Kenya has continued to heavily invest in mega infrastructure projects to spur economic growth in the various sectors including Transport, Water and Sanitation, Energy and Housing. The development projects have variedly impacted the health status of the beneficiaries within localities where they are undertaken. Further, Environmental and Social Impact Assessment (ESIA) studies on projects have shown a huge impact on different health indicators including HIV and AIDS which legally should be factored in the project during the project design, implementation and overall monitoring. There has, however, been no legal and policy framework to safeguard the health and HIV interests. It is against this back drop that the National AIDS Control Council through the department for HIV Investments led in the development of Guidelines for Mainstreaming Health and HIV interventions in Infrastructure Development Projects. The development process was through collaboration with state agencies undertaking infrastructure projects and the private sector. They include Kenya Airport Authority, State Department for Transport, African Development Bank, National Construction Authority, Energy Regulatory Commission, U.S Presidents Emergency Plan for AIDS Relief, International Labour Organization and Kenya National Urban Authority. The guidelines provide a mechanism for state agencies and the private sector in addressing Health and AIDS related issues during the implementation of the mega projects. According to the studies, implementation of projects often increases income among workers, increases migration among the community, besides increasing sexual activities which often leads to a rise in new HIV infections. In line with the principle of public participation the NACC led stakeholders in the validation of the guidelines to promote ownership among critical stakeholders drawn from different sectors undertaking the implementation of Government projects. Validation of the Guidelines heralds a new chapter in the push for a sustainable financing for the HIV response. It’s envisaged that Project designers and developers will mainstream health and AIDS related issues in the entire project cycle in order to address emerging challenges. NACCs Deputy Director HIV Investments, Regina Ombam said, ‘’With the adoption of these guidelines and eventual roll out we envisage a reduction in prevalence, reduced HIV infections and improved health outcomes of the project beneficiaries along the infrastructure development corridor.”
Increased demand for HIV testing services characterize the on-going activations in Technical Colleges
The on-going activations in Technical colleges spearheaded by Communication Division in conjunction with the Ministry of Education, Department of Vocational and Technical Training has been characterized by unprecedented increase in HIV testing services. The overwhelming demand for testing services and information clearly demonstrates that efforts geared towards reducing stigma perhaps are paying off especially among young people and adolescents. Through the Communication Division the NACC is engaging students of four national polytechnics namely Kisumu, Sigalagala, Eldoret and Meru in phase one of the national sensitization programme. Tertiary institutions present a unique niche that has not been adequately covered with HIV programmes as the focus has mainly been on universities. The TVET institutions have also proved to be good ground based on their large populations, with institutions such as The Eldoret Polytechnic catering to over 15,000 students. The sensitization cum advocacy programme seeks to empower students on the HIV response following startling statistics in the Kenya AIDS Response Progress Report of 2018 showing high infection rates among young people. The report cites stigma and ignorance as the main cause of new infections among this cohort. The one on one engagement has proven to be an effective way in demystifying myths and misconceptions on HIV among students. This is being complemented by exhibitions and distribution of Youth Friendly information materials to students geared towards enhancing knowledge and empowering the students.
The recently concluded Fifth Maisha HIV and AIDS Conference organized by the National AIDS Control Council and partners brought to the fore interesting insights in the implementation of Universal Health Coverage and ending HIV by 2030. Under the theme ‘Leveraging the HIV Response to Accelerate Impact for Universal Health Coverage’ the conference provided a platform for engagement with a focus on how to accelerate HIV prevention and the attainment of treatment targets, identifying opportunities and critical drivers for the HIV response that can be used to accelerate Universal Health Coverage targets. Attracting approximately 850 participants from 35 countries around the globe, this year’s conference, which had been preceded by six pre-conference meetings, was lauded as the most successful. Delegates were drawn from Government institutions, Research institutions, Policy Makers, Civil society, Academia and Community of People Living with HIV and AIDS. Among the notable participants and presenters included renowned Researcher Prof. Mark Dybul of the Center for Global Health and Practice for Impact – Georgetown University, Catherine Sozi, Regional Director for UNAIDS Regional Support Team for Eastern Africa, and Directors of National AIDS Commissions from member of The Global AIDS Coalition. A total of 17 panel sessions were held during the conference, including “The Status of HIV Research: Vaccine or Cure?”, “Emerging Prevention and Treatment Technologies: What is the Future?” “Sustainable Financing for HIV in the Context of UHC” as well as a session on “HIV, Sex, Drugs and Young People” which drew high numbers. These affirmed the HIV situation in Kenya, with the country leading research around the HIV vaccine and other prevention interventions, conversations on domestic financing taking the forefront, and the country’s alignment to the global agenda that puts the interests of young people in every aspect of HIV and AIDS Response. Lauding the conference, Cabinet Secretary for Health Sicily Kariuki noted that reflections of the two day meeting in Nairobi would inform implementation of Universal Health Coverage under the Governments Big 4 Agenda. ‘I must commend the choice of this year’s theme, “Leveraging the HIV Response to Accelerate Impact for UHC.” While UHC is increasingly a global goal, Kenya’s commitment is based on the realization of the potential to return huge health dividends for the country because of the focus on community health, preventive health and investments in health systems. It is this focus, common purpose and pulling together that the UHC agenda can draw lessons from,’’ said the CS. Important Quotes: ‘Although we boast of registering impressive results against the epidemic, challenges abound. Eastern Africa region is one of the highly burdened with HIV and AIDS. New infections particularly among young people are quite disturbing. AIDS related deaths remain high. Even as we end this meeting we need to ask ourselves difficult questions and have a candid reflection on these issues as custodian and implementers of policies and programs.’ NACC Chairperson Ms. Angeline Siparo “The two day meeting has taught us many lessons, highlighted challenges and provided solutions which will go a long way in guiding our response efforts at this critical time as we enter the final stretch of ending the epidemic. I am certain we are better equipped with necessary requisites to apply in our different jurisdictions against HIV.”-NACC C.E.O Dr. Nduku Kilonzo The Maisha HIV and AIDS Conference culminated with a call for participants to shift from Evidenced based programs to systematic data driven segmentation & targeting of programs; move from resource mobilization around donor financing to more structured diversified resource partnerships & domestic financing; from coordinating multi-sectoral response to addressing challenges with stewardship on effective leadership; and to move from Governmental accountability to mutual accountability that ensures meaningful community engagements & inclusive governance.
National Health Financing Dialogue for implementation of the Health Sector Domestic Financing Sustainability Plan
DOMESTIC RESOURCE MOBILIZATION FOR HEALTH: NATIONAL HEALTH FINANCING DIALOGUE FOR IMPLEMENTATION OF THE HEALTH SECTOR DOMESTIC FINANCING SUSTAINABILITY PLAN [caption id="attachment_5411" align="aligncenter" width="931"] The NACC CEO Dr. Nduku Kilonzo (In white top) and participants following keenly on discussions during the National Health Financing Dialogue for implementation of the Health Sector Domestic Financing Sustainability Plan that was held in Nairobi, Crown Plaza Hotel[/caption] The National AIDS Control Council (NACC) together with Global Fund – Kenya Coordinating Mechanism (GF-KCM) held a Policy Dialogue meeting early October 2018 in Crown Plaza Hotel, Nairobi to deliberate on the need for Domestic Resource Mobilization for Health geared towards building a Health Sector Domestic Financing Sustainability Plan. The Government of Kenya has been heavily reliant on donor funding for Health programs for over ten years. For example, external financing towards HIV accounted for 73% of resources, 37% of TB spending and 12% of malaria spending in 2015. External funding from the US Government and from the Global Fund are expected to be substantial between 2018 – 2020 for the three diseases with external funding being roughly 1.2 times the Ministry of Health’s budget. There are many challenges confronting the health sector in the area of financing and that is the reason the policy dialogue has become even more critical in light of escalated costs related to the provision of health services, the unpredictability of resource flows and the significant changes in the way external assistance is being financed and distributed in the health sector. The National Health Financing Dialogue highlighted more critical issues in health care service delivery with a focus on efficiency and value for money as well as strengthening the country’s need for a the sustainable health financing mechanism. This is coming at a time when His Excellency the President of the Republic of Kenya has set a target of attaining 100% Universal Health Coverage(UHC) over the next five years. This is in keeping with every Kenya’s right to quality and affordable health care, including reproductive and emergency health services as enshrined in the Constitution. In addition, the recently enacted Health Act 2017 mandates the Government of Kenya to ensure progressive financial access to UHC. There is a clear recognition and increasing conversation about the need to diversify and expand the sources of domestic funding to ensure sustainable financing of the health sector and reduce dependence on development partners. In 2014, the Kenyan economy was rebased and reclassified as a Lower Middle Income Country. The rebasing of the Kenyan economy means that Kenya should significantly increase resources for health from domestic sources, procure essential health related commodities at market prices and will no longer be eligible for World Bank IDA concessional loans. Notably, domestic funding for the HIV, TB and malaria programs have been progressively increasing. The government is strongly committed to increasing its contribution to the health sector including the three disease programs over the 2018-2021 implementation phase as well. The increasing focus on universal health coverage through improved domestic financing for health is articulated through the ‘Second Medium Term Plan of Kenya, Vision 2030’, ‘Kenya Health Policy, 2014–2030’, and ‘Kenya Health Sector Strategic And Investment Plan (KHSSP) July 2014 – June 2018’. It is also worth noting that the Kenya 2030 vision provides for increase of the Government expenditure on health from 8% in 2016 to 12% by 2017/18. This was expected to greatly narrow the funding gaps. Kenya’s disease responses face three key long-term transition challenges. The first is replacing donor funding, a second is closing the resource gap even when external resources are available in the health sector and a third is ensuring the efficient delivery of health services. To address these challenges and ensure that disease responses are financed, the following key recommendations were proposed:
- Integrating sustainability and transition issues into routine health financing discussions between the Ministry of Health and the National Treasury official at the national and county levels.
