theme: kenya; the role of church health system ˛ … annual health...information and services the...

0

REPORT OF CHAK ANNUAL HEALTH CONFERENCE 2011

Theme: “Scaling up quality maternal & child health services inKenya; the role of Church health system”

DATES: APRIL 12-14, 2011

JUMUIA CONFERENCE CENTRE, LIMURU

1

Programme focus

• Day one:– Secretariat programme reports– CHAK HMIS Software

• Day two:– Scaling up quality maternal and child health services– Launch of New CHAK Strategic Plan 2011-2016– CHAK Times 10th Anniversary Celebration

• Day three: AGMAn Exhibition will be held throughout the AHC/AGM

Conference objectives• To reflect on the status of maternal and child health services (MDG 4&5) in Kenya and the contribution

of the Church health system• To discuss challenges facing delivery of maternal and child health services in Kenya and opportunities

for scaling up• To review the role of policy and guidelines in the delivery of quality reproductive health, family

planning and child health services• To discuss essential health systems strengthening for quality maternal and child health services• To discuss financing options for maternal and child health services in Church health facilities• To share lessons on the success of the primary health care approach in promoting access to maternal

and child health services by CHAK member health facilities• To share new developments in Family Planning technology and policy• To Launch the New CHAK Strategic Plan 2011 – 2016 and celebrations to mark the 10-year anniversary

of the CHAK Times Newsletter

2

Why the theme on “maternal and child health?”

1) Health indicators in Kenya

Health indicator 2003 DHS result 2008/9 DHS result

Infant Mortality Rate /1000 77 52

Under Five Mortality Rate/1000 115 74

Newborn Mortality Rate/1000 33 31

Delivery in a Health Facility 40% 43%

FP Contraceptive Prevalence Rate 39% 46%

Unmet FP need 24% 25%

Maternal Mortality Ratio/100,000 414 410

2) Sub-Saharan Africa with 10 per cent of the global population contributes 51 per cent of globalmaternal deaths. (2005 Data)

Total global deaths = 536,000

(Source: UNICEF global database 2009)2













(Source: UNICEF global database 2009)2













(Source: UNICEF global database 2009)

3

3) In sub-Saharan Africa, unmet need exceeds current use of contraception.

Family planning challengesThe Kenya National Reproductive Health Policy of 2007 summarizes Family Planning challenges as “the impactof HIV&AIDS pandemic; general shift of focus for international assistance from population to HIV&AIDS;disparities in health resource allocation; and lack of interventions targeting the resources to the poor and the“hard to reach” populations.”“The result of inadequate funding has been a weak health system, inefficient integration and poor quality ofservice delivery, contributing to negative trend in Reproductive Health related indicators as revealed byDemographic & Health Survey (DHS)”

General challenges facing MCH/FP services• Inadequate funding – there has been major decline of funding to MCH and RH/FP services from the

mid 90’s• Lack of funding to subsidize MCH, FP/RH services and support outreach activities• Lack of security for contraceptive commodities leading to irregular supply to the service delivery

points• Lack of sustained demand creation for family planning services, ANC services and hospital deliveries• Inadequate MCH/FP training for service providers

4

• Shortage of health workers and frequent migration of skilled workers• Lack of integration of family planning with HIV&AIDS and other health services

Millennium Development GoalsThe Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world'smain development challenges adopted by UN Millennium Summit in September 2000. They are as follows:

1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce infant mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development

Millennium Development Goals 4, 5 and 6 focus on women’s and children’s health. Most countries are laggingbehind in achievement of these MDGs. The United Nations Children’s Programme released a global strategy toaddress the situation in August 2010 when stock taking was done and the realization that many countries werelagging behind in achievement of the MDGs hit home. A number of strategies were recommended and a call toaction made. Faith communities are considered very critical players in achievement of MDGs. The WorldCouncil of Churches (WCC) is mobilizing faith communities to wake up to the contribution that they can make.

Global Strategy for Women's and Children's Health released on August 6, 2010, by the UN Secretary General• Target: - Saving 16 million lives by 2015

– Every year around 8 million children die globally of preventable causes.– More than 350,000 women die from preventable complications related to pregnancy.

• Achieving MDG 4 (a two-thirds reduction in under-five mortality) and MDG 5 (a three-quartersreduction in maternal mortality and universal access to reproductive health) - would mean saving thelives of 4 million children and 250,000 women in 2015 alone.

Key areas where action is urgently needed Enhancing financing Strengthening policy Improving service delivery

Recommended Strategy Support to country-led health plans to involve increased, predictable, and sustainable investment. Integrated delivery of health services and life saving interventions so women and children can access

prevention, treatment and care when and where they need it. Stronger health systems with sufficient skilled health workers. Innovative approaches to financing, product development and efficient delivery of health services. Improved monitoring and evaluation to ensure the accountability of all actors for results.

Call to Action by the UNEveryone has a critical role to play in improving the health of the world’s women and children.

Importance of the Global Strategy on Women’s & Children’s Health“The Global Strategy is an important step toward better health for the world’s women and children. But it mustbe rapidly translated into concrete action and measurable results, and all parties must make concretecommitments to enhance financing, strengthen policy and improve service delivery.”

5

Reproductive health policy priorities for Kenya1. Safe motherhood2. Maternal and neonatal health3. Family planning4. Adolescent and youth sexual and reproductive health5. Gender issues including sexual and reproductive rights

Strategies to increase utilization of MCH/FP services• Advocacy and mobilization for MCH/FP at community, national, regional and international levels• Increased funding towards MCH/FP from national budgets and Development Partners to subsidize

costs and fund community based activities• Programmes for community mobilization to create sustained demand for MCH/FP• Guarantee contraceptives/ANC and immunizations commodity security through adequate and

consistent supplies and efficient logistics• Improve access to pre-service and in-service Child Health, RH/FP training• Support community-based education and MCH/FP services through outreach services and community

health workers• Promote public-private-partnerships for a multi-sectoral approach to MCH/Reproductive Health/FP

services• Promote increased involvement of men in MCH/FP mobilization• Ensure that adolescents and youth have access to adequate and appropriate reproductive health

information and servicesThe dream

• That MCH/Family Planning education and services will become easily accessible through a communitybased health care system

• That MCH/FP services will become readily available at subsidized cost in both static and outreachclinics to expand access and utilization

• That FP, ANC health facility delivery and PNC will become a right for every woman and family• That we shall reclaim the gains of the 80s and 90s in MCH/FP mobilization and services• Thus improve MDG 4 & 5 indicators

Questions and discussions Is there focus on the male population as stakeholders in improving the health of women and

children?The strategy has a male involvement component.

6

Key note address from Assistant Minister in the Ministry of Public Healthand Sanitation, Dr James Gesame

Assistant Minister Dr James Gesame addresses the CHAK Annual HealthConference. Sitting to his left is Dr Migiro, Head, Child Health Division,while on the right is CHAK chairman Bishop Sande.

Maternal and child health is particularly important because the health of any nation is determined by thehealth of its women and children. The NHSSP II-KEPH shows how much importance Kenya places on the subjectof maternal child health. On the global front, four MDGs focus on maternal health.

Despite the good policies, Kenya is performing poorly in the area of maternal child health. The 2008/09demographics confirmed this challenge. The number of women delivering in health facilities is quite low whilechild mortality rate is high. Contraceptive prevalence rate is low while maternal mortality rate remains high.

The coastal and lake regions have higher indicators than other areas. In Homa Bay, for example, there were1,000 deaths of mothers per 100,000 live births, probably due to endemic malaria. While the national averagestands at 410, this is quite high and should be brought down. The maternal mortality rate in Nyeri is less than50. We must reverse the trends in MDGs 4 and 5. The ministry has taken the lead in resource mobilization,among other key areas and welcomes participation of other stakeholders.

The priority areas are: Maternal and neonatal health Safe motherhood6






The priority areas are: Maternal and neonatal health Safe motherhood6






The priority areas are: Maternal and neonatal health Safe motherhood

7

Family planning Adolescent and youth sexual and reproductive health Gender issues

All of the Ministry’s annual plans have indicators in the maternal health area. The FBOs need to participate inAOP development as they are key partners in health service delivery. The Government provides less than 50per cent of health services while the remainder is provided by other partners, key among them FBOs. The FBOshave a strategic advantage in the implementation of the community strategy as they have grassrootsstructures and know communities better. In addition, the church enjoys the trust of the community.

The ministry is aware of the challenges faced by FBOs in financing health care. Human Resources for Health isanother major challenge affecting the entire sector. Human resources have not been adequately trained anddo not want to work in the rural areas. A key indication of the human resources for health challenge that thecountry faces is that some constituencies could not get 20 nurses in the recent recruitment, which also causedmigration of health workers from church health facilities.

The Government provides vaccines, TB drugs, HIV test kits, ARVs, ACT for malaria management, family planningmethods and dispensary kits for level two health facilities. The Government has also seconded a few healthworkers to FBO facilities but acknowledge that there is still much to be done.

In the new constitution, health is a right, meaning that the Government may be sued if drugs and commoditiesare lacking. In an effort to address financial challenges, the Health Sector Service Fund (HSSF) was launched inOctober 2010. It will be rolled out in FBO health facilities by the beginning of July 2011. Assessment of FBOsecretariats and lower level facilities is on-going to provide information on capacity needs, among other things.

CHAK has developed a new strategic plan aligned to the NHSSP and which has prioritized health systemsstrengthening, health service delivery, HRH, research, advocacy and communication, among other areas.Congratulations to CHAK on this step forward as we all seek innovative ways to address the challenges we face.The Assistant Minister then launched the New CHAK Strategic Plan 2011-2016 and declared the AHC/AGMofficially opened.

Dr Gesame officially launches the New CHAK Strategic Plan2011-2016 assisted by CHAK General Secretary Dr SamuelMwenda.7







Dr Gesame officially launches the New CHAK Strategic Plan2011-2016 assisted by CHAK General Secretary Dr SamuelMwenda.7







Dr Gesame officially launches the New CHAK Strategic Plan2011-2016 assisted by CHAK General Secretary Dr SamuelMwenda.

8

Questions and comments The Assistant Minister was requested to help in pushing Treasury to sign the MOU between Government

and FBHS. The MOU has been signed by FBHS (CHAK, SUPKEM and KEC), the Ministry of Medical Servicesand the Ministry of Public Health and Sanitation and has been awaiting a signature from Treasury.

Secondment of health workers: Can the Government have a policy of seconding health workers who havemigrated from FBOs back to their work stations? It is the mandate of the Government to provide health careand a key part of this is health workers. The Government wants to second health workers but is also facingchallenges such as health care financing and shortage of health workers. Currently, there are 37,000 nursesin the Government and private sector, yet about 76,000 are needed as per WHO standards. However, theGovernment will continue to support FBOs with human resources for health.

9

Community based approaches in scaling up access to maternal and childhealth services: Strategies and lessons from Maua Methodist Hospital

IntroductionMaua Methodist Hospital is a conference institution of the Methodist Church in Kenya and was started in 1928.Located 310km from Nairobi on Eastern Slopes of Mt Kenya, the 275-bed capacity hospital provides a widerange of diagnostic, curative, preventive and rehabilitation services. The Hospital serves a catchmentpopulation of 700,000 people and runs a nursing college offering Diploma in Registered Community HealthNursing and Internship training for Doctors, RCOs and BSN nurses. The hospital’s total staffing establishment is350.

Sister Janet Munene from Maua Methodist Hospital making the presentation.

Maua Methodist Hospital MCH/FP objectives To provide child health services to the under five year aged children through immunization, growth

monitoring, curative services, growth monitoring and effective referral system To provide access to information to the community on safe motherhood and child survival including

nutrition education To prevent the high number of unnecessary deaths of mothers in pregnancy and child birth- and long term

complications afterwards To provide access to information and services to both men and women to help them make informed choices

for family planning, reduce risk of pregnancies, child birth and reproductive cancers. To encourage males toadopt and practice family planning methods and use Condoms where appropriate

To develop linkages with other health care providers in promotion of women’s health throughstrengthening referral systems.

