Devolution of health services in Kenya by Dr Samuel Mwenda, CHAK

“Promoting Access to quality healthcare”

Devolution

of health services in kenya

Issues affecting Faith Based Health Services

By Dr Samuel Mwenda General Secretary, CHAK


The Faith Based Health Network in Kenya

• CHAK is a national FBO network of the Protestant Churches’ health facilities, programmes and Medical Training Colleges and Universities.

• CHAK core functions include; advocacy, health service delivery, health systems strengthening, partnerships & networking and HIV& AIDS programmes.

• CHAK collaborates closely with the Catholic Health Commission of Kenya which coordinates the Catholic health facilities - within the framework of the Church Health Services Coordinating Committee.

• The FBOs in Kenya (Christians & Muslims) have a partnership framework (MoU) with Ministry of Health that guides partnership engagement, support and accountability. Partnership is coordinated through the Faith Based Health Services Coordinating Committee

• FBOs are recognized as key stakeholders in the Health sector since they contribute about 35% of the health coverage


Devolution

of health services in kenya


THE CONSTITUTION OF KENYA, 2010 has mandated devolution – promulgated

27th August 2010


Constitution of Kenya 2010

Counties – 47

One National Govt


New Constitution & Health

• Constitution of Kenya, which was promulgated on 27th August 2010, provides for the right to health care services. Chapter four (4) on the Bill of Rights states in Article 43(1a) that every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care, and in Article 43(2), that a person shall not be denied emergency medical treatment.

Christian Health Association

of Kenya


Implication of devolution to Health

• According to the Fourth Schedule of the Constitution, County Governments are entrusted with all functions related to health care

• National Government is responsible for health policy and national referral health facilities which


of Kenya


STRUCTURE OF COUNTY GOVERNMENT

[email protected]

8

DEPUTY GOVERNOR

GOVERNOR

HEAD OF COUNTY PUBLIC SERVICE

EXECUTIVE COMMITTEE (COUNTY MINISTERS)

COUNTY DIRECTORS (10)

COUNTY ASSEMBLY

- SPEAKER

- ELECTED MEMBERS

• FINANCE & ACCOUNTING

• AGRIC & LIVE STOCK

• ENV & NATIONAL RESOURCES

• HEALTH SERVICES

• EDUC CULTURE, SOCIAL

• PHYSICAL PLANNING/HOUSING

• PUBLIC WORKS &UTILITIES

• PUBLIC SERVICE MGMT

• TRADE, IND. DEV. & REG.

• ROADS & TRANSPORT

COUNTY SERVICE DEPARTMENTS

ELECTED CIVIL SERVANTS APPOINTED DEPARTMENTS KEY


Major changes in Health

• HRH are employed and directly managed by County including payment of salary

• Prioritization, Planning, Budgeting, resource allocation are done at County and approved by County Assembly

• Direct management of Public Health facilities and health services at the County level

• Counties procure medical commodities

• National manage and fund medical training and is responsible for emergencies


of Kenya


Challenges

• Competing Political vs Technical process

• Transition well planned but not followed

• Establishment of new County Health Governance structures

• HRH deployment/change of employer and associated instability

• Delayed enactment of Health Law to guide alignment to new Constitutional Mandate


of Kenya


Kenya Health Policy 2014-2030

• Policy Goal

– “Attaining the highest possible standard of health in a manner responsive to the needs of the population”

• Policy Focus

– Realization of the right to health – as outlined in the Constitution 2010

– Devolution of Health services: National limited to policy, regulation, capacity building and national referral institutions. County Governments responsible for health service delivery


of Kenya


Kenya Health Policy Objectives

• Eliminate communicable diseases

• Halt and reverse the rising burden of non-communicable diseases

• Reduce the burden of violence and injuries

• Provide essential health care

• Minimize exposure to health risk factors

• Strengthen collaboration with other sectors

• Christian Health Association

of Kenya


KHP-Health service delivery system redefined into 4 tier system

• Community services

• Primary care services – Dispensaries, Health Centres and Maternity Homes of Government and Private

• County Referral Health Services – Hospitals

• National Referral Services

This includes all actors in the health system including FBOs and private sector


of Kenya


Role of FBOs in Devolved Health Sector

• Health services delivery through the 4 tiers following the set policies & guidelines

• Training of health workers through FBO MTCs & Hospitals

• Community based health promotion and disease prevention

• Participate in the County and National health referral system

• MEDS to offer an efficient, competitive and reliable supply chain for health commodities

• Partner and collaborate in planning, implementation and monitoring of health programmes

• Support medical emergency response initiatives Christian Health Association

of Kenya


Issues of concern to FBOs

• Continued access to Essential Public Health commodities - Vaccines, TB Drugs, HIV test kits, ARVs, ACT

• Enabling policy environment

• HRH - Staff secondment

• Health care financing:-NHIF, Government policy of free maternity deliveries and PHC services

• Inclusion in planning and resource allocation

• Facilitation in referral system and HRH training

• Access to Donor funding – bilateral & multi-lateral

• Recognition of existing FBO - MoU with MOH and inclusion in HMIS at county and national level

• Increased burden of taxation, licensing and regulation Christian Health Association

of Kenya


Way forward for FBOs

• FBOs have to establish strategies and mechanisms for mutually beneficial engagement with every county government

• We need to build evidence to support advocacy at county level

• We need to find ways of managing and surviving the competing political interests


of Kenya


THANK

YOU

Devolution of health services in Kenya by Dr Samuel Mwenda, CHAK

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