Posted by on May 8, 2019 in BENSON SEWE OTIENO, Recent News | 0 comments

Sagam Community Hospital was recently represented by her Executive Officer Benson Sewe Otieno in the Annual Health Conference and the Annual General Meeting for the Christian Health Association of Kenya (CHAK) which was held as 23RD April to 25TH April at AACC Desmond Tutu Conference Center, Waiyaki Way, Westlands .The event was also used to discuss future partnerships between SCH and other organizations including KAYI Medical in areas of Imaging Services including setting of MRI and CT Scan among other services and Nephromed LTD in the area of Renal Dialysis services. Below is a brief of how the event went day by day.
Day 1
It was basically arrival and registration of delegates, lunch and devotion and welcoming remarks by CHAK Chairman, Rev Dr. Robert Lang’at and thereafter introduction and conference objectives and its theme which was “Universal Health Coverage, Kenya Roadmap to attaining affordable quality health care for all; role of Faith Based Health Services was done by the General Secretary Dr Samuel Mwenda
The Next topic was Non Communicable Diseases – Successful models presented by MHUs and this session was moderated by Dr Stella Njagi, Dr Njigua and Dr Wekesa and below is the presentation.
Day two began by devotion from Bishop Boniface Adoyo of CITIAM and thereafter this was the program as it flowed. Below is a brief preview how the program went for the three days

WELCOME TO:
CHAK ANNUAL HEALTH CONFERENCE & AGM

APRIL 23 – 25, 2019
Conference theme:
“Universal Health Coverage, Kenya Roadmap to attaining affordable quality health care for all; role of Faith Based Health Services”
Introduction to CHAK
Identity, vision & mission, purpose, governance and programmes
CHAK Identity, membership & partners
 Identity: CHAK is a national Faith Based Organization of the Protestant Churches’ health facilities and programs from all over Kenya that was registered in 1946.
 Membership: We serve our members (Hospitals, Health Centres, Dispensaries, CBHC, Churches, MTCs) and communities
 Partnerships: MOH, County Health Depts, Donors, Consortium partners, KCCB, MEDS, UN Agencies, Other NGOs, CHAs, Private Sector and Communities

CHAK Vision, Goal and Objectives

Health Services delivery

Health systems strengthening
Sustainable financing
Advocacy & partnerships
Training &Research

Promoting access to quality healthcare in Kenya

Purpose
1. To facilitate member health facilities to deliver accessible, comprehensive, quality health services to people in Kenya in accordance with Christian values and professional ethics guided by the Ministry of Health Policies and Guidelines.
2. Our strategies include:
 Advocacy,
 Health systems strengthening,
 Capacity building,
 Partnerships,
 Innovative health & HIV programs,
 Research and community systems strengthening.
Strategic Directions – Strategic Plan: 2017 – 2022
1. Health services delivery
 Communicable diseases including HIV&AIDS, TB & Malaria
 Non-communicable diseases – Diabetes, Hypertension & Cancer
 RMNCAH – Reproductive, Maternal, Neonatal, Child and Adolescent Health
2. Health systems strengthening
 Medical Equipment Program
 Infrastructure improvement
 HMIS
 HRH & Medical Education
 Governance & leadership
3. Capacity Building and Research
4. Advocacy and Partnerships.
5. Sustainable financing and resource management
AHC-AGM 2019
Why theme on UHC Roadmap?
“UHC is one of the “Big 4 Agenda”
Phase 1 (pilot) implementation is in progress and FBOs are exluded
Definition of UHC
 Universal health coverage:
 All people accessing promotive, preventive, curative and rehabilitative health services,
 Of sufficient quality to be effective,
 ensuring that people do not suffer financial hardship when paying for these services.