To prevent and reduce maternal mortality and morbidity related to pregnancy, delivery and postpartum To provide access to information for the community on safe motherhood and child survival. To provide focused antenatal care services to the expectant mothers

10

To provide PMCT services to antenatal mothers and new born babies

Strategies Training community health workers to increase access to health services for the community as well as

serving as a link between the health facility and the community Provision of accessible, sustainable and affordable MCH services both at static clinic and operational

outreach clinics in the hospital catchment area Publicity for available services through churches and open day forums by involving private practitioners,

political leaders, and other influential people in the community. Encouraging the community to enroll with the NHIF to make delivery services by skilled health workers

accessible and affordable Ensuring adequate supply of contraceptives and quality FP services Supplying birthing kits to all pregnant women in remote clinics and dispensaries Community health education to enhance positive behavior change on retrogressive cultural practices with

regard to maternal and child health Integration of primary health care services both in static and outreach services Staff development through CPDs, updates and in-service training for staff providing MCH services Continually monitoring and evaluating MCH/FP services to identify existing gaps for improvement FANC services including Malaria prevention in pregnancy Provision of ITNs in MCH/FP clinic to children under five and pregnant mothers

Strategies to scale up services Waiting time is kept as short as possible. Children who only require immunization go direct to the nurse to allow care takers to go home quickly The hospital has identified a space for immunization of well children, separating them from their sick

counterparts who are examined through IMCI. Services are given at low cost. Health education is provided on MCH/FP services to waiting groups and individual mothers. No eligible child or pregnant mother leaves the clinic without getting services. No mother is scolded or made to feel foolish when they come to the clinic. CHWs assist to weigh the children in the clinics, refer and give them information. Pregnant mothers are able to sit down at each clinic station and waiting time is kept at a minimum. Use of CORPS to identify pregnant women or sick children and refer them to the health facility or other

provider networks in the community Distribution of the appropriate IEC materials on safe motherhood and health education to the

community Holding a quarterly evaluation meeting with MCH/FP CORPS/CHWs and filling health happenings

reports in the villages Provision of PMTCT services to all ANC mothers and referral to Compressive Care Clinic for further

management Provision of cervical cancer screening services in the Hospital MCH clinic and referring cases to a

gynaecologist Weight and BP are taken for all pregnant mothers before review by the nurse. Packets of iron and folic

acid tablets are handed out by the nurse. Charges are kept as low as possible so that the poor can easily afford the services

11

Strategies to improve the health of pregnant mothers Regular urine testing for all ANC mothers on booking and at 36 weeks with additional monitoring

where indicated ANC card is especially designed to help CHWs detect “at-risk” clients and refer them to the hospital IPT for Malaria prevention is given in the clinic ITNs are distributed in community outreach clinics PMCT to mothers attending the ante-natal clinic Palliative care referral for ART and care for the mother and family

Challenges Clients perceive the services to be expensive against the expectation that services in mission facilities

should be free. Inadequate human resource as a result of massive staff turnover Inadequate funds to run some of the services due to low costing Poor infrastructure and road network leading to wear and tear of vehicles and high cost of

maintenance and inability to replace vehicles Inadequate supply of immunization and FP commodities increases missed opportunities Lack of service sustainability due to poverty prevailing within the catchment area High Illiteracy levels prevailing in the community Social cultural beliefs and practices e.g. FGM Political interference Difficulties in reaching some of the areas without 4WD vehicles and high cost of fuel Lack of partners to subsidize the services

Lessons learnt Early Detection of cancer of the cervix (Via/vili) pap smear for prompt intervention or early referral Through community health education, malnutrition has drastically reduced except in times of drought. Improved public relations with the community is important for service delivery. Motivated community health workers are key to improved service delivery. There is reduced mortality and morbidity of mothers and under five children as a result of integration

of MCH/FP services. Health services can be improved through frequent surveys. Maua’s primary health care work over the years has significantly reduced the burden of disease in the

catchment area. The hospital had a dedicated measles ward which was always full but this has sincebeen closed.

There is reduced social stigma in relation to HIV/AIDS. Increased immunization coverage has led to better control of some diseases. Registration of community members with NHIF has increased the number of hospital deliveries. There has been improved family planning uptake and reduced method failure. Due to health education, cases of malnutrition have drastically reduced. It is important to engage the community in dialogue through meetings and barazas to set specific

terms of reference for health committee members at the very beginning of a community outreach. There should be a process of replacing non-performing community health workers. Patience is required to build capacity and achieve fully operational health committees.

12

Scaling up MCH/FP services is always a joint venture with the community who take up increasingresponsibility for setting up and sustainability of outreach services.

Questions and discussions Does the hospital have a pediatrician in addition to the gynecologist? There is a pediatrician

who runs a clinic in the MCH. What is the cost of NHIF to the mother and is it in any way linked to the OBA? The NHIF

covers a family for very many conditions while the OBA targets only deliveries. Is Maua a high risk Malaria zone? Maua is a high risk zone with Malaria being the leading

cause of admission in the hospital. The hospital receives less vaccines than it requires and is looking at modalities of getting the

commodities directly from KEMSA. The hospital is partnering with a friend in the US to get birthing kits. These are taken to very

remote areas as a way of improving care as mothers take a long time to get to a hospital fordelivery.

Service charges: Mothers are charged Ksh80 while children pay Ksh40. Service statistics: The hospital is currently doing about 300 deliveries per month. The

immunization target which is set at district level is 90 per cent and the hospital has been ableto surpass this figure. Maua has also been able to meet the targets for IMCI, Malaria and TB.

Political interference: Maua lost a dispensary due to political interference. How is the hospital tackling the FGM menace? Maua is working in partnership with the

church to address this issue. Mary Gitari, the hospital’s nursing officer is part of the team thatfights FGM. Mothers are sensitized on the dangers of the practice as they are the chiefadvocates for FGM in most cases. In addition, about five days are set aside every year to talkto children about FGM.

Improving male participation: Mothers are asked to bring their husbands to the clinic. Themen are fast tracked through the service queue to encourage them to come to the clinic.

Motivation of community health workers: Although CHWs have been providing free services,there is a need to rethink this strategy and come up with modalities for compensating them.However, the impact of their work also serves as a motivator.

13

Integrating maternal and child health services in communitydevelopment: Lessons from Tenwek Hospital Community Health and

Development

Presented By Jonathan Bii, Director, Tenwek Hospital Community Health and Development

Tenwek Community Health and Development was started in 1983 as an outreach arm of the hospital inresponse to the many patients visiting the hospital due to preventable diseases. Such cases were estimatedat approximately 80 per cent of the total patients visiting the hospital. The moto is “Bir Mat Ko Loo”!(Prevention is better than cure).

Tenwek Hospital Community Health and Development is a holistic ministry that focuses on bringing God’shope to individuals, families, and communities.

Mission: To serve Christ by facilitating change through primary health care and appropriate developmentwithin needy communities. This is carried out in a variety of outreach projects.

Outreach ministries Maternal Child Health (ANC, immunization, growth monitoring and health education, FP and PMTCT) HIV/AIDS prevention and care - counseling and testing become an entry point for care and treatment.

Lessons on prevention are also given during mobile clinics and men as partners meetings. Hygiene and sanitation - lessons given in mobile clinics enhance safe infant feeding, health of the

mother and the entire family. Child to Child (CtC) approach to PHC in primary schools reinforceslessons taught in clinics as children replicate lessons learnt in their homes.

Safe and Accessible Water- Water tanks, spring protection and promotion of bio-sand filters. Thisintervention reduces water borne and diarrheal diseases especially in infants and young children.

Food security - Improved nutrition leading to improved health and livelihoods Church mobilization for wholistic ministry - Church social ministries following the model of Jesus Christ

enhance all the above. People Owned Process(POP) facilitates communities to start own development initiatives

Maternal Child Health Monthly immunization and antenatal care/ FP clinics Growth monitoring Malaria prevention education through Community Health Workers Community based distribution of essential drugs through Community Resource Persons (CRPs). PMTCT follow up and referrals

HIV/AIDS Prevention and care Counseling and testing becomes an entry point for care and treatment. Lessons on prevention are given during monthly mobile clinics. Men as partners meetings

14

Health teachings - hygiene and sanitationLessons given in mobile clinics enhance safe infant feeding, health of the mother and the entire family. Childto Child (CtC) approach to PHC in primary schools reinforces the same in homes.

Safe and accessible waterThis includes construction of water tanks, protection of natural springs and promotion of bio-sand filters.This intervention reduces water borne and diarrhea diseases especially in infants and young children.

Mr Jonathan Bii addresses the Annual Health Conference.

Food securityThe department believes that improved nutrition leads to improved health. It partners with targetcommunities in the establishment of food banks for maize, beans, pumpkins and keeping of dairy goats formilk, among other ventures.

Challenge and equip the Church for wholistic ministryChurch social ministries following the model of Jesus Christ enhance the wholistic human approach.

People Owned Process (POP)The department facilitates communities to start their own development initiatives and enhances healthseeking behavior. The gender daily calendar allows both men and women to note the activities theyundertake daily and has encouraged men to participate in family activities. The department also strives totake MCH services closer to mothers and children.

This approach employs the following strategies: Communities identify themselves for partnership

15

Participatory learning, action and reflection are emphasized. Networking and collaboration for best practices and building synergy Lobbying and advocacy

Challenges Funding Conflicting approaches Poor roads Occasional shortage of clinical supplies

Questions and discussions Resource mobilization: All projects are cost-shared with benefitting communities. Communities contribute

30 per cent in cash, labour, among other resources. Communities also own the capacity building processesand are encouraged on the rights based approach to development so they can mobilize resources fromGovernment and other potential partners. The basket approach allows communities to identify sources ofresources.

How are families that receive the water filters identified? Communities apply and pay Ksh300 as costsharing. The beneficiaries are selected according to laid-down criteria. Construction of the filters is done inthe communities. The communities must form self help groups to fix toilets, drying lines, trash cans andensure clean compounds.

Child to Child (CtC) approach: Every year, the department partners with 15 schools who apply for theprogramme.

Sanitation: Community health programmes mostly focus on villages as opposed to urban areas. There isneed to focus more on urban areas.

The POP approach is being scaled up in many communities. Among the challenges is that someorganizations provide handouts to the communities as opposed to teaching them to manage projects thatbenefit them.

16

Financing maternal and child health services; Opportunities and challenges

Presented by Dr Samuel Mwenda – General Secretary, CHAK

Financing is one of the essential inputs in health service delivery. Finances are needed to procure and pay forother health systems necessary for health service delivery. Health workers may be considered the mostimportant resource due to their role in quality service delivery and management of other resources to achieveeffectiveness, efficiency and desired health goals. However HRH recruitment, development, motivation andrewards all require financing.

Health services are expensive to deliver. When one considers; the capital cost of investment, operational costs,regulatory compliance costs, infection prevention procedures, safe waste disposal and sanitation. The diverserange of health service delivery institutions calls for varied investments and sustainable financing strategies.Diagnostic and curative services involve a lot of inputs that include; consultation, investigation, radiology,procedures and drugs.

Inadequate health care financing is a common and persistent challenge among CHAK member health facilitiesand in developing countries in general. There cannot be any adequate single source of financing.

Challenges faced in achieving annual goals by both MOH and FBO health facilities

CHALLENGES FACED IN ACHIEVING ANNUAL GOALS

Financial Resource shortage Human Resource shortageStaff turnover Community interferenceGovernment/management disagreements defaulters

17

Income sources for health financingThe main financing mechanisms in Kenya include;

i. Tax financingii. Pooled funding – through risk pooling initiatives such as NHIF, private insurances and community

based health financingiii. Employer supported health schemesiv. Fee for service/user fees/cost sharingIn a study of the faith based health services providers which was conducted in 2007, the main sources offinancing health care were; patient fees/user fees – 71 per cent, donors – 13 per cent, NHIF – 9 per cent, others– 7 per cent. Government support is provided in-kind and was not costed in this study.

Income sources; MOH-FBHS situational analysis study 2007

Mrs Nancy Ng’ang’a from AIC Cure Kijabe Hospital raises a point during the event.

GOK0%

Donors14%

User Fees70%

NHIF9%

Others7%

GOK Donors User Fees NHIF Others

17






GOK0%

Donors14%

User Fees70%

NHIF9%

Others7%

GOK Donors User Fees NHIF Others

17






18

Partnership and collaboration with MOH

Who pays for health?According to the National Health Expenditure Household Survey results of 2005/06, the total healthexpenditures was estimated at Ksh69 billion and was financed by; households – 36.7 per cent, Government taxrevenues – 30 per cent, donors – 29.4 per cent and private companies – 3.4 per cent.

Types of Collaboration CHAK Facilities

0%

5%

10%

15%

20%

25%

30%

Drugs

Equipm

ent s

haring

Human res

ource

No colla

borat

ion

Referrals

Training

s

Trans

port

Vaccin

es

18




0%

5%

10%

15%

20%

25%

30%

Drugs

Equipm

ent s

haring

Human res

ource

No colla

borat

ion

Referrals

Training

s

Trans

port

Vaccin

es

18




0%

5%

10%

15%

20%

25%

30%

Drugs

Equipm

ent s

haring

Human res

ource

No colla

borat

ion

Referrals

Training

s

Trans

port

Vaccin

es

19

Government in-kind support comes in the form of:• Commodities such as vaccines, FP methods, PMCT commodities, ITNs• Seconded health workers• Training materials and IEC materials• Clinical guidelines and policies• M&E system including ANC and child welfare cards and service registers

Communities contribute in various ways including:• Fee for service as an out of pocket payment• Human resource contribution through community volunteers –CHWs and Community health

committees• Community fundraising for hospital bills

Partners to FBOs in health care financing include but are not limited to:• Communities• Government departments• Education institutions• Donors• Churches and church organizations• NGOs• Academic institutions in the form of research and new knowledge• Private sector• Other service providers

Several categories of insurance schemes exist:• The NHIF maternity package offers great opportunities for mothers and their families. The CHAK

network has raised several issues on NHIF compensation which are being addressed.• OBA for Reproductive Health which is being supported by GTZ and UNICEF• Private insurances• Community-based health care financing schemes

Fundraising innovationsCHAK member hospitals are engaging various innovative strategies towards increasing sustainablefinancing for healthcare:

Costing of services: according to the findings of a costing study that was conducted by CHAK in2005, cost recovery is often a challenge due to lack of comprehensive costing of service inputs.CHAK has recognized the need to identify and reasonably cost the various inputs that go intohealth service delivery. The cost should inform the pricing strategy for all services. The pricingshould however recognize the subsidies from external funding sources whether in cash or in kind.External subsidies are intended to benefit the patients or users and not the health institutions. InCHAK hospitals the cost elements that are frequently missed include donated services (secondedstaff), indirect costs and the cost of depreciation of medical equipment and buildings.

