FBOs Health System in Kenya; commitment to quality & equity in access,

complimenting MOH in service delivery, training of health workers and

commodity supply chain

Presentation to CCIH 2015 Annual Conference by Samuel Mwenda, General Secretary,

Christian Health Association of Kenya (CHAK)

Presentation outline • Introduction to CHAK and FBO health network in Kenya • Reality of two-extreme ends of FBO health systems • MEDS the FBO pharmaceutical supply chain in Kenya • The Africa Christian Health Associations Platform (ACHAP) • Public-private-partnership framework • CHAK strategies in health systems strengthening • Challenges faced by Faith based health services

A success story of a Resilient Health System; KIJABE MISSION HOSPITAL teaching & referral hospital celebrating 100 years last month by opening a new 100 Bed Paediatric Neurosurgery Teaching & Referral unit

Fragile health systems and loss of opportunity

• FBOs have lost many lower level health facilities which have closed down due to lack of funding; Why?

• Loss of Donor subsidies • No Government funding • Poor communities served who have no or limited means of paying for medical

services • Increased cost of health service delivery inputs • Difficult and challenging environment

• This represents lost opportunity for communities previously served by these health facilities

The unique wholistic system of Church Health Services

The Faith Based Health Network in Kenya • CHAK is a national FBO network of the Protestant Churches’ health

facilities, programmes and Medical Training Colleges and Universities.

• CHAK core functions include; advocacy, health service delivery, capacity building, health systems strengthening, partnerships & networking and HIV& AIDS programmes.

• CHAK collaborates closely with the Catholic Health Commission of Kenya which coordinates the Catholic health facilities - within the framework of the Church Health Services Coordinating Committee.

• The FBOs in Kenya (Christians & Muslims) have a partnership framework (MoU) with Ministry of Health that guides partnership engagement, support and accountability. Partnership is coordinated through the Faith Based Health Services Coordinating Committee

• FBOs are recognized as key stakeholders in the Health sector since they contribute about 30% of the health coverage

FBO Health network in Kenya - total = 1,025

80 Hospitals 26 Referral Hospitals in 23 Counties (49%) 11 Doctors Internship Training Hospitals 4 provide Post Graduate Residency programs

135 Health Centers 692 Dispensaries 90 CBHC programs 28 Medical Training Colleges 7 Universities offering Medical programs Medical Outreach programs operated from existing

health facilities Programs for special needs; disabled, deaf, blind,

mentally challenged, drug rehabilitation etc

CHAK Vision, Mission & Goal

Foundation: Rev 22:1-2: “On either side f the River stood the tree of life…… and the leaves of the Tree were for the healing of the Nation”

Promote access to quality health care

Vision Efficient and high quality

health care that is

accessible, equitable,

affordable and sustainable

to the glory of God

To facilitate member health

units in their provision of

quality healthcare services

through advocacy, health

systems strengthening,

networking and innovative

health programmes

Mission Goal

Strategic Directions / core functions : Revised Strategic Plan 2011 - 2016 1. Health services delivery 2. HIV&AIDS programmes 3. Health systems strengthening including Medical Equipment

Programme 4. Governance and accountability 5. Research, advocacy and communication 6. Health care financing and sustainability 7. Human Resources for Health (HRH) 8. Grants management 9. Total quality management & patient safety 10. Engagement with devolved county health system

Health Commodities Supply Chain; Mission for Essential Drugs and Supplies (MEDS) www.meds.or.ke - established in 1986

• MEDS is a partnership trust of CHAK and the Kenya Conference of Catholic Bishops whose

• Mission is “to provide reliable, quality and affordable essential drugs, medical supplies, training and other pharmaceutical services guided by Christian and Professional values.