Kenya UHC aspirations
• “It is envisaged that by 2020, all persons in Kenya will have access to the essential services they need for their health and well-being through an explicit essential benefit package, without the risk of financial catastrophe as a result”.
• UHC will ensure that all Kenyans have access to safe, integrated quality health services (promotive, preventive, curative and rehabilitative) without suffering financial hardship” ….(UHC Roadmap).
Main objective of UHC
• Progressive increase in the percentage of Kenyans with coverage for essential health services covered under pre-paid health financing mechanisms such as health insurance, subsidies, and direct government funding and progressively expand the scope of the health benefit package and the quality of services while protecting Kenyans from catastrophic health expenditures particularly the poor and vulnerable groups.
Primary Health Care & UHC
• The 2018 Declaration of Astana on PHC, vows to strengthen primary health care systems as an essential step towards achieving universal health coverage.
• The Declaration reaffirmed the historic 1978 Declaration of Alma-Ata
• The UHC Roadmap has prioritized investment towards strengthening community level services.
PHC envisions
• Governments and societies that prioritize, promote and protect people’s health and well-being, at both population and individual levels, through strong health systems;
• Primary health care and health services that are high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone and everywhere, provided with compassion, respect and dignity by health professionals who are well-trained, skilled, motivated and committed;
2019 Conference objectives
Conference output
• The conference is expected to generate recommendations for advocacy and health systems strengthening to enhance FBOs engagement in the UHC Roadmap and UHC initiatives in Kenya.
Conference objectives
1. To review the Kenya Roadmap for implementation of UHC
2. To discuss the role of Faith Based Health Services towards attaining UHC
3. To share best practices of delivering sustainable quality health services from CHAK member health facilities
4. To share strategic partnership models towards health systems strengthening of faith-based health services
Conference structure
 Plenary panel sessions where key note presentations will be done and panelists engage audience. Key Note Address by CS-MOH
 Technical Workshops: 3 of these will be held:
1. Health Services.
2. Health Systems & Partnerships.
3. Feedback session with Taskforce for NHIF Reforms for UHC.
 The Medical Exhibition will be open throughout the conference for display of medical equipment and dissemination of posters and publications.
AHC-AGM Programme focus
 Day one:
 Formal opening & Secretariat/MHUs programs
 Day two:
 Best practices from MHUs
 Conference on Universal Health Coverage
 Breakaway Parallel Workshops: (HRH, Partnerships, Quality)
 Day three:
 MEDS – efficient supply chain for quality health commodities for UHC.
 Enhancing partnership with Church Health Programmes
 AGM Business Session
 :Medical Exhibition – Open throughout the AHC-AGM

Appreciation to Sponsors
• Bread for the World – Germany
• MEDS
• NIC Bank
• Nephromed
Let us use this conference to discuss opportunities for CHAK MHUs engagement in UHC

Welcome! Karibuni
Looking forward to a successful and enriching Annual Health Conference, 2019

CHAK NCD PROGRAMS
SUCCESSFUL MODELS
Annual Health Conference 2019
CHAK NCD Team
INTRODUCTION
• The CHAK NCDs program is implemented in 125 CHAK member health units and 37 county government hospitals in 30 counties of Kenya.
• The program has 4 projects that are donor funded i.e.
1. Base of the Pyramid (BOP) project funded by Novo Nordisk.
2. Healthy Heart Africa (HHA) project funded by AstraZeneca.
3. Novartis Access Program (NAP) funded by Novartis.
4. Action for Diabetes in Kenya (AFORD) project is funded by World Diabetes Foundation.
• Create awareness of and risk factors associated with selected NCDs.
• Promote screening for selected NCDs at community, improve screening at health facilities and creating effective linkages for those with abnormal results.
• Capacity building of the health system (community, health care providers, physical infrastructure – equipment).
• Access to timely, uninterrupted supply of high quality affordable NCD medications
• Improved county and national health systems including NCD health management information system (MIS) for monitoring and evaluation(M&E) at facility and community levels.
• Advocate for prioritization of NCDs at both national, county and hospital levels
OBJECTIVES
• Create awareness of and risk factors associated with selected NCDs.
• Promote screening for selected NCDs at community, improve screening at health facilities and creating effective linkages for those with abnormal results.
• Capacity building of the health system (community, health care providers, physical infrastructure – equipment).
• Access to timely, uninterrupted supply of high quality affordable NCD medications
• Improved county and national health systems including NCD health management information system (MIS) for monitoring and evaluation(M&E) at facility and community levels.
• Advocate for prioritization of NCDs at both national, county and hospital levels
2018 Performance
• Implemented programs in 125 health facilities.
• New counties: Turkana – 9 sites, West Pokot – 4, Busia – 1, Migori – 1.
• Distribution of Health Care Facilites Implementing the CHAK Hypertension Program by Level of Facility
Health Care Facility Level No. of Health Care Facilites
Level 2 58
level 3 37
Level 4-6 30