Computerization of revenue collection and management systems: experiences from CHAKhospitals has provided evidence that changing from manual revenue management tocomputerized system significantly enhances transparency and efficiency by providing itemized

20

patient bills and receipts. CHAK is now advocating that all member health facilities should movetowards installation and use of computerized revenue management system. CHAK has supportedthis strategic move by developing an open source Hospital Management Software which can beused at all levels of health care facilities. The software is able to do patient billing, receipting,debtors management and inventory/stock control. It also has an accounting system which enablestimely generation of accounting reports. CHAK Hospital Management Software was launched on12th November 2010 following successful six months pilot at Maseno Hospital and Soweto KayoleDispensary.

Diversification of services: CHAK hospitals are working on diversification of services throughintroduction of specialized services and training programmes in order to gain a competitive edgeover competitors. Some examples include;

a. Tenwek Hospital has introduced Heart Surgery services, the first to be offered in ruralareas of Kenya. The hospital has also introduced High Dependency Unit, OrthopaedicSurgery, specialized Endoscopy services, cleft lip corrective surgery, Eye Surgery andMedical Training including residency programmes in Family Medicine and Surgery. Plansfor installation of a CT Scan machine are underway

b. PCEA Kikuyu Hospital has introduced a Renal Dialysis Unit. It already has a well establishedspecialized Eye Care services, Orthopeadic Surgery and Dental services. PCEA ChogoriaHospital is working on the installation of a CT Scan to become a regional referral hospitalfor this diagnostic service as well as support surgery services at the hospital

c. AIC Kijabe hospital has developed highly specialized surgical services for children andadults. With the opening of nine well equipped major Theatres in October this year, thehospital has become the busiest surgical facility among the Church Hospitals in Kenyaconducting an average of 10,000 major surgeries each year. The specializations includepaediatric neurosurgery and ortheopaedic surgery. It has also established a surgicalresidency programme and anaesthetist training programme. The hospital has a wellequipped intensive care unit (ICU).

Marketing of services: CHAK hospitals have recognized the need to publicise the variety of healthservices available. With the increasing competition from alternative providers, CHAK hospitalshave recognized the need to identify their service niche and use it as an entry point for publicityand marketing. Kijabe hospital is leading as a best practice in establishing a marketing departmentwhose core business is to package and disseminate information on the broad range of servicesavailable. The hospital has established a niche in highly specialized surgical services which isdrawing patients from all over Kenya and neighbouring Somalia. The Private ward with additionalcomfort and amenities attracts patients who are able to pay higher fees for services provided. Themarketing department is actively engaging media, communities, leaders and also uses a revampedhospital website for marketing. Maua, St Lukes and Lugulu Hospitals are engaging strategies of

21

community outreach, community mobilization, Hospital Open Days, Free Medical Camps andAnniversary celebrations for hospital services publicity and marketing

Partnership with the National Hospital Insurance Fund (NHIF): NHIF is the largest social healthinsurance in Kenya with over 10 million beneficiaries. NHIF provides comprehensive in-patientcover in various Church Hospitals in Kenya. Revenues from NHIF have been recording a steadyupward trend and this has come to be regarded as a key health financing mechanism for CHAKHospitals which ranges between 10 – 40% of the inpatient revenue. NHIF has continued toinnovate in it’s services and systems to enhance efficiencies in beneficiaries identification andclaims processing. NHIF is compulsory for all Kenyans in formal employment and voluntary for theinformal sector. In the rural areas where most of the population is in the informal sector there arefew members with NHIF cover. CHAK hospitals have recognized the need to enter into partnershipwith NHIF for mobilizing informal sector recruitment. A best practice is found in Maua MethodistHospital, which has offered NHIF an office at the Hospital entrance. The hospital has invested in anNHIF community mobilization team and programme. The community team has a vehicle, powergenerator, a photocopying machine and a digital camera. The team collaborates with NHIF andthe Provincial Administration to conduct community education and mobilization campaigns forNHIF membership. The Hospital Staff SACCO Bank also assists community members with Accountsat the SACCO Bank to join NHIF. This initiative has enabled the hospital to change the trend indebt accumulation and significantly increase revenues from NHIF from 15% - 40% of the in-patientfees.

Analysis of revenue from NHIF as a percentage of the total in-patient revenue at Maua Hospital

Maua has inspired other CHAK hospitals to prioritize NHIF membership mobilization as a strategy ofempowering communities to access inpatient services. Plans by NHIF to roll out out-patient insurancecover services will further expand opportunities for revenue generation from this national social health

0

10

20

30

40

50

2005 2006

MMH - %NHIF TO GROSS FEES

21





2006 2007 2008 2009 (JAN&FEB)

MMH - %NHIF TO GROSS FEES

21





22

insurance system. Similar partnerships are being engaged for community based health financinginitiatives even though these are to a much smaller extent.

Out-sourcing of non-core functions: there is growing realization that Hospitals can successfullyoutsource the burden of several non-core services. This enhances efficiency and reducesmanagement time consumed in planning and monitoring these services. These include; securityservices, banking services and equipment maintenance services. Other services that can beconsidered include cleaning and catering services.

Income Generating Activities: CHAK hospitals are engaging various approaches towards additionalrevenue generation to compliment user fees. From previous experiences, income generatingactivities in non-core business areas proved challenging, time consuming and did not result tosignificant investment returns. An example was Chogoria hospital IGA in Restaurant, Petrol Stationand Farming all of which were outsourced due to persistent non-profitability and burden onhospital management time. There are however some exciting income generating initiatives withinthe core business of health services provision or investments towards lowering the cost ofproviding services

a. Innovative income generating activities – examples of successful initiative include:i. Private or Amenity Wards where the package of in-patient services includes

higher privacy and comfort. The patients able to pay for these services also paydifferentiated higher rates for all the other services including Laboratory, Theatre,Radiology, Drugs and procedures

ii. Fast track outpatient clinics – these are provided at a much higher consultationfees for clients who can afford and who are unwilling to queue for routineservices. These also include direct Doctors consultation. Lighthouse for Christ EyeCare Centre runs a Private (Appointment Clinic) by Opthalmologists with creditcard payment facilities and additional comfort where the consultation fees is fivetimes higher than the general clinic. Funds generated from this clinic are used tosubsidize patients from the general clinic who cannot afford to pay the Ksh 200fee charged.

iii. Satellite clinics – Church hospitals were supporting opening of satellite clinicsdriven by the mission to take essential primary health care services to thecommunities most under-served. These however create a much bigger challengeof financing. For income generation, Church Hospitals are now moving intoestablishment of branded satellite clinics in urban areas where there are potentialclients with ability to pay. Kikuyu and Kijabe hospitals have already startedsatellite clinics. Lighthouse for Christ Eye Care Centre has established severalOptical Shops in various towns within the Coastal region. This is a strategy thathas been used by well established private hospitals in the city of Nairobi.

23

iv. Diagnostic and Pharmaceutical services – hospitals are also establishing Laboratory and Radiologicaldiagnostic services as income generating services which attract referrals from other health facilitiesand private clinics. Well equipped Laboratories and Radiology units offer specialized diagnosticservices that attract well paying clientele. The challenge remains how to balance the pricing strategythat does not exclude the poor needy patients

v. Funeral Homes – Hospitals with well developed and equipped Mortuary services are developingcomprehensive funeral homes services. These include Body cold storage or embalming, Chapel forprayers, body preparation for burial and a hearse transport service. Funeral Homes are run asindependent service which should attract demand from outside the hospital

vi. Endowment funds:- Hospitals are establishing Endowment Funds in which capital is raised fromdonors and other sources, which is then invested and the interest generated is used to financedesignated services. Examples include Chogoria Hospital endowment fund for community outreachservices, Maua Hospital endowment fund for Doctors training sponsorship. There are also innovativedesignated funding initiatives such as hospital bed cost per day and per year which is marketed fordonor support, needy patients support fund to assist very poor patients.

b. Investments to subsidize cost of health services: - these investments in medical equipment andhospital plants target to reduce the cost of providing medical services. Some innovative examplesinclude;

i. Hydro-electric power generation plant at Tenwek Hospital which has provided the hospital withreliable electricity supply for over 20 years. This project saves the hospital an average electricity bill ofKsh 1.2 million per month

Hydro-electric power generation plant for Tenwek Hospitalon the Amara River waterfall. This generates enoughelectricity for the whole hospital lighting and electricequipment and the staff housing

24

ii. Oxygen Generation Plant – these have been installed to produce, purify, compressand store oxygen from the atmospheric air. This is then stored and distributedthrough oxygen piping to the various user outlets in the emergency rooms,theatres, OPD and wards. Though the cost of initial investment is expensive, itpays off over time by removing the cost of Oxygen cylinders deposit, oxygenpurchase and transport and enhances efficiency and convenience. The cost on thesystem is electricity and routine maintenance. Maua, Kijabe, Chogoria, Litein andTenwek have installed this system. Tenwek has an additional facility of fillingOxygen Cylinders for backup storage.

iii. Intravenous fluids production plants – MEDS supported the establishment of IVFluids production units in several CHAK Hospitals. These support production of thecommonly used IV fluids at a rate that meets the fluctuating hospital needs. Thechallenges of stocks management, procurement and transport logistics areminimized

iv. Biogas production project – this is a new emerging area of potential hospitalsinvestment to address the challenges of rising cost and non availability offirewood fuel for cooking services for patients and Nursing students. There arealready positive lessons on this in Kenya and two CHAK Hospitals are working onbiogas harvesting projects from waste disposal

Partnerships with Donors and NGOs – project funding to support capacity building and healthsystems strengthening for new or ongoing services mobilizes additional funding to providesubsidized services to the users. Good examples are found in HIV prevention, care and treatment,Malaria and TB programmes. Funding is either obtained directly from Donors or throughinternational NGOs. PEPFAR has provided a lot of resources in support of HIV treatmentprogrammes through AIDSRelief project and other partnerships. There is need for CHAK healthnetwork to build technical skills in project proposal development and project management inorder to effectively pursue available funding opportunities

Public-private-partnerships: CHAK promotes public-private-partnerships as a strategy formobilizing financial, material and technical resources to support health service delivery. Wepartner with Government for enabling policy environment, patient management guidelines forvarious conditions, regulatory compliance requirements, IEC materials, disease preventive andcurative commodities such as vaccines, ARVs, TB drugs, HIV test kits, Anti-malarial drugs,Dispensary Drug Kits and reproductive health commodities. Hospitals are also partnering with theprivate corporations for funding through the corporate social responsibility programmes. A goodexample is the Standard Chartered Marathon which raises funds that supports payment forcataract surgeries at the Specialized Eye Care Hospitals. Another form of partnership is withMedical Equipment Companies which offer medical equipment of lease arrangement. Examplesinclude BD Facs Count HIV testing machines, Abbots Chemistry Analyzers, Oxygen Concentratorsand a most recent modern high capacity Chemistry Analyser provided by Philips Company to

25

Tenwek Hospital. The lease arrangement provides for the hospitals to buy the reagents over aperiod of time during which the Medical Equipment is placed at the hospital and maintained bythe company. Commercial Banks are also willing to offer credit facilities to hospitals for capitalinvestment and operational financing needs through short-term credit facilities.

A new Chemistry Analyzer at Tenwek hospital acquiredfrom Philips Company through a lease arrangement hasadded 14 new blood tests at the hospital and enhancedefficiency and volumes of samples that are processed daily

• Pre-payment delivery packages where patients pay a certain amount of money before delivery toaccess services.

• We can appeal to donors for funding of delivery beds or delivery of babies• We can also fundraise for equipment and supplies which are very essential for maternal child health.

