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:

1. 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.
2. Specifying the national and county roles with respect to program activities that will be transitioned the short, medium and long term.
3. Ensuring efficiency is a central focus in the sustainability and transition planning for the three diseases.
4. Ensuring the health financing functions are aligned with public financial management and analysed at the program level.
5. 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.

This Policy dialogue interrogated these recommendations further with the aim of developing and finalizing a road map for implementation of the country’s domestic financing sustainability plan for health. The discussions focused on increasing domestic financing for health and reflected on the advocacy plan for the same. This will help in forming consensus on government health financing priorities and next steps to ensuring robust funding is available to meet not only the programmatic gaps for the AIDS, TB and Malaria programs but the entire health sector programmes. The deliberations also pointed at the need to provide a platform for which the key Kenya stakeholders including government, civil society, NGOs as well as partners to discuss and showcase mechanisms to increase domestic resources for health in the effort to achieve Kenya’s goals towards universal health coverage and also develop the Transition roadmap for implementation of the country’s domestic financing sustainability plan for health. The dialogue successfully brought key stakeholders of public sector financing and health financing, the Ministries of Health, Finance and Planning, Members of Parliament, civil society partners, development and other technical partners. Click the links below to read the Policy Issue papers on:

1. Co-financing Commitments and Strategy: The HIV, TB and Malaria Replacement Challenge
2. UHC Delivery for Kenya
3. Unlocking Investors’ Potential in the delivery of UHC in Kenya

First Lady embarks on implementation of 2^nd Strategic Plan as she flags off Medical Safari