- Specifying the national and county roles with respect to program activities that will be transitioned the short, medium and long term.
- Ensuring efficiency is a central focus in the sustainability and transition planning for the three diseases.
- Ensuring the health financing functions are aligned with public financial management and analysed at the program level.
- Ensure all government stakeholders adopt ‘urgent incrementalism’ in ensuring step-wise annual progress on which aspects of programs will be transitioned to the government of Kenya for funding. A forecast could be developed for a 10 year period.
Leveraging on Communities and Improving Use of Data to Advance Universal Health Coverage and HIV Prevention
[caption id="attachment_5311" align="aligncenter" width="1018"] Governor Ferdinand Waititu (in a checked shirt) hosted a team of representatives from Georgetown University Medical Center – A Center for Global Health and Quality led by Prof. Mark Dybul, a Co-Chair of Center for Global Health and Quality at Georgetown University and National AIDS Control Council team led by the CEO Dr. Nduku Kilonzo (middle) at the county’s headquarters.[/caption] The National AIDS Control Council in partnership with the Georgetown University Medical Center – A Center for Global Health and Quality is piloting a Business Process for Impact (BPI) model that will scale up HIV and Universal Health Care (UHC) results through a Human Centered Design (HDC) approach. BPI will focus on supporting the coordination of youth led HIV programmers to promote good health choices and uptake of health services among Kenya’s Adolescents and Young People (AYP) in Kiambu and Homabay counties for two years. During the inception visits to the two counties that took place from 8th to 10th August, 2018 by the Georgetown University Medical Center representatives together with National AIDS Control Council team led by NACC CEO Dr. Nduku Kilonzo, the leadership of these counties showed support for the Business Process for Impact. In Kiambu County, Governor Fedinand Waititu together with the presentation of the key county health management representatives cited alcoholism as one of the key socio dynamic issue that contribute to increase of new HIV infections among AYPs, an issue that the county is struggling with and cited the Business Process for Impact is an initiative that will bring along various stakeholders in reversing the trend of increase of new HIV infections among the AYPs in the county. Also in Homabay County, deputy Governor Hamilton Orata welcomed the process as he cited that previously, a lot of money and resources have been poured in the county for HIV response related activities with no tangible results and the county continues to struggle with increase of new HIV infections, a challenge he attributed to lack of framework of monitoring the activities of various programmers on the ground and he sees the BPI process as the only way that will bring on board various stakeholders in a systematic way and monitor their activities in order to boost results in HIV response. [caption id="attachment_5307" align="aligncenter" width="1127"] Prof. Mark Dybul (left), a Co-Chair of Center for Global Health and Quality at Georgetown University making a point on the Business Process for Impact model to the representatives of the county health management team led by deputy governor Hamilton Orata (center) in the presence of the NACC CEO Dr. Nduku Kilonzo (2nd left) during the inception visit in Homabay County.[/caption] BPI will see data driven decision making in all levels of health system, promoting innovation and develop systematic linkage of Communities of Practice (CoPs), creating energetic and empowered layers in both private and public sector from the grassroots level that will inform the top county management in making decisions that will promote community prevention and care delivery in HIV that will eventually heighten the attainment of the Universal Health Care. According to Prof. Mark Dybul, a Co-Chair of Center for Global Health and Quality at Georgetown University, Kenya has tremendously achieved in various innovations and the BPI approach will go a long way in bridging the gap to building mechanisms that will capture such innovations through coordination, information sharing and make use of the available data that will build accountability mechanisms and reporting in HIV response specifically among the AYPs. During the courtesy call to Homabay County government, the National AIDS Control Council CEO, Dr. Nduku Kilonzo reiterated the benefits of the model in HIV response in the counties saying that “it will not only coordinate external partners but also bring coordination within communities and strengthen communication across different level of government – a two-way communication between communities and the governance leadership”. Drawing from effectiveness in networking Communities of Practice (CoPs) in healthcare, BPI will identify and develop formal networks from various professional disciples and existing service delivery structures such as Comprehensive Care Clinics that provides comprehensive care where people living with HIV and AIDS go for holistic care and management, creating a two-way flow of data and information. During the pilot phase, the CoPs who have focus on HIV programming for the Adolescents and Young People (AYP) will be drawn from various stakeholders including community based organizations, community health workers, groups and networks of persons living with HIV or young