Emerging and promising options• Health Sector Services Funds (HSSF)• AOP financing at District level.• Devolved funds e.g. CDF: These are set to increase with creation of county governments• Fundraising proposals• Integration of Donor funded programmes like APHIAPlus USAID programme; DFID, UNICEF, GTZ/GIZ,

DANIDA

26

Kenya Strategy for scaling up quality maternal and neonatal healthservices

Presented by Mary Gathitu-Division of Reproductive Health

Reproductive Health programming in KenyaReproductive Health Programmes in Kenya aim at improving maternal health, reduce maternal, neonatal andchild mortality, the spread of HIV/AIDS and promote women’s empowerment and gender equality. Thiscontributes to achieving the Millennium Development Goals. The National Reproductive Health Policy focuseson enhancing the reproductive health status of all Kenyans in alignment with the National Heath SectorStrategic Plan II (NHSSP II). The NHSSP II represents a paradigm and policy shift that emphasizes on preventiverather than curative services. It focuses on service delivery to the general public and promotion of healthylifestyles for individuals and communities.

Essential components of Reproductive Health Maternal and Neonatal Health Family planning/STIs/HIV Adolescent/youth sexual and reproductive health Gender Rights Reproductive Tract Cancers Reproductive Health for Elderly persons IEC/BCC Monitoring and Evaluation RH Training Infertility

Current status Total Fertility Rate: 4.6 CPR- any method: 46% Unmet need for FP: 26% Population growth rate: 2.8% per yr Total population (2009): 38.6 million Proportion of under 15yrs: 45% Maternal mortality ratio: 488/100 000 Neonatal mortality rate: 31/1 000 HIV prevalence among pregnant women: 9.7%

Coverage for interventions Proportion attending at least 1 ANC visit: 92% Proportion attending 4 ANC visits: 47% Delivery by skilled birth attendant: 44% Delivery in a heath facility: 43% Proportion receiving PNC within 48hrs: 42% Skilled birth attendant/1000 population: 1.2 /1000 (requirement to attain MDG 5 is 4/1 000)

27

Key challenges Inadequate skilled care throughout the continuum of pregnancy, delivery, post-partum and post-natal

periods Inadequate coverage of EOC interventions Low FP CPR and high unmet need Health system Challenges Low community involvement in maternal health

High impact interventions for accelerating the attainment of MDG 5Early in 2010, Maternal and Neonatal Health stakeholders in Kenya defined high impact interventions asfollows: Demand creation for early initiation of ANC Increased coverage of basic and emergency obstetric and newborn care Skilled care along the continuum of pregnancy, childbirth and the postpartum period Family Planning (increased CPR) Essential newborn care

Ms Gathitu makes her presentation at the conference.

The Kenya MNH road mapThis is the strategy document for accelerating the reduction of maternal and neonatal morbidity andmortality in Kenya. It was adapted from the AU road map and has been adopted by MNH stakeholders.

VisionEfficient and high quality MNH services that are accessible, equitable, acceptable and affordable for allKenyans

GoalTo accelerate the reduction of maternal and newborn morbidity and mortality towards the achievement ofthe Millennium Development Goals (MDGs)27







GoalTo accelerate the reduction of maternal and newborn morbidity and mortality towards the achievement ofthe Millennium Development Goals (MDGs)27







GoalTo accelerate the reduction of maternal and newborn morbidity and mortality towards the achievement ofthe Millennium Development Goals (MDGs)

28

Specific objectives Specific Objective – 1: To strengthen data management and utilisation for improved MNH Specific Objective – 2: To increase the availability, accessibility, acceptability and utilisation of skilled

attendance during pregnancy, childbirth and the post partum period at all levels of the health caredelivery system

Specific Objective – 3: To strengthen the capacity of individuals, families, communities, and socialnetworks to improve maternal and newborn health

MNH road map strategies1. Strengthen Monitoring and Evaluation system for Maternal and Newborn Health2. Strengthen focused operations research in Maternal and Newborn Health3. Strengthen National, provincial, and district MN health planning and management4. Improving availability of, access to, and utilisation of quality Maternal and Newborn Health Care

including adolescents, youth, people with disabilities and other vulnerable groups5. Reduce unmet need through expanding access to good quality family planning options for sexually

active men, women adolescents and people with disabilities.6. Strengthening the referral system7. Advocating for increased commitment and resources for MNH and FP services8. Fostering partnerships9. Strengthening community based Maternal and Newborn Care approaches

Roles and responsibilitiesMOMS and MOPHS Ensure the creation of an enabling environment for the implementation of MNH programs Ensure that health facilities have adequate capacity in terms of staffing, equipment and supplies to

adequately provide quality services Allocate necessary resources using existing national initiatives for the implementation of MNH

programs. Establish mechanisms for supervision and ensure regular monitoring and evaluation of progress made

Health facilities As far as possible, provide timely, efficient, and quality health care to all women and newborns presenting

to the hospital Ensure that standards of care are effected and maintained Consistently document processes and keep registers so that data is available for decision making Establish facility based maternal and perinatal death review committees

NGOs, CBOs, FBOs and Private sectorThese organisations will be encouraged to expand coverage and improve access to MNH services. They willadvocate for and promote the rights of women and children and the need to address their problems inaddition to mobilising and allocating resources for MNH programmes. They would also implement communitybased strategies to promote healthy behaviour during pregnancy, childbirth and the postpartum period.

Other sectorsThese include education, agriculture, police, water, transport, roads, trade, communication/ media, gender,social services, parliament, councillors, chiefs, etc. All have to play their part to ensure that women andchildren access services that are necessary to reduce death and disability.

29

Communities, households and individualsCommunities will participate through the health facility committees, village health committees as well ascommunity health extension workers in resource mobilisation, planning, monitoring and evaluation of MNHservices. Households and individuals will be encouraged to participate and contribute towards improvement ofMNH.

Role of training institutionsThe Ministry Of Education needs to ensure that the girl child has the basic education as this positively impactshealth seeking behaviour. The approved university based medical and nursing schools, Kenya medical trainingcolleges, and private and mission medical training hospitals will be expected to regularly update andincorporate evidence based MNH practice into their curriculum.

AIC Kijabe Hospital CEO Mrs Muchendu speaks during the meeting.

29




29




30

The Role of FBOs in scaling up quality child health services in Kenya

Presented by Dr Migiro, Head, Child Health Division

Child health indicators (KDHS 2008) Infant Mortality Rate: 52/1,000 live births Under-five Mortality Rate: 74/1,000 live births Neonatal Mortality Rate: 31/1000 68 per cent of children aged 12-23 months are fully immunized Overall underweight stands at 22 per cent Stunting has increased from 33 per cent in 2003 to 35 per cent in 2008/9

0

20

40

60

80

100

120

140

1990 1998 2003 2006 KIHBS 2008/9 2015 MDG GOAL

Trends in Under five and infant mortality 1990-2015

IMR U5MR

NOT ON TARGETAcceleration

Required

31

Causes of under-five mortality in Kenya

Main Causes of <5 mortality(WHO Country Fact Sheet, 2006)

Neonatal causes- 24 per cent (contributes up to 60 per cent in some provinces) Pneumonia – 20 per cent especially where malaria prevalence is low Diarrhoea -16 per cent Malaria-14 per cent (intense control efforts have borne fruit) Malnutrition is the underlying factor in up to 55 per cent of <5 deaths

Causes of death in newborns Infections - 36 per cent (sepsis, neonatal tetanus, diarrhoeal disease) Prematurity – 28 per cent Asphyxia – 23 per cent

Coverage of neonatal interventions along the continuum of care in Africa

24%

15%

16%3%

14%

20%

3%5%

0

Distribution of causes of deaths among under fives in kenya, 2000-2003

Neonatal causes

HIV/AIDS

Diarrhoeal diseases

measles

malaria

pneumonia

injuries

0thers

6 9

4 2

1 6

3 0

6 5

0

20

40

60

80

100

ANC (a n y) S kil le da tte n d a n t

P o stn a ta l ca re Ex clu siveb re a stfe e d in g

(< 6 m o s)

EP I (DP T 3+ )

Co

vera

ge

%

32

Scaling up high impact interventions as articulated in the Child Survival and development Strategy 2008-2015would help address these negative trends.

Child Survival and Development Strategy 2008-2015Objectives

To provide a framework that all partners will support to scale up and accelerate child survival anddevelopment in Kenya

To advocate for increased political will and financial commitment for child survival and development inKenya

High impact interventionsMaternal Health (2010, 2011)

Early initiation of ANC Individualized birth plan Emergency preparedness Use of Partograph Maternal nutrition Family planning Maternal and Perinatal Death review and Verbal Autopsy

Newborn Early and exclusive breastfeeding Temperature management Identification of danger signs and early referrals Hand washing with soap and water Skilled attendance at delivery

Universal coverage with a few interventions can prevent over six million deaths every year

PreventionIntervention

Deaths prevented as proportionOf all child deaths

TreatmentIntervention

Deaths prevented as proportion ofall child deaths

Breastfeeding 13% Oral rehydration 15%

Insecticide-treatedmaterials

7% Antibiotics forpneumonia

6%

Complimentary feeding 6% Antimalarials 5%

Zinc 5% Zinc 4%

Hib vaccine 4% Antibiotics fordysentery

3%

Water, sanitation,hygiene

3%

Vitamin A 2%

33

Global evidence-based cost effective interventions

Integrated Management of Childhood Illness (IMCI)

T a b l e 2 a : C o st E f fe c t i v e P r e v e n t i v e I n te r v e n t i o n s: L a n c e t 2 0 0 3

0 % 5 % 1 0 % 1 5 %

A n t im a la r ia l f o r IPT in p r e g n a n c y

A n t ib io t ic s f o r p r e m a tu r e r u p tu r e o f m e m b r a n e s

N e v ir a p in e a n d r e p la c e m e n t f e e d in g

T e ta n u s T o x o id

N e w b o r n T e m p e r a tu r e M a n a g e m e n t

W a te r S a n ita t io n H y g ie n e

A n te n a ta l s te r o id s

H ib V a c c in e

C le a n d e liv e r y

Z in c

C o m p le m e n ta r y f e e d in g

IT M

B r e a s t f e e d in g

S e r i e s 1

IMCI

IMCI: Healthy Child

HealthSystem

Health Worker Skills

Families and Communities

34

Comprehensive school health programmeThe National School Health Policy 2009 promotes a comprehensive school health package of: Values and life skills Environmental health and sanitation Disease prevention and nutrition Special needs and rehabilitation Safe environment and infrastructure

Challenges High poverty levels Inadequate human resources (numbers, skills) Low health seeking behavior Inadequate child care practices among care givers Inadequate financial resources for child survival activities Poor access to health services (cost, distance)

Areas of collaboration Partnership with GOK and other stakeholders in achieving local and global targets Implementation of GOK policies, strategies, guidelines & standards in;

• Provision of preventive, curative and rehabilitative childhood health services• Improving access and equity• Training of Health workers at community & facility levels

Achievements During the NHSSP II and after there has been joint planning between GOK and FBOs Trainings: DCAH has included FBOs in trainings on relevant areas e.g. IMCI Participation in policy meetings (Child Health ICC) FBO training institutions have been included in updates FBOs are key partners in increasing access to services (malaria, TB, HIV and FP)

Roles of various partners in child healthGovernment of Kenya Development of policies, guidelines and strategies. Sensitize all stakeholders on child survival and development Engage and coordinate CBOs, FBOs, NGOs and partners operating at various levels of healthcare

Role of child health partners Advocate for resources for child health Work with the government at national and sub national level in implementing health priorities Mobilize communities and link them with the health services Identify and link the un-reached population Assist in research on new initiatives

35

Role of FBOs Provide their members with accurate information on maternal and child survival Integrate skilled support for maternal /child survival and development in community based interventions Ensure effective linkages within the health care system Provide community based support through existing support groups and initiatives Participate and support in maternal and child health nationwide activities like Malezi Bora

Questions and discussions Is there an action plan from the Government with regard to maternal and new born health? The

government works with NHSSPs. The two ministries have also developed their own strategic plans. There isalso planning at the district level while planning is also done according to populations.

The Government has been absorbing well trained staff from FBOs. The FBOs then have to recruit new stafffrom training institutions who unfortunately lack experience. What is the solution to this challenge?Unfortunately, we cannot do much about migration of health workers as they are free to work anywhere.The best we can do is put in place motivation and retention strategies.

Is there a specific plan targeting reproductive health for elderly persons? The elderly are partakers ofsexual health services. They form a special cohort even in the KEPH. The division recognizes the need toaddress issues such as andropause and menopause, HIV, cervical and prostrate cancers, all of which affectthe elderly.

Should negligence by health workers be cited as a cause of death and how can patients seek redress?Hospitals have quality audits which should be able to identify such cases. Redress comes from the Medicaland Dentists Practitioners Board. However, it is important that clients know their rights and ask foropinions from several doctors.

Have dispensaries in the rural and remote areas been provided with equipment to assist mothers in theircatchments? The Government and donor partners have made huge investments in improving equipment inthe rural areas. Health workers, however, need to be monitored to use the equipment and correctly.Replacing broken equipment may take some time but it is being addressed every year in the procurementprocess.

There is need to ensure structures in Level 2 facilities include maternity wards since mothers are often inlabour as they wait for the nurse to attend to them.

Are FBO facilities entitled to any form of support after participating in formulation of AOPs? Governmentresources are limited and FBOs therefore need to plan for the resources they have at hand.