MEDS 3 core functions

1. Supply Chain function: to provide reliable, quality and affordable medical commodities within Kenya and beyond.

The functions include sourcing medical and non-pharmaceutical products locally and internationally, warehousing, quality control, sale & distribution in a system that ensures equity of access

2. Capacity Building/Training function: to improve the quality of patient care through promoting rational drug use and effective health commodities management

3. Quality Control Laboratory: to ensure quality assurance mechanism for quality products through it’s WHO prequalified Medicines Quality Control Laboratory 11

MEDS Systems & Services

Wharehouse with excess capacity

Medicines Quality Control Laboratory

12

Regional and country level partnerships

Africa Christian Health Associations Platform • The Africa Christian Health Associations Platform

(ACHAP) was established in 2007 through the inspiration and support of the World Council of Churches to facilitate joint advocacy, networking, partnerships and capacity building of Christian Health Associations and other Church Health Networks in Africa. www.africachap.org

• ACHAP brings together 31 Christian Health Associations and other Church Health Networks from 26 countries of Sub-Saharan Africa and the Secretariat is hosted by CHAK in Nairobi, Kenya..

• Registered in Kenya as an international Faith Based NGO with mandate in Africa and Secretariat is hosted by CHAK in Nairobi

• Has established an Advisory Team to help advise and better connect with partners in the north www.africachap.org

ACHAP Vision, Mission & membership

Vision “Health and Healing for all

in Africa” Mission “ACHAP supports Church

related health associations and organizations to work and advocate for health for all in Africa, guided by equity, justice and human dignity”.

Biennial conferences provide opportunity for joint learning, advocacy strategy and global policy dissemination (7th ACHAP Biennial Conference Feb 2015-Nairobi, Kenya on “Universal Health Coverage”)

Public-Private-Partnership framework • Due to their significant contribution FBO health services are

recognized by Government as key stakeholders in the implementation of the national health sector strategic plans.

• A partnership framework or MoU between government and the FBO national networks (CHAK, KCCB & SUPKEM) was developed in 2009 that defines roles and obligations and through which government provides structured support on HRH and essential health commodities. FBOs have initiated a process of MoU review to re-align it with the new Devolved Governance system

• This partnership framework ensures alignment with national health sector plans, policies and information system and facilitates structured support.

• Kenya has broader partnership that includes FBOs & Private Sector through the Public-Private-Partnership - Health Kenya (PPP-HK)

Medical Education – contributing to HRH development (Nurses, Doctors, Paramedics)

Site based mentorship for Health Workers

Community Systems Strengthening as an extension

of the health system

Church-Community volunteers engagement for NCD – Hypertension awareness & screening with target of 2.0m people in 18 months through 134 FBO facilities, 350 HCW, 425 CHVs and 200 Religious Leaders Presbyterian Church Women’s Group member trained as CHV checks BP of Group members & documents data

Hypertension awareness mobilization partnering with AstraZeneca

Community based initiatives: Global Fund supported community based TB screening and PEPFAR funded community HIV treatment adherence support and RH/FP mobilization

Infrastructure development

Architectural & Building Project Management technical support services for member Hospitals

Health Care Technical Services (HCTS) – Medical Equipment Program for technical support in medical equipment & technology

• Medical Equipment needs identification, procurement & installation

• Medical Equipment repair & maintenance

• Involved in standardization of Medical Equipment through KEBS

HMIS

• CHAK Hospital Management Software (CHMS) – an integrated solution for computerization of medical records, clinical services, diagnostics, medicines stock inventory, revenue receipting and financial accounting and HRM

Governance and Leadership

• Policy guidelines and tools for Hospital Boards • Board development through capacity building,

orientation and performance review • Financial Management policy guidelines • HRM Policy and technical support • Strategic planning technical support • Grant management systems

FBOs contribution to HIV treatment achievement in Kenya– over 200,000 of the total 850,000 (24%) ART coverage – with some of the best Centers of Excellence

We welcome Universal Health Access and Universal Health Coverage and expect that UHC financing mechanisms will allow equitable opportunity for financing FBO Health Facilities & Services We can do more and better with increased resources, further strengthening of systems and technical support

Challenges • Inadequate financing – dependence on user fees due to loss of donor

subsidies and government funding. Only HIV treatment services are well funded by Donors

• Human Resources for Health – attracting, developing, retaining, financing • Dynamic Regulatory environment with multiple actors and frequently

changing conditions • Burden of engaging with 47 County Governments in the devolved system of

governance and health service delivery to build partnership framework and mobilize support

• Insecurity in some remote rural areas and terrorism targeting Christians and Christian Institutions

• Lack of segregated data since FBOs report through the MOH - HMIS

THANK YOU