Kenya

 {Photo credit: Anteneh Lemma/MSH}The Health for All Campaign in Kenya is hosting a series of debates on universal health coverage.Photo credit: Anteneh Lemma/MSH

“I wish I had called this event,” said Mr. Simone Ole Kirgotty, CEO of Kenyan National Hospital Insurance Fund (NHIF). This came as a surprise to many since the CEO was bombarded with critical questions and comments about the activities of the organization he has been leading for the last two years. “If it was new for me to lead such a controversial organization, I would have run away after all these comments,” added Mr. Kirgotty cheerfully.

It was during a public debate in Nairobi, organized by the Health for All: Campaign for Universal Health Coverage in Africa (Health for All Campaign), that the CEO of Kenya NHIF made these remarks. The debate, entitled: “Improving Communications to Scale up Public Engagement with NHIF: Challenges and Prospects,” was part of a series of debates being conducted in seven counties in Kenya. As highlighted by Dr. Daraus Bukenya, Country Representative for MSH Kenya, the major objective of the debates is to get clarity on NHIF activities, to create a platform for community engagement, and to identify and put together recommendations to NHIF to work toward universal health coverage in Kenya. The first debate was held on November 17, 2014 in Nyeri.

{Photo credit: Chelsey Canavan/MSH, in Kenya.}Photo credit: Chelsey Canavan/MSH, in Kenya.

“While Kenya has seen improvements in areas like HIV care and treatment and child survival, many Kenyans still struggle to access basic healthcare,” says Dr. Jonathan D. Quick, President and CEO of Management Sciences for Health (MSH), in an op-ed published today in The People, a Kenyan newspaper.

Quick returned to the country to speak at Kenya’s launch of the Health for All: Campaign for Universal Health Coverage in Africa (Health for All) last month.

In the op-ed, Quick highlights the country’s progress toward universal health coverage (UHC) and the role of Health for All:

The campaign’s role is to help build awareness at national and county levels about the importance of expanding access to healthcare, and to ensure that issues like infrastructure, health workers, and financing receive adequate attention in the planning process.

{Photo credit: Todd Shapera.}Photo credit: Todd Shapera.

In a health clinic outside Nairobi, Kenya, Janet* waits to see a doctor. Janet is a 32-year-old widow and mother of four from Kibera, a neighborhood of Nairobi. Her 11-year-old daughter, Jane*, isn’t feeling well. Both mother and daughter are HIV-positive.

Janet and Jane are lucky to live walking distance to the Langata Health Center, where they receive high-quality health care for free. Jane has been on antiretroviral medication for more than two years. Janet hasn’t paid a shilling. Around the world, millions of people living with HIV struggle to pay for care, or receive none at all. But Janet and Jane are among the 600,000 Kenyans whose HIV care is free through programs from the Government of Kenya, US President's Emergency Plan for AIDS Relief (PEPFAR) program, and The Global Fund to Fight AIDS, TB and Malaria.

Janet wishes everyone could receive the same care that she does at Langata. But even for her, the system just barely works. She explains:

The doctor is only one, and we are many.

Patients at Langata face long waits to see a doctor or pick up their medications. Patients like Janet spend hours away from work and may have to arrange for child care.

 {Photo credit: Anteneh Tesfaye/MSH.}MSH staff Grace Gatebi and Patrick Borruet at the MSH Kenya UHC Symposium photo exhibition.Photo credit: Anteneh Tesfaye/MSH.

The goal of universal health coverage (UHC) is to improve equitable access to health services while protecting households from impoverishing out-of-pocket health spending. In principle, UHC means that lifesaving services and medicines will be accessible and affordable for those who need them. To create deeper awareness of UHC in Kenya, Management Sciences for Health Kenya (MSH Kenya) country office organized a symposium on setting the national health agenda post 2015, called, “Achieving Universal Health Coverage through Stronger Health Systems”.

During the symposium, MSH Kenya organized a photography contest. MSH staff submitted photographs on the theme of “Achieving Universal Health Coverage in Kenya – Financing, Quality, Access and Essential Medicines” (with a focus on the most vulnerable populations). An independent jury selected 19 of the photos for an exhibition at the symposium.

 {Photo credit: Anteneh Tesfaye Lemma/MSH.}Kenyan Cabinet Secretary for Health James Macharia (left) and MSH President Jonathan D. Quick (right) sign the canvas pledge.Photo credit: Anteneh Tesfaye Lemma/MSH.

I felt like I had traded my mother’s health for my children’s schooling. It was a tough choice, and I cried every day.

This emotional remark was made by Lucy Njoki, a Kenyan mother and grandmother, at the Health for All Campaign Launch Event on April 28, 2014, in Nairobi. She had been forced to choose between paying for her children’s education or her mother’s urgently needed medical treatment. She could not afford both. Affordable and accessible health care remain an unrealized dream for many Kenyan citizens.  