The number of trained nurses coming out of nursing schools is very small. What is being done to ensurethis shortage of health care workers is addressed? The FBOs, including CHAK, should also devote someattention to training health workers. The Government is not able to train as many health workers as itwould like to and this is a big concern at national level. Although the health sector is the end user of thetrained health workers, training institutions fall under the Ministry of Education. Discussions are howeverunderway on how to improve skills and numbers of health workers.

Traditional birth attendants (TBAs) are being faced out and are not supposed to conduct deliveries.Community health workers are being used to speak to communities about the need for skilled birthattendants. Many women want to be delivered by TBAs and there is need to motivate them to go to healthfacilities.

Community health workers are being trained and a budget is available to employ 20 community healthworkers per constituency.

The Government made a commitment to implement the global strategy on women’s and children’s health.What is the role of FBOs in the strategy’s implementation? The ministry is employing health workers suchas nurses, clinical officers, and laboratory technologists, among others. Money has also been allocated to

36

health facilities under the economic stimulus programme. About 75 new health facilities will be madeoperational by the next financial year.

Male involvement seems to be missing from the list of strategies to improve the health of mothers andbabies. There are clinics where men’s needs are addressed in isolation while women should be encouragedto take the message to their partners.

Culture and health: Kenyan communities have very diverse and influential cultures that health workersneed to be aware of. The Government has produced a faith for life handbook to empower pastors withhealth messages. In addition, all divisions have units that deal with IEC materials and behavior changecommunication. The department of health promotion addresses communication at various levels.

Health Sector Service Fund: Although there have been a lot of expectations by FBOs on the fund, there hasbeen no commitment from the Government on the percentage of the budget to be given to FBO level twofacilities. We want FBOs to benefit from this fund.

To address neo-natal deaths, there is need to put more emphasis on neo natal resuscitation trainings ashealth workers have limited skills on this. In 2008, the Division of Reproductive Health and Child Healthdeveloped a package for health workers on essential care of new borns. Health workers were trained andsimple guidelines are being finalized to address this issue. Training institutions are also being empoweredin this vital area.

There is also need for capacity building for health workers in family planning where there is a bigknowledge gap particularly when it comes to the long-lasting methods. The Government came up with astrategy in 2009 to revitalize FP. Health workers are being trained and are in turn expected to conduct on-job training for their colleagues. Training institutions have also been encouraged to update their syllabi onfamily planning.

Kenya has introduced the new pneomo cocco vaccine which was launched by the President in February. Itis available with KEPI and health workers have already been trained to be able to give the vaccine.

Comment on ORT Connors support for all facilities in the country. Children with diarrhea are given ORS andmonitored. Simple equipment for this has been procured for all facilities. Provincial officers are required toperform an evaluation of all facilities in their regions, including FBOs for distribution of the low-costequipment as it has very high impact.

37

Legal/Investigative concerns in quality assurance-Role of KEBS in thenational QA infrastructure

By Oyoo T.O, KEBS

The Kenya Bureau of Standards commenced its operations on July 12, 1974, following the enactment of theStandards Act, Chapter 496 of the Laws of Kenya. Its functions are as follows:a. To promote standardization in industry and commerceb. To make arrangements to provide facilities for the testing and calibration of precision instruments, gauges

and scientific apparatus, for determination of their degree of accuracy by comparison with standardsapproved by the Minister or on the recommendation of the Council, or for the issue of certificates in regardthereto

c. To make arrangements or provide facilities for the examination and testing of commodities and anymaterial or substance from or with which and the manner in which they may be manufactured, produced,processed or treated

d. To control, in accordance with the provisions of this Act, the use of standardization marks and distinctivemarks

e. To prepare, frame, modify or amend specifications and codes of practicef. To encourage or undertake educational work in connection with standardizationg. To assist the Government or any local authority or other public body or any other person in the

preparation and framing of any specifications or codes of practice,h. To provide for co-operation with the Government or the representatives of any industry or with any local

authority or, other public body or any other person, with a view to securing the adoption and practicalapplication of standards

i. To provide for testing on behalf of the Government, of locally manufactured and imported goods at theports of entry or country of origin with a view to determining whether such goods comply with theprovision of this Act or any other law dealing with standards of quality or description

j. To provide for testing of goods destined for export for purposes of export certificationk. Doing or performing all such other things or acts necessary for the proper performance of its functions

under this Act which may lawfully be done by a body corporate.

The aims and objectives of KEBS include development of standards relating to products, measurements,materials, processes and services, and their promotion at national, regional and international levels;certification of industrial products; certification of management systems; assistance in the production ofquality goods; improvement of measurement accuracies and dissemination of information relating tostandards.

As stipulated in the Standards Act, the core functions of KEBS, therefore, are to provide and/or promote:• Standards Development• Testing• Metrology• Implementation of Standards in commerce and industry• Accreditation• Certification

38

• Inspection of imports and local products• Training and education in Metrology, Standards, Testing and Quality Assurance (MSTQ)

Challenges KEBS faces in QA activities• Inadequate training in IT skills — There is need to train standards writers and conformity assessors in

the use of ICT equipment for standards development and implementation. This ranges from the basicdata inputting to advanced computing, modelling and simulation.

• Inadequately trained technical personnel — This is a major constraint especially in the benchmarking ofproduct specific standards and codes of practice, e.g., EUREGAP, HACCP, food safety, ICT, pesticide,SPS, etc, which are crucial to competency in certifying exports.

• Inadequate physical facilities — Requisite physical and technical facilities are not adequate to beutilized for standards development. Conformity assessment procedures require validation whichcannot be readily achieved with the current facilities.

• Lack of specialized staff — Specialized staff are not available in key sectors which could supportdevelopment of standards and conformity assessment procedures. Retention of such staff once trainedis difficult due to the availability of better remuneration alternatives. However, targeted training canbe carried out for specific objectives. There is need, for instance, for food safety specialists tospearhead the development of food safety codes and guides and eventual formation

• Lack of synchronization of standards development activities with government development policiesand objectives — There is a disconnect between the government perception of the role of standardsand its development agenda. KEBS lacks the resources to conduct government-wide orientation of allsectors of the government towards putting forward standards as a competitive edge for our exports.

• Lack of staff exposure to export/import requirements for the country and export destinations of Kenya— There is a clear need for the standards writers and conformity assessors to be put in the clearpicture of the requirements of our export destinations so that they conceptualise the likely obstaclesbefore they are impact on our exports. The staff needs to be sensitised on the standardizationframeworks of key export markets like the EU, Japan, US and others.

• Communication, specifically the task of increasing general knowledge levels about standardization, itsassociated benefits, is a constant challenge. In the current environment of competing messages,multiple delivery methods (presentations, internet, print based material, tradeshows, etc.) and a finitelevel of resources, it is sometimes difficult to engage and hold the attention of specific audiences (e.g.,key government officials, senior business managers, etc.) in order to underscore the value of standardsand conformity assessment.

• Closely linked to communications is the concept of promotion. An understanding of the structure andfunction of standardization bodies and their activities must be complemented by practical andsuccessful examples of standardization ‘in-practice’. Examples of successful applications of standards inspecific sectors or circumstances are crucial to increasing acceptance and usage of standardization bygovernments, private industry, and consumers.

• Lack of national standardization strategy — There is an urgent need to develop an adaptive nationalstandardization strategy. Such a strategy should have the following as its objectives:

a) Influence the formation, evolution and operation of standardization committees/bodies that areimportant to Kenya. Kenya is among the developing countries with a track record as a valuedcontributor to international standards development activities. Kenya should continue to influence,both directly and indirectly, the policy formation and governance of international standardsdevelopment organizations. Kenya should also continue participating in key standards-developmentcommittees and pursue opportunities to participate in new cross-cutting standards-developmentprojects (e.g., security, social responsibility, climate change, etc.).

39

b) An important means of influencing international standardization activities is participating in regionalorganizations. Regional standardization bodies (e.g., the EAC, COMESA, SADCSTAN, ARSO) are excellentfora for collaborative policy development and information exchange on a host of standardizationissues. Kenya should seek to influence the growth and governance of these organizations for themutual benefit of their respective members and for our own strategic interests.

c) Improve access to existing and new markets for Kenyan goods and services:Trade continues to be an engine of the global economy and its impact on Kenya’s economy remainssignificant. Standardization plays a fundamental role in trade relationships, both positive (i.e. as anapproach to meet multiple national/regulatory requirements) and negative (i.e. as a method to erectobstacles to the free movement of goods and services).

d) Build competitive advantage through technology and information transfer and global marketintelligenceAmong the many benefits associated with the application of standards and conformity assessmentmechanisms one in particular stands out — the immediate and ongoing infusion of currenttechnologies, methodologies and techniques into businesses, departments or organizations. Successfulexports often hinge on properly manufactured and tested products and an internationally recognizedstandardization infrastructure.

e) Meet the needs of an evolving regulatory and policy environmentStandardization is used to meet a number of regulatory and policy requirements. As new products andservices, innovative certification and testing procedures, environmental considerations and changingregulatory requirements challenge all levels of Kenyan government as well as the citizenry, morebroadly, standardization will continue to be an important policy and regulatory tool.

f) Represent fully the range of standardization stakeholdersAttention to the development of a more robust stakeholder base will result in a more representativesystem with applicable and acceptable standardization products.

g) Communicate effectively the role and benefits of standards and conformity assessment practices

Way forward• Upgrading facilities through international partnerships• More public education• Embracing exchange programmes• Entrenching standardization activities in government policies• Strengthening regional offices’ capacities

Medical equipment standardsMedical equipment standardization commenced in Kenya in 1999 and is achieved through KEBS/TC 157:Hospital equipment. About 56 National Standards have since been developed.

MethodologyIn order to come to the consensus required, Kenya Bureau of Standards has come up with procedures that,when followed as closely as possible, ensures that the views of as many stakeholders as possible are taken careof. In standards development, KEBS acts with utmost neutrality with its only function being that of providingthe secretariat.The justification for the development of the standard proposed shall clearly state: Importance of economic field Degree of economic benefit Importance as export item Capacity as import substitute

40

Level of consumer protection Availability of reference material indicating whether the proposal is for adoption or adaption of the

reference material Availability of testing facilities Status of standard i.e. whether mandatory or voluntary Volume of production or operation Ease of adoption and implementation Transfer of technology

Categorization of standardsStandards are divided into the following categories: Standards developed from scratch (Committee draft standards) Adopted standards

Committee draft standardsStandards developed through research go through eight major stages before they are adopted as Kenyastandards. These standards bring together industrialists, researchers, government officers and any otherinterested parties into technical committees where the committee draft is discussed with the Bureau acting asthe secretariat.The committee draft can be derived from, among other sources:

a. Company standardsb. Other National/International standardsc. Other publicationsd. Tests results

At the end of the eight stages, it is assumed that the views of the majority (small and big companies) have beentaken care of and the document is then gazetted as a Kenya standard.

Adoption of standardsAdoption means copying, in total, the contents of the reference standard with the exception of the standardnumber, cover page format, forward or the preface and the reference standards. Where an International orforeign standard is considered technically suitable for application or use in Kenya, it is adopted as a Kenyastandard.

Nature of adoptionThe nature of adoption is based on the degree of correspondence of the regional/national standard to theinternational standard. It could be: Identical Modified Not equivalent

Methods of adoptionEndorsement methodIf the international standard is declared by the region or national body to have the status of a regional ornational standard, an “endorsement notice” may be issued. The endorsement notice may contain informationor instructions pertinent to this declaration. An endorsement notice should only be issued where the degree ofcorrespondence is “identical”.

41

Cover sheet methodAn international standard (including any amendments and/or technical corrigenda) may be published with aregional or national cover.

RepublicationThere are three methods of republication

a) Reprintingb) Translationc) Redrafting

ReprintingThe international standard is printed as a region or a national standard by direct reproduction of the publisheddocument (e.g. by photocopy, scanning or from an electronic file). In addition, the regional/national standardmay include the following:

i. A regional or national introduction, preface or forewordii. A translation of the text

iii. A different titleiv. Amendments and/or technical corrigenda to the international standardv. Regional or national informative material in a regional or national foreword, notes or annexes

vi. Editorial changes or technical deviations

TranslationIf the regional or national standard is solely the translation of an international standard, it may be published ina bilingual or monolingual form. In either case a regional or national introduction, preface or foreword isusually included.

RedraftingIf an international standard is published as a regional or national standard and the regional/national standard isnot a reprint or identical translation of the international standard, this is considered to be a redraft.

Aims of standardizationThe aims of standardization in general are:

1) To achieve maximum overall economy in terms of: Cost Human effort Conservation of essential materials as opposed to more readily available materials through prudent

selection of raw materials and the adoption of the production and handling practices known orexpected to most economical

2) To ensure maximum convenience in use3) To adopt the best possible solutions to recurring problems consistent with (a) and (b) above4) Compatibility – suitability of products, processes or services for use together under specific conditions

to fulfill relevant requirements without causing unacceptable interactions5) Variety control – selection of the optimum number of sizes or types of products, processes or services

to meet prevailing needs, variety control is usually concerned with variety reduction,6) Protection of the environment – preservation of the environment from unacceptable damage from

effects and operations of products, processes and services7) Interchangeability – ability of one product, process or service to be used in place of another to fulfill

the same requirements (functional or dimensional)

42

8) Safety – freedom from unacceptable risk of harm. In standardization, the safety of products, processesand services is generally considered with a view to achieving the optimum balance of a number offactors, including non-technical factors such as human behaviour that will eliminate avoidable risks ofharm to persons and goods to an acceptable degree.

