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Multi Stakeholder Partnership (MSP) Annual Stakeholder Forum

Multi Stakeholder Partnership (MSP) Annual Stakeholder Forum

31ST JANUARY 2019

Achievements and Learnings of the MSP project by Vincent Ibworo, MSP Project Manager

Vincent gave a snapshot of what work the project has done in relation to:

  • Health Records and Information Officers (HRIOs)
  • Community Health Workforce (CH workforce)
  • Emergency Medical Technicians (EMTs)

Professional Association best practices by Daniella Munene, CEO – Pharmaceutical Society of Kenya (PSK)

PSK has about 1000 members, 10 branches, annual membership approval and there is a national governing council (NEC) for decision making. The secretariat reports to a committee which is a subset of the NEC.

How to strengthen HRH through an association:

  • CPD: we provide opportunities to our members so that they can get the points they need to renew their licenses.
  • Self-Regulation: Compliance standards are required for membership; accreditation mechanisms (not required by the regulator but we have endorsed the green cross as a way of self-regulation).
  • Advocacy: As an association, we are well placed to influence policy and regulation by participating in government working groups, task forces etc. A professional association’s relationship with the government needs to be friendly but firm.

Healthcare trainings by Dr. Solomon Kilaha, KMTC Deputy Registrar Curriculum

KMTC adheres to the National Policies in relation to training. We emphasize on the framework set by the government because we want to align with Vision 2030. At the same time, we need to adhere to the workforce needs and also changes in the profession. We have quality management systems that regulate new programs that are being started in our colleges.

We are focusing on 3 out of the 70 cadres because these three cadres required more strengthening.

  1. HEP program: This faculty focuses on public health and provides training in health promotion, health extension work, community health extension workers, health assistants and a short course in drug addiction management.
  2. Health Records and Information Program:
    1. Diploma in health records and information
    1. Certificate in Health Records and Information
    1. Upgrading Diploma in Health Records and Information
    1. E-learning (Diploma in Health Records and Information).
  3. Emergency Medical Program: First Aid, Nurse Anesthesia, Clinical Medicine (Anesthesia and Emergency); short courses:
    1. BLS and ACL
    1. Emergency Medical Technician
    1. Diploma in Pain Management.

Presentations from Professional Associations

HRIOs: They asked for assistance with the implementation of the Act, developing of training materials (Knowledge management and protection structures)

EMTs: An EMT predominantly provides services pre-hospital and out of hospital settings. They provide timely access in the out of hospital setting which ensures that patients get the right services before they reach the hospital.

Gaps:

  • Lack of legislation.
  • Lack of awareness on EMT.
  • Lack of direction on the policy.
  • Lack of funding.
  • Lack of centralized control center: we need an information center deployed by the government to deal with emergencies.
  • EMTs want assistance in launching EMS policy, drafting an EMT bill and empowering of the EMTs.

CH Workforce: One of our challenges is that there isn’t standardized training for CH workforce. In terms of policy, program management is one of the problems.

Government response by Dr. Salim Ali, Head Community Health & Development Unit-MOH

We are currently finalizing the review of Community Health Strategy and there are standards in place. With the current focus on UHC, CH workforce will play a very critical role in the achievement of UHC.

There was a query on EMT policy but the issue is that the MoH would like EMTs to sit within the larger EMS policy. We need to have evidence-based decision making.

We need to look at health strategy in totality with emphasis on policy review and development.

Panel on UHC Counties

Opportunities and Challenges in Roll out of UHC

  • CEC Health Member Isiolo: We only have 7 CHEWs in the whole County. One of the problems is that we are always confronted with issues in relation to salaries. Unfortunately, our staff hiring is not informed by needs assessment.
  • CEC Health Member Machakos: We are really trying in terms of emergency care in Machakos. In terms of CH workforce – we have volunteers and we still need support from all stakeholders. Community health is an area where there are different professionals and we really need to define who a CHEW is. We have 27 HRIOs but we need over a hundred in Machakos. We need to discuss how to strengthen this.
  • Anne (Nyeri): We are piloting therefore there are no challenges since part of piloting is to see what the challenges are.
  • Isiolo: What informed the choice of Isiolo as one of the pilot counties is that we have one of the highest maternal mortality rates. Challenges:
    • HRH is a big challenge for UHC; we are operating at 45% capacity. We also don’t have resources to manage the salaries of the current lean workforce.
    • This forum has been an opportunity as a policy maker to understand which cadres require strengthening.
    • Health Supplies: we are engaging Meds and Kemsa
    • Referral system: the size of our county and the distances between facilities (average of 49 kms) and lack of infrastructure makes it difficult.
    • Emergency: We are discussing on how to outsource ambulance services.
  • Kisumu: What are you doing differently? In Kisumu, we really love our partners and I would like to highlight how we are implementing.
  • We are lucky that in our governor’s manifesto, UHC was a priority so we had already started efforts towards UHC.
  • We are working with Pharm Access to achieve UHC as envisaged in our government manifesto. Enrolment to NHIF is ongoing; we are also focusing on government sponsored insurance scheme.
  • We have been struggling to get a budget for salaries for CH workforce, but we have included a stipend starting this month.
  • Because of high prevalence of HIV, malaria and TB, we need to find out how to bring this down. We are focusing on prevention, promotion and early detection.
  • It is high time that through public and private partnership we think of how to meet the unmet needs in the sector.
  • 70% of our budget goes to salaries so we have to think about how to make this sustainable for counties.
  • Machakos: highest road traffic accidents and this is the reason we were picked for UHC. Before the pilot, our county got 70 ambulances to deal with this issue. We are happy to be in this program because we want to learn on how to budget for health when we are going to give free services? We are only charging level 4s and 5s. At the end of the year we will consider whether this should be scaled to other levels of health facilities. We are doing renovation of our health facilities.
    • We have 2500 CHVs, putting them on the payroll will be difficult. We give them incentives when we can afford.
  • Nyeri: How can the private sector work with you? We are supposed to get 70% of our supplies through KEMSA but KEMSA is not prepared for this. We are supposed to get all reagents from them, but they are not ready in terms of capacity. We need the private sector to do subsidized care in order to assist with the challenges. Can the national government pay the private sector to provide health services?
  • Isiolo: We have not had many PPPs but I am a firm believer that partnership is key in service delivery. We have been engaging with living goods (NGO) for CH strengthening. We are looking at developing financing designs; the challenge is that the population cannot pay.
  • Kisumu: We need to be able to decide what to do with the grants on our own rather than at national level.
  • Machakos: There are many ways that we can partner with private sector.

Rosemary Obara: We get equipment for free on the agreement that we buy the reagents from the same company.

Ruth Mutua: I want to thank Mtiba who are helping us with registrations.

Way Forward:

  • Best Practices in Associations: you should avoid divisions and embrace unity. When the association is strong, you will get to the level of having a regulatory board.
  • Full implementation of the Health Act.