
KHF identifies gaps within the public health sector and advocates for improvement or restructuring,including through Public Private Partnerships (PPP). For example, there is a problem in recruitment and retention HRH in the public sector. The committee will be holding a workshop that will address neglected specialized cadres, recruitment and retention strategies, Innovations (Corvus Health) and setting up objectives and terms of reference for the committee. It was agreed that in the workshop, there will be a representative from MoH HR unit.
Mr. Kennedy Auma and Dr. Joyce Sitonik were re-elected as the committee chairperson and vice chairperson respectively.This was the first meeting under the directorship of the elected KHF vice chair Dr.Elizabeth Wala and Ms.Faith Muigai.