9) Protection of the environment – preservation of the environment from unacceptable damage from theeffects and operations of products, processes and services

10) To facilitate international exchange of goods and services and develop mutual co-operation in thespheres of intellectual, scientific, technological and economic activity.

Benefits of standardization to procurement Creation of level playing ground for potential supplier Enhancement of corporate transparency Demonstrating customer confidence Minimization of waste Shorter downtime Obtaining worth for money

Questions and discussions Is it possible to check on credibility of equipment? There are various levels of checking imports i.e. levels

1-4. If a product has been coming into the country very regularly, then it is put at level 1. Level 4 is foritems that are completely new. A key requirement is that the equipment should be able to fulfill itspurpose. The S-marks are to ensure that equipment is fit for use. Import standardization marks are alsoused. There are also certificates of conformity to be shown at the port of Mombasa. A key challenge hereis inadequate manpower with only 200 officers currently doing the checks.

Is it possible for KEBS to organize field visits to check on the medical equipment that is in use in hospitals?The KEBS officers visit facilities to do calibration.

Hospitals need to verify the quality of donated equipment which they sometimes take out of desperation.How can KEBS assist with this? The KEBS is coming up with a procedure to verify the quality of equipmentcoming into the country despite the challenge of cost. Kenya also has over 10,000 standards, a goodindication of control. Products need to be taken onboard on the basis of performance.

43

Health Science Online

Presented by Prof. Paul Mbugua, Director, School of Health Sciences, PUEADemocratizing health sciences knowledgeIn 2006, WHO said that at least four million additional trained health care workers were needed around theworld, and existing providers needed continuing education. According to WHO, it is also clear that this is nota problem we can or should fix using standard teaching techniques, delivered in large, centralized buildings,filled with learners. We need to use information and communication technologies, and locally available,computer and skills-based learning to make this happen.

www.HSO.infoHealth Sciences Online is the first website to deliver authoritative, comprehensive, free, and ad-free healthsciences knowledge. One can search for any health sciences topic from over 50,000 courses, references,guidelines, and other learning resources in medicine (basic and clinical sciences), public health, pharmacy,dentistry, nursing, and other health science disciplines. Materials are selected from accredited educationalsources including universities, governments, and professional societies, by knowledgeable staff at HSO.Resources can be searched and retrieved in 58 languages. The resources can easily be translated into any ofthe 58 languages.

HSO’S Vision – Phase I: A world where health professionals in training and practice access comprehensive,easily-found, high quality, free, current courses, references, and other learning resources to improve health.

HSO’S Vision – Phase II: A world where health professionals in training and practice continue to have freeaccess to www.HSO.info -- a comprehensive, easily-found, high quality, free, current website, with courses,references, and other learning resources to improve health AND A world where anyone can become andremain a well-trained health professional in any discipline where they are qualified – to answer WHO’sexpressed needs.

Both community and university-based education is being used to enormously and rapidly expand the numberof well-trained health workers and professionals. We combine online knowledge transfer with localmentored experiences.

Four assessment methods are used: objective (multiple-choice), mentor, peer-to-peer, and self.

How e-learning is different from distance learning• Student teacher interaction seven days a week.• Highly interactive - Student teacher interaction and Student to student interaction.• Students are given immediate feedback on work done.• Group work and group discussions possible in spite of the distance• Material is available online all the time.• Instructor is available to students all the time.• Lectures can be archived to the student all the time.• It offers continuous /weekly/module assessment

44

Advantages of e-learning• Self-paced learning modules allow learners to work at their own pace• Flexibility to join discussions in the bulletin board threaded discussion areas at any hour, or visit with

classmates and instructors remotely in chat rooms• Different learning styles are addressed and facilitation of learning occurs through varied activities• Development of computer and Internet skills that are transferable to other facets of learner's lives• Successfully completing online or computer-based courses builds self-knowledge and self-confidence and

encourages students to take responsibility for their learning• Class work can be scheduled around personal and professional work• Reduces travel cost and time to and from school• Learners may have the option to select learning materials that meets their level of knowledge and interest• Learners can study wherever they have access to a computer and Internet

Challenges• Slow or unreliable Internet connections can be frustrating• Managing learning software can involve a learning curve• Some courses such as traditional hands-on courses can be difficult to simulate• Unmotivated learners or those with poor study habits may fall behind.• Lack of familiar structure and routine may take getting used to• Students may feel isolated or miss social interaction• Instructor may not always be available on demand

Professor Mbugua speaking at the conference.

44






44






45

Role of the Kenya Medical Supplies Agency (KEMSA)

Presented by KEMSA teamKEMSA supplies hospitals and Rural Health Training and Demonstration Centers on a bi-monthly schedulebased on the orders they submit. Rural health facilities on both pull and push methods are served quarterly.

KEMSA customersKEMSA serves a total of 4001 public (Government and faith-based) facilities countrywide. These includefacilities falling under MOMS and MOPHS and programs such as DOMC, NASCOP, DRH, DLTLD. Distribution ofcommodities depends on the type of commodity, facility level and the supply system the facility is on.

Types of facilities served

Facility Type Push Pull Total

Hospital 0 305 305

Health Centres 410 144 554

Dispensaries 2183 1029 3142

Total 2593 1408 4001

The hospitals served include mission hospitals who receive programme commodities from KEMSA. All hospitals(Levels 4, 5 and 6) are on the demand-driven system i.e. pull system as are rural health facilities in North-Eastern, Coast, Nairobi and parts of Central and Eastern Province. Facilities in the rest of the country receive astandardized kit i.e. are on the push system.

Facilities served according to ownership/affiliation

Facility Type GoK KEC SUPKEM CHAK Total

Level 4,5,6 278 22 1 4 305

Level 3 554 0 0 0 554

Level 2 2587 293 19 243 3142

Total 3313 384 19 285 4001

The KEMSA warehouse in Nairobi is now fully automated and has been operating on a 24-hour basis sinceDecember 2010. There has also been enhancement in human resource capacity in the warehouse resulting indoubled output.

46

Distribution reforms• Enhance visibility of all health care commodities in the supply chain thru receipt confirmation system

within the ERP.• Rationalization of drawing rights based on actual need and available resource basket will positively impact

on the overall customer order fill rate. Task force working on rolling out Pull System to all by Dec 2010.• Distribution using outsourced private transporters.

Customer service reforms• The Logistics Management Unit (LMU) is now collecting consumption data for all Essential Medicines and

Medical Supplies (EMMS).• The information collected will be useful in quantifying and project demand planning.

47

Achievements of selected CHAK departments in 2011

Health Services Support DepartmentPresented by Dr Stanley Kiplagat, Health Services Support Manager

Key roles of HSSD• Trainings in TB, HIV/AIDS, Malaria, child health, Reproductive Health, eye care• Proposal development and programme oversight• Essential drugs and medical supplies• Internship programme• Quality assurance• Advocacy and networking• Technical support and systems strengthening

Technical support to MHUs in 2011• Responded to adhoc requests from 30 MHUs for technical assistance• Did supportive supervision to 150 facilities• Responded to emergency requests for assistance in disasters e.g. H1N1 in Namasoli and cholera in

Turkana• Mentored staff in MHUs on reporting

Management of essential drugs• Ensured that essential drugs list and rational drug use and guidelines were availed and used in MHUs• Encouraged MHUs to procure drugs from MEDs• Coordinated with KEMSA for drug supply to level 2 and 3 facilities (322 MHUs)• Followed up complaints from MHUs to KEMSA• Developed tools for redistribution of KEMSA kits• Facilitated MHUs to participate in MEDS education days and facility based trainings• Monitored the rational use of essential drugs e.g. anti malarial, anti TB and RHF kit

Internship programmeSix CHAK hospitals are involved in the internship training programme as follows:

• AIC Kijabe Hospital – 10 interns• PCEA Kikuyu Hospital – 6 interns• Tenwek Hospital – 10 interns• PCEA Chogoria Hospital – 8 interns• PCEA Tumutumu Hospital – 4 interns• Maua hospital – 4 interns

Advocacy and networking• Health Sector Service Fund: assessment of FBOs is ongoing for possible inclusion in the July

disbursement.• CHAK facilities are represented in the Nursing Council of Kenya by a member of the department.

48

• There is also representation in several MOH technical committees including those on HIV, Malaria,Child Health, Reproductive Health, Water and Sanitation.

Malaria updates• This was done through funding from Global Fund Round 4 Phase I and II. At the end of Global Fund Round 4

phase I, 400 health care workers had been trained and ITNs distributed to over 120 health facilities. GlobalFund Round 4 Phase II started in March 2010.

• Additionally, 140 health workers were trained through a MEDS grant.

Global Fund Round 4 Phase II Objectives/targets• Train 400 health care workers on malaria case management• Train 180 hospital managers on effective management of malaria commodities• Conduct four field visits• Distribute Rapid Diagnostic Test kits (RDTs) to four districts

Achievements• 184 health care workers trained on malaria case management• 30 hospital managers trained on effective management of malaria commodities• Three field visits conducted

Reproductive Health (RH) programmesA new RH project funded by World Bank in which CHAK is partnering with CCIH and Georgetown Universitybegan in February 2011. It is a one-year project.

Objectives of the project• Strengthen the capacity of faith-based health providers to offer FP information and services• Build capacity of community health workers, religious leaders and other community stakeholders to

mobilize community demand for FP• Strengthen the linkages between CHAK and the MOH/national FP programme by improved

communication, planning and reporting processes

Activities• TOT training of 13 health workers has been done.• Cascaded training of health workers, CHWs and religious leaders• Provision of IEC materials and supplies to CHWs for community-based FP• Monitoring and evaluation• Linkage with the MOH reporting structures

TB updatesThese were done with funding from the Global Fund Round 6 implemented in 15 sites. The project whichended in June 2010 also had the following activities:

• Site assessment to identify needs of the sites• Training of 60 health workers on HIV/TB integration• Training of 150 Community Health Workers to on community TB work• Support of the CHWs to do community TB work• Renovations of 5 laboratories to do TB diagnostics• Support supervision• Support health care workers to attend district TB/HIV stakeholder forums.

49

• Support for postage of reports to CHAK Secretariat

Achievements• Trained 60 health workers on HIV/TB integration• Trained and supported 164 CHWs to do community TB work• Renovated five laboratories• Did four site support supervision visits• Supported 30 health workers every quarter to attend the district stakeholder meetings• Supported postage of reports monthly from the 15 sites

CHW TB ActivitiesNo. of cases referred to health facility 500

TB suspects referred by CHWs and tested 300

No. of cases enrolled under care of CHWs 300

No. of defaulters traced 100

No. of patients who completed treatment 86

No. of patients referred due to side effects 20

No. of Health Education forums held by CHWs200

Other TB activities in MHUs• Intensified case finding• Improved treatment outcomes• TB/HIV integration• TB case management trainings

Water and sanitation projectGoalTo reduce diarrhoeal morbidity and mortality especially in children under five years in the target regionsthrough access to safe drinking water and adoption of hygienic practices, especially hand washing with soap,using health facilities as the entry point

Target populationThe project is being implemented in 180 health facilities in selected cholera prone regions and their clientcommunities. It is targeting at least 100,000 people in Nyando, Rachuonyo, Siaya, Bondo, Busia, Pokot andTurkana counties.

Project partnersCHAK is leading the project in which it has partnered with:

• Safe Water and Aids Project (SWAP)• Centres for Disease Control & Prevention (CDC)

50

Expected results• Clients and health workers at 180 health facilities in the target regions accessing safe drinking water

and facilities for hand washing with soap by October 2011• 180 health workers in 180 health facilities trained in hygiene promotion focusing on treatment and

safety of drinking water and hand washing with soap by October 2011• Communities (at least 100,000 people) in the catchment areas of health facilities reached with point-

of-use water treatment and storage, and hand washing messages by October 2011; safe drinking waterapproaches and hand washing with soap adopted by at least 50 per cent of the target population

Activities conducted were as follows:• Baseline survey in 30 health facilities• TOT trainings targeting 20 trainers• Regional trainings targeting 180 health workers• Establishment of hand washing and water drinking stations in the health facilities and communities• Community outreaches.