• Awareness Creation
• Conducted 527 community outreaches.
. Reached over 2.8 million persons with education messages on NCDs.
• JJ Heart Run (400 KM in 40 days).
• CHAK Diabetes Walk
SCREENING
• 702,679 adults screened for Hypertension.
• 168,065 screened for Diabetes
• 21,763 women screened for breast cancer.
CAPACITY BUILDING
• Trained over 500 health care workers.
• 330 Patients (Diabetes Peer Educators).
• 258 Community Health Volunteers

ADVOCACY
• CHAK is a member of the NCD-ICC.
• 8 County engagement meetings on NCDs (Meru, Nyeri, Tharaka-Nthi, Kiambu, Kisii, Nyamira, Kericho and Vihiga counties).
• 2018 NCD UHC Conference in Nyeri

NCD SUCCESSFUL MODELS
ITIBO HEALTH CENTRE

ITIBO HEALTH CENTRE
• Level 3 facility in Nyamira County sponsored by the SDA Church.
• Founded in July 2017 with 18 people by October 2018 had 54 members. Hence split into 2 groups (A and B).
• Diabetes/Hypertension patient support group – offers psychosocial support, spiritual support and financial support. Health Care Workers are also members of the group.
• Table banking model “Chama” – for community based health insurance – for payment of drugs and NHIF subscription.
OASIS MEDICAL CENTRE

• Level 3 newly upgrade to level 4 health facility in Kilifi County sponsored by Jesus Celebration Centre.
• Facility has enabled patients from the larger coastal area (Coast General Hospital) access breast cancer medicines (Tamoxifen) at Ksh. 200 per month.
• To ensure patients access critical monitoring test HBA1c for Diabetes follow-up, reduced the cost from Ksh. 1,300 to Ksh. 600.
• Have started a diabetes/hypertension support group.

CHAK DIABETES WALK

CHALLENGES
• Declining donor funding for programs.
• Healthcare financing for NCDs.
• Loss of NCD frontline staff in CHAK MHUs.
• Lack of or poor governance and leadership at health facilities affect program implementation – training of HCPs, procurement of drugs.
WAY FORWARD
• Actively writing proposals for funding.
• Continuous advocacy with NHIF – NCD Package.

TRANSFORMATION OF AIC LITEIN HOSPITAL SERVICES THROUGH PARTNERSHIP:
NHIF
KAYI MEDICAL

Presented by: Erick Lang’at
INTRODUCTION
 Partnership: A joint working arrangement where the partners; are otherwise independent bodies; agree to co-operate to achieve a common goal;create a new organizational structure or process to achieve this goal; plan and implement a joint program; share information, risks and rewards.
MISSION & STRATEGY:
 Mission: To create a high-level partnership between health care, public health, community-based organizations and other stakeholders, with the goal of improving the health of local communities.
Strategy:
 Locally specific interventions
 Stakeholder partnerships
 Mixed-methods analytic plan
TRANSFORMATION OF AIC LITEIN HOSPITAL