[caption id="attachment_5529" align="aligncenter" width="920"] First Lay Margaret Kenyatta (2nd Left) and Health CS Sicily Kariuki (Right) during the launch of Free Medical Safari in Narok County.[/caption] H.E The First Lady Margaret Kenyatta has embarked on the implementation of her Beyond Zero Second Strategic Framework that focuses on the promotion of healthy lives and wellbeing of women, children and adolescents. The inaugural Beyond Zero Medical Safari that was held on September 12 and flagged off by the First Lady in Narok County heralds a new chapter in health service delivery in the country. It is a platform that provides integrated health services to people including enrollment to the National Hospital Insurance Fund, a critical step towards the attainment of Universal Health Coverage under the Governments Big 4 Agenda. The First Lady said under the principle of leaving no one behind, the Beyond Zero Medical Safaris seek to enhance integrated health service delivery to all Kenyans that will significantly contribute to Universal Health Coverage. “We have committed to leave no one behind. We have committed to remain responsive to critical challenges by offering integrated specialized services to all groups in our life-cycle – pregnant mothers and their babies, adolescents and young people, adult women and men and elderly persons,” said the First Lady. The First Lady also launched Narok County eMTCT of HIV and Syphilis Plan. The plan is a timely initiative to create momentum in fast-tracking Kenya’s validation of Elimination of Mother to Child Transmission by 2021. Health Cabinet Secretary Sicily Kariuki who also spoke at the event said the Beyond Zero Medical Safari provides an interesting platform to leverage on in provision of health services in line with the Governments Agenda on Universal Health Coverage. The Beyond Zero Medical Safari in conjunction with County Governments and other partners will cover Bungoma, West Pokot, Kwale, Marsabit/Wajir, Nairobi/Machakos and Kisumu before scaling up to cover all counties across the country. The First Lady’s initiative comes on the heels of a Forum on China–Africa Cooperation (FOCAC) in Beijing China where African First Ladies under the Organization for African First Ladies (OAFLA) met Chinese First Lady Peng Liyuan and re-affirmed their commitment to spearhead the fight against HIV and AIDS on the continent. Informed by startling HIV statistics in Africa, a continent that accounts for two thirds of total global new infections, African First Ladies committed to champion the fight against HIV especially among young people on the continent. According to UNAIDS, there are around 3.9 million young people between the ages of 15 and 24 years living with HIV globally. About 1,600 young people acquire HIV every day and a young person dies every 10 minutes from an AIDS-related illness. First Lady Margaret Kenyatta who made a statement on behalf of the East Africa region called on African States to invest more in the fight against HIV and AIDS to halt high new infections especially among young people. This she said is critical in securing an AIDS free generation. The meeting saw the launch of a three year China-Africa Advocacy campaign. The partnership seeks to promote Sexual and Reproductive health programs and uptake of HIV and AIDS services by young people across the continent. --------------------------------------------------------------------------------------------------------------------------------------------------------- NACC Hosts Zimbabwe delegation on a bench marking mission. A visit by Zimbabwean delegation is the latest in a series of high level visits to Kenya by African countries on a learning mission about her HIV Programming. The NACC hosted the delegation that was in the country to learn on Kenya’s HIV programs and strategies against HIV and AIDS. It comes on the heels of high level visits by Senegalese and Zambian delegations that were in the country on a similar mission with particular interest in the Kenya HIV situation room. Kenya is the first country to adopt the HIV Situation room, a platform that tracks HIV information for decision making and planning purposes and has thus been providing technical support to her peers. Several African countries including Zambia, Uganda, Namibia and Lesotho have since set up their country HIV Situation rooms as they seek to enhance their AIDS response with the use of good quality data. In an apparent admission, the head of Zimbabwe delegation Mr. Hezbon Chamisa said the visit was prompted by Kenya’s dominant show during the 2018 International AIDS Conference. While appreciating the multi-sectoral approach in the fight against HIV in Kenya, Mr. Chamisa who is also the Head of Monitoring and Evaluation of Zimbabwe AIDS Control Council noted that the country’s HIV Programming provided interesting and insightful strategies that shall inform the Zimbabwe’s future HIV response. He also noted that the adoption of -Human rights approach in Key Population programming was a game changing strategy in the fight against HIV. NACC Deputy Director, Support Coordination Dr. Emmy Chesire who spoke at the meeting noted that the country’s stride against HIV and AIDS is as a result of concerted efforts by stakeholders and implementation of impactful programs. --------------------------------------------------------------------------------------------------------------------------------------------------------- Relative peace, ignorance and poverty behind new infections in West Pokot: Prof. Lonyangapuo [caption id="attachment_5366" align="aligncenter" width="1100"] West Pokot Governor Prof. John Lonyangapuo (Right) when he hosted NACC officials and KTN Crew at in his office at Kapenguria town.[/caption] West-Pokot Governor Prof. John Lonyangapuo has decried an upsurge of new infections in the county due to relative stability. The Governor spoke in his office when he hosted officials from the National AIDS Control Council and KTN who had paid him a courtesy call while on a mission to highlight factors fueling new HIV infections in the county. The expansive county has enjoyed relative stability in recent times, a factor the Governor attributes to rising cases of new infections. “The truce with Turkanas and stability along Uganda border means people move freely. The influx of people means many things including intermarriages in a county with low levels of comprehensive HIV knowledge coupled with lack of HIV services, which have exposed residents to the pandemic,” Prof. Lonyangapuo said. The Governor however says his Government will leverage on the peace building path to reach out to communities with HIV and AIDS messages. This includes community involvement to compliment other interventions by the National Government and partners working in the county under the rallying call of ‘leaving no one behind’. This he says seeks to empower people on HIV and AIDS. “I will also ask partners to support this initiative as we step up efforts to address increasing cases of new HIV infections in the county,” he added. Latest statistics shows that about 6,012 people lived with HIV in West Pokot County yielding 1.6% prevalence by the end of 2017. Women have a higher prevalence (2.2%) than men (1.3%) in West Pokot County. --------------------------------------------------------------------------------------------------------------------------------------------------------- Calls to tackle stigma, structural barriers dominate during HIV Prevention Conference. The just concluded 2018 Scientific Conference on HIV Prevention and Treatment by NASCOP in Nairobi brought together stakeholders involved in the fight against HIV and AIDS to deliberate on issues around HIV prevention and Treatment programmes in the country. Under the theme ‘Turning the tide; preventing new HIV infections and optimizing treatment outcomes” the conference sought to position the country on the right path to the realization of global targets and eventual eradication of the AIDS pandemic by 2030. It took place days after the country adopted the new Guidelines on Use of Anti retroviral Drugs for Treating and Preventing HIV that set in new impetus towards the attainment of 90:90:90 targets. It was observed during the conference that although Kenya is among countries in the region making major strides towards global targets, stigma and other socio-economic barriers fuelling new infections particularly among Adolescents and Young People may jeopardize the gains if not addressed promptly. The meeting also called for the need to fast-track implementation of programs including scaling up of ART Program to avert new infections. These include investment in condom use advocacy, a cost effective preventive measure, as well as the use of innovative youth friendly strategies to reach Adolescents and Young People with HIV and AIDS messages. --------------------------------------------------------------------------------------------------------------------------------------------------------- Upcoming events