HIV/AIDS activitiesGlobal Fund Round 7 HIV ProjectSpecific objectives of the project are as follows:

• Conduct 101 mobile counseling and testing events through 8 CHAK health facilities to reach 9,090clients by March 2011

• Sensitize 750 PLWHAs and their families through 50 meetings for improved uptake of HIV/AIDSprevention and treatment services through 8 CHAK health facilities

• Conduct 261 community outreach events to sensitize youth and MARPs on HIV counseling and testingthrough 8 CHAK health facilities

• Sensitize youth and MARPs on sexual behaviour change through 48 Youth-to-Youth activities in 8 CHAKhealth facilities

Service delivery areas• Mobile HIV testing and counseling• Sensitization of PLWHAs and families on ART• Community outreach events for youth• Youth to youth activities including HIV prevention activities

Project sitesHealth Facility District Province

1. Kapsowar Hospital Marakwet Rift Valley

2. Kaimosi Hospital Hamisi Western3. Kima Hospital Emuhaya Western4. Namasoli Health Centre Butere Western5. Dophil Health Centre Siaya Nyanza6. Ngiya Health Centre Siaya Nyanza

7. Zombe Dispensary Mutitu Eastern8. Zion Community Health Clinic Kilifi Coast

51

AchievementsPerformance indicators %age

achievements1. No. of Mobile HIV C&T events held. 95%

2. No. of women and men aged 15-49 C&T and received their testresults

90%

3. No. of sensitization meetings held targeting PLWHAs and theirfamilies

413%

4. No. of PLWHAs sensitized on ART (disaggregated by sex) 820%5. Number of family members of PLWHAs sensitized on

ART(disaggregated by sex)652%

6. No. of Community Outreach Events for youth 223%7. No. of youths sensitized on HIV C&T for HIV prevention

(disaggregated by sex)1208%

8. No. of youth groups formed 100%9. Number of youth groups maintained 100%10. No. of youths in the maintained groups sensitized on HIV prevention

(disaaggregated by sex)100%

Criteria for selecting sites for Global Fund Round 7 HIV Project• Demand for HIV/AIDS care and treatment• Capacity for the rapid implementation of HIV prevention activities• High prevalence of HIV• Previous experience in the implementation of HIV/AIDS prevention and treatment activities

Challenges• Sites had capacity gaps in programmatic and financial reporting leading to delayed and incomplete

reports.• There was no budgetary allocation for monitoring and evaluation therefore inadequate site support

supervision to address the gaps.• The sites did not receive budgetary provisions for administrative support as the budget was based on

unit costs of events. There was therefore lack of management support for the project in the sites.• Sites did not have dedicated GF R7 accounts. It therefore proved difficult to determine the expenses

that were incurred for GF R7 activities.

AIDSRelief- KenyaThis is a faith-based consortium made up of four partners: CRS which is the lead CMMB IHV/University of Maryland Constella Futures

The project has 29 local partner treatment facilities and 100 satellites providing HIV care.

52

AIDSRelief transitionThe US government is seeking to transition the AIDSRelief programme to a consortium of local partnersmade up of MEDS (lead), CHAK and KEC (sub grantees) and University of Nairobi (Local TechnicalOrganization).

The transition process started in 2008 with sustainability meetings of all the eight partners involved. Manymeetings and workshops have been held aimed at: Clarifying the process Ensuring buy-in and ownership from the heads of the eight organizations involved Creating understanding among the technical staff

The initial components of the programme to be transitioned were finance and grant management, sitemanagement and health systems management. A joint office has also been opened for synergy and easycoordination of the programme and was dedicated in February, 2010. The office has eight officers from KECand CHAK and three from MEDS.

Summary of AIDSRelief patient numbers by site

ChogoriaKenduAdventist

Kijabe Kikuyu Lugulu MasenoMauaMethodist

Mombasa CBHC

Tumutumu

Totals

Achievement inall the ARsites

Total number of unique patients that received HIVcare during the last 3 months 2,475 4,604 4,604 2,024 2,444 2,262 2,374 1,888 1,540 24,215 62,817

Males (0-14 years) 224 354 354 133 232 239 216 166 1142,032

5,527

Males (15+ years)645 1,220

1,220565 523 524 548 442 372 6,059 15,626

Females (0-14 years)224 347

347140 220 244 289 164 125 2,100 5,661

Females (15+ years) 1,382 2,683 2,683 1,186 1,469 1,255 1,321 1,116 929 14,024 36,003

Current number of patients on ART (CDC QuarterlyReport - Table 2, Column 6)

1,713 2,832 3,494 1,406 1,778 1,447 1,571 1,165 1,126 16,532 41,766 Males (0-14 years) 140 106 217 55 131 81 134 70 74 1,008 2,481Males (15+ years) 489 841 1,010 418 427 395 399 303 281 4,563 11,561

Females (0-14 years) 109 120 196 57 122 96 150 75 79 1,004 2,440Females (15+ years) 975 1,765 2,071 876 1,098 875 888 717 692 9,957 25,284

53

Summary of achievements• There are a total of 62,817 pts in the 29 sites plus 100 satellites• The number of adults on ART are 41,766• The number of children on care are 11,188• Children on ART are 4,921• The project is in nine major CHAK hospitals and over 20 CHAK satellites.

The project continues to provide quality HIV care in FBO health facilities in addition to human resourcesupport and equipment. It has provided for health systems strengthening and built the capacity of healthcare workers to offer high quality services.

The CHAK HIV and Human rights projectThe CHAK HIV/AIDS and Human Rights project is based on the premise that HIV/AIDS is a human rights issueand HIV/AIDS interventions work best when there is a supportive legal and ethical environment, in which therights of those infected and affected by HIV/AIDS are given maximum protection and promotion.

Activities1. Capacity building involving: On-site training for health care workers on the rights-based approach which has been conducted in 15

sites and a total of 340 health workers trained. On-site refresher training for TOTs on human rights which has been conducted in 15 sites and a total of

420 TOTs retrained. A two-part training on economic empowerment for PLWHAs: A total of 21 participants have been

trained from six facilities (Zion, Kaimosi, Litein, Kapsowar, Tumutumu and Kijabe) Sensitization training for community opinion leaders on Alternative Dispute Resolution has been

piloted in seven project sites and a total of 180 leaders trained.

2. Community mobilizationThis involves open day forums for free legal services and follow up of cases referred and those in court.A total of 2,976 clients attended the legal clinics while a total of 409 cases were reported.

3. Networking and collaboration4. Documentation5. Monitoring and evaluation under which an evaluation of the project was conducted by OSI and Harvard

University and site supervision visits conducted.

Challenges• Transfer of some of the TOTs from the OSI project sites has slowed down raising of awareness in those

regions.• Some TOTS raised concerns of being threatened by suspects of potential cases that they have been

following up.• Reluctance by members of the public to report human rights violations to the local police due to fear of

harassment and intimidation.• Lack of cooperation from the police in arresting alleged suspects of HIV related human rights violations• Laxity on the part of some area chiefs in addressing some of the cases referred to them. Some of these

administrators have been accused of human rights violations.• The impact of the HIV and AIDS Prevention and Control Act, 2006, is yet to be seen since it has been in

force for only 1 year and most people are not familiar with it.

54

HIV pre-service projectThis project is a partnership between CHAK-KMTC-JHPIEGO and is funded by CDC. It targets to strengthenHIV content in pre-service curricula in GOK and FBO medical training colleges.Key activities

• Infrastructure assessment of 20 training institutions• Incorporation of changes into curriculum in various cadres• Capacity building of tutors• Training of students using the revised curriculum

The APHIA II Nyanza projectThe goal of this project which began in 2006 is to reduce the risk of HIV transmission and fertility rate inNyanza. It is a partnership of CHAK, AED, Engender Health and PATH, IDCCS. The project’s strategy involvescomprehensive care and treatment at the facility level, information, education and communication at thecommunity level and care and support to PLWHAs at the family level.

Progress reportCounseling and Testing services

• 65 HIV Testing and Counseling settings (VCT, PITC & TB C&T) have been set up against a supportedyear two target of 50.

• 56 community health educators have been trained in counseling and testing to support ComprehensiveCare Centres against a target of 90.

• Health facility-based counselor supervision meetings have been held.• Mobile VCT outreaches and moonlight counseling and testing have been conducted.• 20 VCT counselors have been trained.• A total of 53,071 clients (PITC – 13,491, VCT 36,667, TB 2,913) were reached in year 2 against a target

of 15,000.

C&T Targets Vs Achievemnets

0

10,000

20,000

30,000

40,000

50,000

60,000

Q6 Q7 Q8 Q9 Year 2

Period

No. C

&T Achieved

Target

55

PMTCTAbout 60 PMCT sites have been engaged and four PMCT trainings held for FBO and GoK facilities. About 150health care workers were trained. Mentoring of health care workers for EID has been on-going and DBScollection materials, logistical support for PCR and job aids have been provided. The Child at Risk TracingInitiative (CRTI) traced 94 minors of whom 62 had results and 17 were HIV positive. Health Care workersensitization on PITC continued to be a major focus during the year in 54 facilities and 146 health careworkers were reached.

Palliative care servicesAbout 48 sites have been engaged for palliative care in addition to:

• Lab networking and materials support• Mentoring of health care workers• Support for volunteers in CCCs and facilitation of CMEs

About 47,079 patients are on palliative care against a target of 30,000.

ART therapy servicesAbout 44 sites were supported with ART against a target of 20. Two adult ART trainings were conducted andsites facilitated for CME and consultative meetings. Sixteen volunteers from community support groupssupported the health care workers with CD4 blood sample transportation, filing and defaulter tracing. About14, 272 patients, representing 30 per cent of those on palliative care, were on ART.

15,049

12,927

16,114

14,272

8,824

7,000

16,114

14,272

8,824

7,000

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Achieved Target Achieved Target Achieved Target Achieved Target Achieved Target

Q6 Q7 Q8 Q9July-Sept 2008

Y 2Achieved

Year 2July 07 -Sept 08

Achievement by Period

ART Provision

#individualsnew ly initiatingART

# individualsever receivedART

# individualsreceiving ART

56

Male circumcision uptake in Nyanza

Prevention of Mother to Child Transmission of HIV&AIDS (PMTCT)Funding sources

• APHIA II Central• APHIA II Nyanza• ICCO

Achievements• 17 facilities were brought on board to offer PMTCT services• The number of ANC mothers counseled and tested in ANC clinics were 1,558 by September 2010• Of these, 46 ANC mothers were HIV-positive.• Those tested in maternity were 125 and five of them were HIV-positive.• Exposed infants tested with PCR were 236.• The PCR results received were 164 and only eight infants were HIV positive.

APHIA Plus HIV project Zone 4This project covers Central and Eastern provinces and is being undertaken by a JHPIEGO-led consortium of 10members, including CHAK, which is expected to do HIV care and treatment in FBO facilities. Six staff havealready been recruited and start-up activities are on-going.

438

143 (33%)

305

69 (23%) 683

337 (49%)

0

200

400

600

800

1000

1200

Q10 Q11 Q12

Number C&T for HIVNumber Circumcised

57

Kendu Bay Population Council PartnershipA study done by Population council in Kendu Hospital and its catchment area revealed low uptake ofpaediatric HIV services. A number of interventions were designed in partnership with CHAK to address thebarriers to utilization of pediatric HIV services at the hospital.

Interventions• Capacity building of health workers, community health workers and pastors to create demand for

services• Community outreaches• Provision of PMTCT supplies• Staff support with one clinical officer and one nurse• Use of mentor mothers

The one-year intervention has come to an end and an end of project research is planned to assess impact.

Questions and discussions The participants emphasized the importance of sending service reports to the Government and

CHAK. Members thanked CHAK for assistance with the doctor’s internship programme. It was however

noted that there had been some confusion with regard to the start and end dates of the internshipprogramme. Participants were told that this had been occasioned by a three-month gap in theinterns’ programme in 2011.

Criteria used to distribute the doctor interns: The hospital concerned is expected to write to theDentists and Medical Practitioners Board who visit to assess the available facilities and establishwhether there are consultants in four key areas. Other factors that determine eligibility to run adoctors’ internship programme include the capacity of the hospital and availability ofaccommodation for the interns. Hospitals are initially allocated four interns.

How will the six APHIA PLUS staff be involved in the facilities? Participants were informed that theAPHIA PLUS staff worked in all facilities in the Eastern region. It was also noted that some facilitieswere benefiting from the AIDSRelief programme. It would therefore be important that a single facilitydid not benefit from both projects to ensure equitable distribution of resources.

What is the criteria for selecting facilities to benefit from CHAK projects and programmes? The mainconsiderations are past performance and capacity to implement a particular project. Site assessmentsare done in more facilities than are needed for the project. Developing an Annual Operational Planwould ensure that more facilities benefit from the resources available. In addition, the RegionalCoordinating Committees would be useful in identifying facilities to implement certain projects.Facilities that are not implementing any CHAK projects need to establish dialogue with those in theirregions that are benefiting to identify opportunities for collaboration. CHAK, however, needs to domore to ensure more members are utilizing the resources available.

Who are benefitting from the Safe Water Project currently being implemented by CHAK? The projectis designed to benefit facilities that have clean drinking water and no places for hand washing. Abaseline survey was used to identify such beneficiaries.