WHO WE ARE:
 A.I.C Litein Hospital is a self-sustainable mission hospital (Level-5b). It was established in early 1960’s by Africa Inland Missionaries to provide treatment to the community. Currently, it provides primary and specialist medical care to a catchment population of 800,000 people mainly from six counties (Kericho, Bomet, Nakuru, Nyamira, Narok and Kisii) in the South Rift region of Kenya.
VISION STATEMENT

 To be a preferred Centre of Excellence in Healthcare Provision, Training and Research.
MISSION:
 We are committed and motivated to serve our Community through provision of high quality, Affordable, sustainable and Holistic Health Services.
AIC LITEIN & NHIF PARTNERSHIP:
 AIC Litein Hospital has partnered with NHIF to give quality care to their clients. NHIF made an agreement with the hospital to procure provision of service for NHIF members.
 Litein has transformed through this partnership over the years. At Outpatient before introduction of Universal Healthcare, we use to serve 250-300 patients per day.
 With introduction of UHC through NHIF, we are serving 800-1000 patients daily. A huge improvement through that partnership.
SURGICAL SERVICES ACCESS
 Partnership with NHIF has improved access to surgical Services by our clientele.
 We are able to offer surgical services that NHIF covers at no extra cost to the patient.
 This has reduced the burden of healthcare to those we serve.
 Our theatre case volume has risen from 60-80 cases per month in 2016(mainly emergencies) to 200 per month(60% electives)
UNIVERSAL HEALTHCARE
The two partners have ensured customer satisfaction in quality health care is the key to success.
The attached graph shows growth through partnership.

HOSPITAL GROWTH (UHC)

CUSTOMER SATISFACTION & NEEDS
 After analyzing the growth in numbers, we still realized that there were some choking points in service delivery.
1. Turn around Time
2. Prescriptions Level
3. Specialized Tests
4. Snarl up at some sections e.g Lab

Gibbs Reflective Model
 Gibbs’ Reflective cycle model is used in various situations and is useful in evaluation of scenarios and events.
 Reflection is used to improve understanding and proof of practice-based learning. The process requires that one look beneath the surface of events and experiences to achieve deeper levels of understanding and learning.

SERVICE DELIVERY
 Gibb’s reflective model made the Hospital Management to source for more partners in order to alleviate identified choking points as earlier stated.
1. Add another resident Orthopedic Surgeon, so we have two.
2. Add another gynecologist
3. Have a Resident pediatrician
4. Add more clinicians
5. Add more entry points
ENHANCED PARTNERSHIP
 With improved service delivery, we also realized our clients were travelling far and wide to seek specialized services e.g. CT Scan,MRI, Lab Tests and Radiology reporting.
 The hospital then decided to engage another partner KAYI MEDICAL ; a Turkish firm to place MRI,CT Scan, Modern Ultrasound and Digital X-ray at our facility. All these will speed delivery of service to our clients.
 Lancets Kenya also came on board to partner with us on specialized Laboratory tests with reduced prices and minimal turn around time.
Quote
“The best way to find yourself is to lose yourself in the service of others”
Mahatma Gandhi

THE NEXT TOPIC FBO- Private Partnership model for quality Renal Dialysis Service presented by the CEO OF Nephromed Ltd DR Deepak Sharma

Comprehensive Kidney Care Centre

Comprehensive Kidney Care Centre

National Statistics

Serene & Secure
We are located close to KHN and The Nairobi Hospital on 4th Ngong Avenue.
Ample parking space!

Integrated Care Approach

 

Quality Improvment

MMMMMOD
Modern Technology

QualityMedical
Staff

Our Medical Director, Prof. Dr. A. J.O. Were is a top Nephrologist in Kenya.

More Privacy
We offer more
personal space and privacy. Each bed have personal TV’s and power connections

No Waiting
With 20 Dialysis machines, patients never has to wait for their turn.