1. The Launch of Kenya AIDS Response Progress Report, The 2018 HIV Estimates and 2018 County HIV Profiles-The documents developed using scientifically proven projection model provides latest HIV and AIDS data at both national and county level. The KARP and Estimates report form part of the Kenya report to the UNAIDS. Date and venue will be communicated later.
2. 1^St Siaya County Annual Health Scientific Conference-18^th -20^th September at Jaramogi Oginga University Bondo. The NACC CEO Dr.Nduku Kilonzo will address the meeting on Wednesday 19^th September 2018. NACC is also exhibiting at the conference as part of the wider strategic partnership to provide HIV and AIDS information

       

[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 8^th to 10^th 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.

Experts Warn of Complacency as the World Drags on Ending AIDS

[caption id="attachment_5301" align="aligncenter" width="1106"] H.E The First Lady, Margaret Kenyatta- 2nd left, CAS Ministry of Health Dr. Rashid Aman- left, UNAIDS Executive Director Mr. Michel Sibide - 3rd left, NACC Chairperson Ms. Angeline Siparo - Extreme right, NACC CEO Dr. Nduku Kilonxo - 2nd right and Ms Lucy Njenga - 3rd right in a Leadership and Innovation for Results in Elimination of Mother to Child Transmission (eMTCT) and Adolescent Care Symposium during AIDS2018 Conference in Amsterdam.[/caption] The just concluded 22^nd edition of the International AIDS Conference under the theme ‘Building bridges breaking barriers’ took place on 23-27 July  amid fears by UNAIDS that the global commitment to end AIDS as a public health threat by 2030 could remain a pipe dream. This was revealed by UNAIDS in its Global AIDS Update 2018 report dubbed Miles to go launched days before the biggest global AIDS meeting kicked off in the Dutch Capital- Amsterdam. According to the report, the recent gains in the AIDS response does not match global ambitions set to be attained by 2020. The report further says that complacency has slowed down the pace of the AIDS response working against efforts to curb new infections, reduce stigma levels and provision of HIV and AIDS services to vulnerable populations. It further says the world is experiencing a ‘Prevention Crisis’ at a half-way mark towards the attainment of global  90:90:90 targets by 2020. Read the report here…  https://bit.ly/2NVQUT0 The report thus set the tone for the meeting attended by close to 15,000 delegates who included researchers, scientists, activist, donors, policy makers, Government representatives and the civil society. Kenya hosts a record five symposia Kenya once again affirmed her position at the Global stage as a key player during the AIDS 2018 Conference after a well-organized participation through the leadership of the National AIDS Control Council. H.E The First Lady Margaret Kenyatta led the Kenyan delegation which included Chief Administrative Secretary Ministry of Health, Dr. Rashid Aman, National AIDS Control Council Chairperson Ms. Angeline Siparo and C.E.O Dr. Nduku Kilonzo. Others were NACCs Deputy Director Dr. Emmy Chesire and Head of National AIDS and STI Control Program me (NASCOP) Dr. Kigen Bartilol among other representatives from the private sector and civil society.  The Conference provided a platform for Kenya to share with the world her achievements, successes and challenges in her three decade long fight against HIV and AIDS. Kenya thus hosted a record five symposia, the highest number ever in an international conference. These included two high level sessions on Leadership and Innovation for Results in Elimination of Mother to Child Transmission (eMTCT) and Adolescent Care in which H.E The First Lady Margaret Kenyatta gave a key note address, and Ending the AIDS epidemic and Achieving Universal Health Coverage by 2030 in Africa where the Chief Administrative Secretary Ministry of Health, Dr. Rashid Aman was the key note speaker. Other sessions were; Youth Leadership in Action; Lesson from Kenya and Beyond from Research to Real World Settings; Scaling up PrEP within National Programs and The elusive 90:90:90 The Experience of Kenya as an early adopter of evidence.  