people, non-government organizations and health providers including nurses and public health officers, either in their various homogenous groups or as mixed groups. The BPI will use the Human Centered Design (HCD) in developing the CoPs in the counties. HCD is a concept that is gaining momentum globally as it seeks to accelerate the development of locally effective solutions as seen in international health and development projects such as family planning and comprehensive sanitation systems. Currently, in Kenya, the use of HCD methods in public health remains minimal yet its broader application of HCD to CoPs of providers and policymakers has yielded important results globally. The use of HCD to enhance the use of data that will boost development and adoption of locally relevant innovations for health in the two counties and a model that is expected to be applied in other counties in Kenya. Currently, NACC has made available Kenya HIV situation room in all counties and is accessible to county leadership and programmers. The Kenya HIV situation room facilitates tracking of key HIV indicators at national and county levels and is also configured to mine data from key monitoring and evaluation systems in Kenya such as DHIS and other public and private sector systems. BPI will leverage on the system to help find solutions, communicate action and seek innovative ways to ensure that there is consistent action towards results in HIV response among the AYPs, through networking and providing opportunities that will drive systematic change and accelerate better health outcomes that will eventually promote UHC. During the inception visit in Kiambu and Homabay counties the NACC team was led by CEO Dr. Nduku Kilonzo and the Georgetown University Medical Center was presented by Prof. Mark Dybul, a Co-Chair of Center for Global Health and Quality at Georgetown University, Prof. Susan Kim and Stephen Kretschmer, an expert consultant on Human Centered Design. The visits also included Mbagathi Hospital Comprehensive care clinic and the AHF Center of Comprehensive Care Clinic in Nairobi’s Eastleigh, located east of the capital’s central business center and WOFAK – an NGO that is in the forefront in fighting HIV and AIDS in Homabay and finally paid the courtesy call to the Homabay County Commissioners office.
NACC calls for inclusion of HIV in the NHIF to attain Universal Health Care Talks on modalities of implementing Universal Health Coverage have gained momentum, so has the National AIDS Control Council similarly embarked on a process of ensuring HIV and AIDS is included in the Universal Health Coverage. The Council has constituted a multi sectoral coordination team to aid in voicing the need to have HIV and AIDS condition included in the National Health Insurance Fund (NHIF) in an effort towards attaining Universal Health Coverage. Currently health care related to HIV and AIDS is partly absorbed from the opportunistic infection perspective given that ARV are publicly provided by the government. However, the full and direct HIV and AIDS spectrum of treatment is not included due to high cost of retroviral therapy largely supported by donor funds. The Ministry of Health has already put in place a Rapid Results Initiative (RRI) to fast track the implementation of Universal Health Coverage which is one of the pillars of the Governments Big Four Agenda. Others pillars being Housing, Manufacturing, and Food Security. Anchored on Four Pillars the National AIDS Control Council coordination and reporting model seeks to guide the realization of Universal Health Care with the Inclusion of HIV and AIDS as well as People Living with HIV in the essential benefits package. Through the model, a replica of a similar coordination structure by the Ministry of Health, The NACC will be reporting to the Ministry in a well laid down mechanism up to the Presidency. The four committees namely communication, service delivery, HIV Financing and legal teams are critical in this process. The composition of the team includes representation drawn from the private sector, civil society, development partners and the community of People Living with HIV. [caption id="attachment_5172" align="alignleft" width="515"] Proposed Coordination structure and reporting mechanism Why leverage on HIV for Universal Health Care.[/caption] The fight against HIV and AIDS like many other conditions is essential in the ongoing talks on the implementation of Universal Health Care. Cushioning People Living with HIV from expensive life-long anti-retroviral treatment certainly is critical in the realization of this Agenda. At the Centre of Universal Health Coverage is the issue of affordability. Thus Universal Health Coverage means people have access to health services required, not necessarily free but without suffering financial problems. It’s on this premise that the National AIDS Control Council is spearheading the inclusion of HIV response in the attainment of Universal Health Coverage through three pronged proposal under the rallying call of ‘Leaving no one behind’ in this important course.
- Attaining Universal Health Coverage requires that People Living with HIV and AIDS are also included in the Social Health Insurance Scheme under the Social Protection theme.
- Leveraging anti-retroviral therapy funding through the National Health Insurance to cover resources gaps and significantly accelerate achievements targets.
- Attaining Universal Health Coverage demands that the rising epidemic of Non-Communicable Diseases (NCDs) is controlled.