We Care For You
We provide you with a full set
of services including Laboratory Services,
Nutritional counselling &
Doctor Consultation

Nutritional Support

We offer a nutritionally balanced meal suitable for the dialysis patients

Emergency Support

Our linkup with AAR Emergency and Rescue gives the best Emergency support

Affordable Pricing

• We offer competitive pricing for our services
• We are NHIF accredited facility

OUR CENTERS
• NAIROBI UPPER HILL – 14 BEDS
• MEWA HOSPITAL – MOMBASA : 5 BEDS
• NYAHURURU – 6 BEDS
• PROPOSED : NAIROBI -2 / KISSI

DIALYSIS CENTRE BASICS
• MACHINES
• R.O. PLANT
• GENERATOR
• R.O. CLEANING
• KITS/ MEDICATIONS/ CONSUMABLES
• OXYGEN CYLINDER
• PATIENT MONITOR
• BEDS / CHAIRS ETC.
• WEIGHING CHAIR
• FOOD
• LAUNDRY / CLEANING
• STAFF
• RECORDS
• SLUICE
• STRECHERS ETC.
• More not listed here !

Responsibility of NEPHROMED:
1. Provide 4 to 6 dialysis machines at its cost.

2. Provide staff to operate the unit at its cost. Nurses , cleaners , receptionist etc.
3. will install all support equipment like RO , hospital support equipment required like beds ,
crash card , ECG , suction machine , triage equipment, office furniture etc. at its cost.
4. Will buy it’s own consumables for the dialysis unit at its own cost.

5. Can bear the license cost if any for the center.

6. Will manage the day to day expenses like paying the nephrologists , training , running a kidney clinic.
7. Day to Day Management of the dialysis center.
8. Staff training & development.
9. Payment collection from NHIF.

Responsibilities of Hospital
1. Provide space of 1500 to 2000 square feet area to set up the dialysis unit , triage , consultation room, procedure room , store , staff changing room , RO room, waiting area for patients etc.

2. Uninterrupted electricity / power supply at all times.

3. Uninterrupted clean water supply.

Benefits to Hospital

1. No need to refer dialysis cases outside.

2. While we focus on dialysis / hospital continues to focus on its main objective of providing quality tertiary care.

3. No money spent on setting up the unit & NO cost on management & day to running.

4. The dialysis center will provide the lab tests / minor surgical procedures to the hospital to perform.

DEEPAK SHARMA
CEO
NephroMed Limited
2nd Floor, Williamson House
4th Ngong Avenue, Upperhill
Nairobi, Kenya
+ 254 (0)737 787878
+ 254 (0)792 787878
marketing@nephromed.co.ke
www.nephromed.co.ke

ESOPHAGEAL CANCER IN KENYA ; OPORTUNITIES FOR COLLABORATION
This session was moderated by Dr Michael Mwachiro
General Surgeon and Director, Endoscopy Unit, Tenwek Hospital
Country Representative, College of Surgeons of East, Central and Southern Africa

Esophageal Cancer in Kenya:
opportunities for collaboration
CHAK ANNUAL HEALTH CONFERENCE AND AGM
April 23- 25, 2019
Dr Michael Mwachiro
General Surgeon and Director, Endoscopy Unit, Tenwek Hospital
Country Representative, College of Surgeons of East, Central and Southern Africa

Tenwek Hospital

Located in Bomet county, southwestern Kenya. 300 bed faith based hospital serving a population of ~800,000.