All the symposia were co-hosted with the support of partners. Speaking during the Universal Health Coverage symposium, Chief Administrative Secretary Ministry of Health, Dr. Rashid Aman said that the Government has taken decisive actions towards the realization of Universal Health Coverage- one of the Governments Big Four Agenda. This he noted includes prioritizing HIV in the benefits package as a critical component to the attainment of Universal Health Coverage in Kenya.  ‘The inclusion of HIV services in the essential benefits packages is critical.  It will encourage People Living with HIV to enroll in national health insurance scheme, this way, increasing the contributory base.  It will also fast-track us towards achieving our target seeing as UHC will not be achieved if the 1.5 million people living with HIV in Kenya are left out. Said Dr. Aman. Kenya’s First Lady Lauded for her efforts towards EMTCT [caption id="attachment_5299" align="alignleft" width="1363"] H.E The First Lady Margaret Kenyatta - 3rd Left among participants in one of the Kenya session.[/caption] H.E The First Lady Margaret Kenyatta was lauded for her instrumental role in providing leadership through the Beyond Zero initiative towards Elimination of Mother to Child Transmission in Kenya. As part of her efforts, Kenya has seen a significant drop in new infections from 13,000 in 2010 to 8,000 in 2017. Addressing participants at the symposium on   Leadership and Innovation for Results in Elimination of Mother to Child Transmission (eMTCT) and Adolescent Care, The First Lady decried high infection rates among adolescents especially young women. She said more concerted efforts are needed to curb new infections in order to sustain the recent gains in the response against HIV and AIDS. ‘The goal to eliminate new infections among children is not yet within reach.  We have way too many preventable deaths among children, not only in Kenya, but globally.  We have seen an upsurge in new infections among Adolescents and Young People, especially young women which means that our investments in eMTCT are being wiped out in two decades,’ said the First Lady. UNAIDS Executive Director Mr. Michel Sidibe while lauding Kenya’s progress in the AIDS response called on more investments to sustain impactful programs that have seen reduction in new infections while keeping those infected with HIV on treatment. This he said will ensure no one is left behind in the fight against the pandemic. “Every child has the right to be born free from HIV. And every child living with HIV should receive life-saving treatment to stay AIDS-free. And every young person should be supported to stay free from HIV. We cannot leave any child or mother behind.” Said Mr. Sidibe. NACC CEO addresses the plenary, warns of a Prevention Crisis NACC CEO Dr. Nduku Kilonzo while addressing the plenary on Differentiated models of HIV prevention said the world is starring at a Prevention Crisis as the number of new infections remains unacceptably high. 1.8M people were infected in 2017 globally at a time of dwindling resources for HIV response. While calling for investment in provision of HIV services to scale, Dr. Kilonzo also urged stakeholders to address structural and legal barriers hindering access to HIV services. “We have to address structural and legal barriers hindering service provision to critical cohorts including Adolescents and Young people as well as key populations,’ she said. Dr. Nduku also warned of complacency noting that basic evidence based program that has proven to turn the tide against HIV and AIDS such as advocacy for appropriate condom use is not given the desired attention while the fight against stigma is not being prioritized. Apart from hosting five Symposia, the Kenyan team also exhibited at the conference showcasing partner’s efforts towards the AIDS response in the country under a popular hashtag/tagline #KENYAatAIDS2018. The Kenyan team also made 18 oral presentations, presented 143 posters and participated in 43 sessions as chairs and guests speakers. As the world reflects on deliberations of the conference one thing is clear-‘End of AIDS is in sight’ will remain rhetoric unless we renew our commitment including increasing investment in impactful programs and involving communities that bear the greatest disease burden. The 23^rd Edition of International AIDS Conference will be held in San Francisco Carlifonia in partnership with Oakland City, USA in 2020. .