Unfortunately, Lucy’s story is not uncommon. Lucy represents millions of people who are pushed into poverty due to catastrophic health expenditures in Kenya. The Health for All: Campaign for Universal Health Coverage in Africa is building awareness and advocating for universal health coverage (UHC) in Nigeria, Ethiopia, and Kenya. Implemented effectively, UHC ensures that all people have access to the quality services they need, without suffering financial hardship.

 {Photo credit: Juliette Mutheu/MSH}Dr John Masasabi, Director of Policy, Planning and Health Care Financing, Kenya Ministry of Health, giving the keynote address at the launch.Photo credit: Juliette Mutheu/MSH

As a government we cannot work alone. However, it is important that those contributing to achieving the government’s vision of a healthy Kenya be guided by standards that encourage them to provide a certain level of quality that is acceptable and desirable.

These were the words of Dr. John Masasabi, the director of policy, planning and health care financing in Kenya’s Ministry of Health, as he launched the Institutional Strengthening Standards for Kenyan Civil Society Organisations, organized by the USAID-funded FANIKISHA Institutional Strengthening Project, led by MSH in partnership with Pact, Danya International, and the African Capacity Alliance.

The event took place at the AMREF Headquarters & International Training Center Grounds in Nairobi, Kenya on February 18, 2014.

 {Photo credit: MSH} (Left to right) Geoffrey Ratemo of Rutgers University; Senator Godliver Omondi, chair of United Disabled Persons of Kenya (UDPK); Dr. Abdi Dabar Maalim of the Transition Authority; Ndung’u Njoroge of the Transition Authority; and Evanson Minjire of Vision 2030 Secretariat at the first "Health for All" technical working group meeting in Kenya.Photo credit: MSH

The Health for All: Campaign for Universal Health Coverage is working to ensure that challenges that hinder access to quality health care in Kenya are addressed. The campaign aims to ensure that governments and stakeholders in health services delivery prioritize strengthening infrastructure, human resource for health, and health care financing to improve service delivery.

The campaign will official launch on April 28, 2014 with the theme, "Health systems strengthening for universal health coverage".

In preparation for this launch, the campaign team has recruited a Technical Working Group to spearhead the campaign. At the first meeting on January 21, 2014, the team identified the health systems strengthening theme and three sub themes for the campaign: strengthening infrastructure, human resource for health, and health care financing.

[Campaign partners at the messaging workshop in Kenya.] {Photo credit: MSH}Campaign partners at the messaging workshop in Kenya.Photo credit: MSH

{Photo credit: Todd Shapera.}Photo credit: Todd Shapera.

This post originally appeared on The Lancet Global Health Blog.

A strong civil society is essential for realizing the lofty goal of achieving universal health coverage (UHC). While the ongoing global discussions around UHC have largely focused on the role of government and development partners in designing and implementing risk pooling mechanisms that have the potential to improve access to essential health services, there has been little discussion on the key role that local civil society organizations (CSOs) play to ensure various communities support UHC and hold governments accountable.

{Photo credit: Rui Pires.}Photo credit: Rui Pires.

In the beginning of my medical career during the early 1990’s, I witnessed the devastating effects of HIV & AIDS.  Nearly 60 percent of the hospital beds I attended were filled with AIDS patients, many of them my close friends and colleagues. At the time, little was known about the AIDS epidemic; no effective treatments were available; and as a physician, I watched helplessly as day after day those closest to me suffered until their death.  

Today, almost three decades later, thanks to increased prevention and access to care and treatment for HIV, most of these hospital beds have emptied of HIV & AIDS patients.  Now, these same beds are filled by those suffering from preventable chronic diseases, including vaccine-preventable cancers.

Today, February 4, we commemorate World Cancer Day, joining the global community to raise awareness about the global cancer epidemic, and renew our commitment to address cancer in low-and middle-income countries (LMICs).

{Photo credit: Mike Wang, courtesy of Photoshare.}Photo credit: Mike Wang, courtesy of Photoshare.

In Kenya, cancer is ranked third as a cause of mortality and morbidity after communicable and cardiovascular diseases.

The Ministry of Health, supported by the USAID-funded, Management Sciences for Health (MSH)-led, Health Commodities and Services Management (MSH/HCSM) Program, led the development and launch of the First National Guidelines for Cancer Management in Kenya, in collaboration with World Health Organization (WHO), Africa Cancer Foundation, and other stakeholders.

The Cancer Guidelines are intended to help increase access to cancer screening, early diagnosis, referral and management of diagnosed cases.

In Kenya, cancer-related services have previously been available only in the top private hospitals and the public teaching and referral hospitals, which have restricted access to a few well-to- do individuals who can afford the related costs. The guidelines de-mystify cancer management and have outlined the core health system requirements needed to offer services in the different tiers of health care, including: community, primary care, county referral and national referral hospitals.

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