Facilities that were benefitting from the APHIA 1 PMTCT project in Central region received only onefunding installment and but spent much more. Participants were informed that APHIA II Central hadpromised to refund whatever was due to the facilities although the project was winding up. Themoney would be released within one week.

58

Institution and Organisation Development Department (I&OD)Presented by Patrick Kundu, Manager, IODIntroductionThe I&OD department assists CHAK health facilities to deliver quality health services throughcapacity building which involves:

• Building of physical infrastructural capacity (architectural and medical equipment)• Building MHUs’ human resource capacity in management and governance

Human Resource capacity buildinga)Project Formulation & Proposal writingi) National workshop was held for 30 participants from MHUs (21-25th December 2010)ii) Strategic Planning: Assisted RCEA Plateau Hospital and Tei Wa Yesu Health Centre in developing

strategic plansiii) Learning and experience sharing exchange visits: Facilitated management of MCK Maua hospital

to visit AGC Tenwek hospital

Regional Coordinating Committees (RCCs) Held 2 meetings in each region. Focus was to plan for new year and to review activities of previous

year;• Nyanza & South Rift – 25/2/10 & 9/12/10• Western & North Rift – 26/2/10 & 10/12/10• Eastern & North Eastern –11/3/10 & 14/12/10• Nairobi/Central/Coast & Ukambani – 30/3/10 & 15/12/10

The RCCs reached 150 MHUs in 2010

Western & North Rift RCCThe RCC held a workshop on sustainability for 27 participants from MHUs on 27-30thJune 2010. A follow-up consultative meeting for improved partnership with MOH (MOMS & MOPHS) was held at the WesternProvincial headquarters in Kakamega on March 23, 2010.

Nyanza & South Rift RCCThe RCC held a workshop on sustainability for 26 participants from MHUs on October 3-6, 2010. A team of 12RCC members held a follow up consultative meeting for improved partnership with MOH (MOMS & MOPHS)at Nyanza Provincial Headquarters on October (18, 2010.

Rift Valley MHUsA team that was put together by the RCC chairmen for Western & North Rift, Nyanza & South Rift andNairobi/Central/Coast & Ukambani in 2009 to represent Rift Valley MHUs held a follow up consultativemeeting with Rift Valley MOH ( MoMs & MoPHs) at Nakuru Provincial headquarters on June 22, 2010.

Governance and management supportThe department participated in Board meetings for ACK Maseno Hospital, Friends Kaimosi Hospital and AICKijabe Hospital.

Architectural support servicesThe scope of these services includes:1. Site visits inspection and assessment

59

2. Architectural design and production of drawings3. Production of technical specifications4. Costing and schedule of materials5. Production of tender documents6. Supervisory support during construction

AGC Tenwek Hospital• Designed a CT Scan and Radiology Unit• Supervised to completion construction of five two-bedroom units for medical interns• Commenced support to construction of another six two-bedroom units for Medical Interns

RCEA Plateau hospital Designed an X-ray unit for an abandoned block

PCEA Tumutumu hospital• Made design improvements on the mortuary block for the hospital• Produced a revised design layout for the hospital’s CCC

PCEA Chogoria hospital• Produced design proposal for a new dental Unit• Produced a revised design proposal for new MCH/FP unit

Health Care Technical Services (HCTS) programmeIntroductionA restructured and centralized HCTS which emphasizes on specialization has been in operation for threeyears. Despite severe competition, significant strides towards sustainability have been registered.

Services offeredThree categories of services are offered:

X-Ray Services Anesthesia Services General Services

The services cover repair works, service/calibration, installations, supplies and technical advice. In 2010 atotal of 40 mission health facilities were supported by the programme.

Financial performance in 2010Total Income: Ksh5,073,094.00Total Expenditure: Ksh5,582,394.00Net Performance: Ksh(509,300.00)

Expected Performance: Ksh604,060.00

The performance was not as good as expected due to: Debts The debtors tended to avoid working with the HCTS technicians CHAK management: Operational funds are not easily available. There is also lack of a rapid

response mechanism.

60

New developmentsRefurbished x-ray equipmentThe National HCTS is working with the African Medical Support Centre and US partners in sourcing forrefurbished X-ray machines. CHAK facilitates importation and delivery of the equipment to the NHCTSworkshop. Two x-ray units that are fully tested and ready for dispatch are currently at HCTS workshop.One hospital has expressed interest in acquiring one x-ray unit and is working out modalities to have itsupplied and installed. The x-ray units are offered with a maintenance package and a reliable aftersales supply of spare parts

Quality assurance and radiation safety servicesNational HCTS is licensed by the Kenya Radiation Protection Board to provide quality assessmentservices for X-ray repairs and calibration. Member health units may seek this service which is doneannually or when need arises from the National HCTS workshop.

The Kenya Bureau of Standards (KEBS)The Kenya Bureau of Standards (KEBS) has appointed HCTS technical officers to KEBS HospitalEquipment Technical Committee which sets standards for new items brought in to the country andnew ones being manufactured. The technicians have been involved in setting standards for varioushospital equipment and disposables such as wheel-chairs, disposable circumcision devices, syringes,among others. Even where items have international and ISO standards, a Kenyan standard is producedto take care of the gaps in levels of technology. The committee also sets standards for new innovationsby Kenyans before they are introduced into the market.

Challenges• Conflict between customer expectation in terms of rapid response & CHAK policies with regard to

procurement, transport and availing funds for work.• Some clients with debts shy away and opt to source for new service providers.• Lack of appropriate transport e.g. an open pick-up van to carry machines from the field to the central

workshop for repair.• Some health units do not consult HCTS team when acquiring equipment and only seek assistance when

such donations pose challenges.• Frequent turnover of the HCTS Board members and hospital administrators makes continuity of

services and debt collection difficult.

Questions and discussions There is need to give more work and responsibilities to the RCCs. CHAK member health facilities can benefit from a biomedical training that takes place in Rwanda. The HCTS programme needs to send out constant reminders to its debtors as such debts are often

forgotten. A contributor felt that CHAK should intervene to ensure that dispensaries benefit from the

Constituency Development Fund (CDF). Currently, faith-based health units are perceived as privatefacilities and often left out when constituency funds are allocated. However, members were urged tobe cautious as it had become common for politicians to lead communities in grabbing church facilities,especially those developed using CDF. It may therefore be necessary to lobby politicians to supportchurch facilities in their respective constituencies and train MHUs on how to access and utilizedevolved funds.

Eye problems have become prevalent. What is CHAK doing towards training ophthalmic nurses? CHAKheld discussions with CBM towards supporting eye care within the network but these plans had to be

61

abandoned as the CBM experienced a major budget cut. However, CHAK will keep members updated incase of any developments.

Maseo Hospital expressed gratitude to CHAK for its assistance in improving the hospital’s governance. Members requested that learning exchange visits between facilities be organized to improve services.

The meeting was informed that the programme was running and members who wished to benefitwere required to submit a proposal for consideration. Facilities’ response to the programme hashowever been poor.

What is the composition of the RCCs? There is an urgent need to overhaul the RCCs. The RCCs startedwhen CHAK invited a representative from each facility in each region to a meeting. The facilities weregiven guidelines to come up with a 12-member committee incorporating the Government. A number offacilities would be under each member of the committee. On completion of the exercise, letters weresent out telling members who their representative was. However, this took place about five years agoand there is urgent need to reconstitute the RCCs.

How does CHAK select the facilities to benefit from its programmes? This is mostly determined by theprojects’ demands. Some facilities have tended to benefit more than others and there is need toensure that all members benefit.

Data collection and M&E: CHAK is in the process of developing a common reporting tool to ensure datagets to the Secretariat to enable lobbying and advocacy.

62

Embracing new technology for health: CHAK HMIS SoftwareBackgroundThe CHAK HMIS software is the result of a long-held belief that it was possible to have a software specificallyfor CHAK member units. CHAK member units had experienced poor software support from vendors and oftenrequested CHAK to intervene whenever they experienced breakdowns. In addition, the available commercialsoftware was expensive and not standardized.

CHAK therefore had three options:a) Buy already existing software from the market and distribute to members

This would have been the simplest option since the vendor would have taken care of all logistics andsupport with regard to the software. Due to economies of scale, this option was also seen as cheaperthan others. However, given past experience with commercial software, there was a possibility that itwould turn out to be extremely expensive.

b) The other option was to design a programme from scratch. However, it was thought that this wouldturn out to be time consuming and expensive with high risk of failure.

c) The third option was an open source software which could be customized to meet the needs of CHAKmembers. This was seen as the most feasible option as other countries had taken a similar route with adegree of success. It was also cheaper as most of the work had already been done.

StrategyTo ensure the software took care of the needs of member units, CHAK took the following measures:

• Input was garnered from member units• Experts in clinical, administration and IT sections also gave their input.

CHAK was able to gather and synthesize their needs and fears before holding a consultative workshop inwhich all CHAK hospitals, some health centers and some dispensaries participated. The software’s pilot wasalso discussed during the workshop.

Outcomes of the consultative workshop• It was agreed that Open Source Software was the most viable option.• A Technical Working Group (TWG comprising people in administration, clinicians and IT was formed.• CHAK Secretariat was tasked to look for software that would be easily adaptable to member units.

Two softwares were found to be most viable, i.e. Care2x and OpenMRS.

Care2xThis software was almost complete and already in use in Lutheran hospitals in Tanzania. AIC Kijabe Hospitalhad also tried it. A lot of work had been done to integrate it with an ERP (Enterprise Resource Planning)WepERP and some clinical functions were available. In addition, a PHP programmer was readily available towork on the software.

The Tanzania Lutheran Church was contacted and agreed to give CHAK the version of the software that theywere using. Programmers then looked through the software and identified the issues that needed attention. Inaddition, a time frame in which the software would be finalized and pilot done was established.

63

OpenMRSThe OpenMRS is mostly being used for HIV clinics. Although the modules are not yet linked, it has a goodconcept dictionary. It would however take time and substantial resources to adapt and make it user friendly forthe CHAK network.

It was decided that both systems be used with Care2x being adapted first after addition of a payroll andcashbook. In addition, CHAK was tasked with identifying resources to work on the OpenMRS.

PilotSelection criteriaIt was decided that the software would be piloted in two hospitals and two lower health facilities. The facilitieswould have no existing software but would be required to have funding and some networked computers.

Where are we now?Care2 XThe pilot started in January in Soweto Kayole PHC Clinic and February in Maseno Hospital. All general moduleshave been completed and are working well in the pilot sites. The system has been working in the pilot sites forover 6 months with a degree of success and it is expected that rollout to other MHUs will be done soon.OpenMRSA concept paper has been developed and a number of proposals written. Meetings have been held withpotential donors and MOH HMIS department. Backstopping has been agreed upon and potential programmersidentified.ResourcesCHAK Secretariat wrote a proposal to CMMB and was given seed money to start the project. CHAK also used itsown resources in the pilot while AidsRelief supported networking and purchased computers for MasenoHospital. It is expected to provide similar support to St Lukes Kaloleni Hospital.

SupportThis was identified as a big challenge at the consultative workshop and a thorough evaluation was aprerequisite. It is very costly in terms of time, travel and accommodation. CHAK has embraced technology toprovide this support.

Selection criteria for beneficiaries• There should be a computer network in place at the facility.• A server is preferable.• There should be at least seven computers in a hospital and four in a lower health facility.• Internet connectivity is a must.• The facility’s leadership should be committed to the success of the software.• Staff, especially clinical, should be receptive to the change as they are the originators of the usage

chain.• The software is offered on a first-come-first-served basis.

Challenges• The demand is high but hands are few.• Is it possible to continue providing the software free of charge to facilities?• A lot of time is spent in one facility.• Many facilities do not have the requisite infrastructure.• IT staff in MHUs are sometimes unable to handle the demands that come with the software.

64

CHAK Mobile Data Reporting SystemThis system has been developed due to poor reporting by MHUs. CHAK requires data for advocacy from MHUsbut this has not been forthcoming due to high postage costs and lack of motivation for MHUs to send the data.In addition, donors require data if they are to continue supporting projects. This system allows facilities tosend data not only on the computer but also via their mobile phones as long as they have internet access.

Advantages of the system Reporting is now easier and faster• No data entry• Analysis is easier• User friendly• Phone and computer interface• One can upload photos.

The system can be accessed on chak.spidtel.com with the user name chak and password chak. One shouldensure that they fill in all the mandatory sections marked with an asterisk.

Questions and discussions Does the software need clearance with CCK or KEBS? This is an international software, hence no clearance

is required. Can the data form in the reporting system be saved in the institution’s database once it is completed? It is

possible to print it and file it away. How often should facilities report? This should be done at least annually although the newly developed

reporting system can take many more forms. . The reporting system is secure hence no risk of viruses. Due to the high cost of the HMIS software, CHAK should consider charging a nominal fee. The Government is developing HMIS standards. Is what CHAK is doing compatible with the Government

systems? It may not be possible to have one system with the Government but HMIS systems need tocommunicate.

theme: kenya; the role of church health system ˛ … annual health...information and services the...

Documents