Surgery Department

Endoscopy Department

Geographic Variation of Esophageal Cancer

Esophageal cancer is the 8th most common cancer and the 6th most common cause of cancer death in the world, with 456,000 new cases and 400,000 deaths in 2012
High rates of esophageal cancer are found along two geographic belts, one from north central China through central Asia to northern Iran, and one from eastern to southern Africa

East Africa is a region of high esophageal squamous cell carcinoma (ESCC) incidence.
[below] Esophageal cancer incidence map, Dr. Denis Burkitt 1973

Oesophageal Cancer in Africa

A distinct HR belt along the East Coast
Incidence = 20-30/100,000/year, >90% ESCC
~20% of cases <40 years old
Tremendous genetic diversity
Almost totally unstudied

Esophageal Cancer in Kenya

ESCC Risk Factors in HR Populations
Very important: Low serum selenium
Non-tobacco PAH exposure
Hot food and drinks
Important: Tobacco, alcohol
Poor oral health
Low SES
Family history
Possible: Opium
Ruminant contact

In LR countries, 90% of the ESCC cases are attributable to tobacco and alcohol use, but in HR populations these exposures are much less important. EG. the RR of cigarette smoking in the US is ~9, and in HR areas it is ~1.5.
I divide the ESCC risk factors in HR pops into 3 groups: those that are very important (ORs = 7-8), those that are important (ORs ~ 2), and those that are possible (but we don’t yet have enough data to be sure).
Low serum Se is very important in China and Africa, and in both areas it is the only common RF that appears to have very different exposure in HR and LR areas.
Non-tobacco PAH exposure (mainly indoor air pollution from cooking with coal or wood) and consumption of hot food and drinks are universal RFs in HR pops.

EC represents 35% of all malignancies and 90% of EC cases are ESCC.
8% of ESCC cases occur in individuals <30yo

Preliminary Studies at Tenwek Hospital

Median serum Se = 79 μg/L
Median urine 1-OHPG = 7.2 pmol/ml
Mean tea temperature = 72oC
Only 5% of cases are resectable

Parker et al, Dis Esophagus 2010
Most of my studies of ESCC in Africa have been carried out at TH, a 300 bed mission hospital in W. Kenya where a missionary surgeon, Dr. Russ White has developed a very active clinical program for ESCC pts.
In our first study, we described the ESCC pts seen in the past 20 years, and we found a remarkably younger age distribution than is seen anywhere else in the world. The bar graph shows the TH cases in black and US SEER registry cases in gray. 20% of the TH cases were <40yo, 8% were <30, and some were as young as 14! How can a 14yo develop an obstructing esophageal cancer? There is something different going on here.
Next, we evaluated 200 healthy people from the general population for the major RFs in other HR regions.
Urine 1-OHPG is a stable marker of PAH exposure in the past 2-3 days…
And finally, the TH clinicians taught us about stents. Esoph stents are the best palliation for advanced ESCC. Dr. W developed an insertion technique without fluoroscopy, making stenting feasible in Africa, and TH has now inserted >3000 stents (~300/yr)
Preliminary Studies at Tenwek Hospital
• Parker, R.K., Dawsey, S.M., Abnet, C.C. et al, Frequent occurrence of esophageal cancer in young people in western Kenya. Dis Esophagus. 2010;23:128–135.
• White, R.E., Parker, R.K., Fitzwater, J.W. et al, Stents as sole therapy for oesophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol. 2009;10:240–246.
• White RE, Chepkwony R, Mwachiro M, Burgert SL, Enders FT, Topazian M. Randomized Trial of Small-diameter Versus Large-diameter Esophageal Stents for Palliation of Malignant Esophageal Obstruction. J Clin Gastroenterol. 2015 Sep;49(8):660-5.
• Parker RK, White RE, Topazian M, Chepkwony R, Dawsey S, Enders F. Stents for proximal esophageal cancer: a case-control study.
Gastrointest Endosc. 2011 Jun;73(6):1098-105. doi: 10.1016/j.gie.2010.11.036. Epub 2011 Feb 3. PMID: 21295300
Esophageal Dysplasia studies

Recent ESCC publications from Kenya

Challenges facing ESCC care
• Inadequate Reporting System
• Fatalistic Attitude
• Late Presentation
• Inconsistent Referral Patterns
• Traditional Healers/Treatment
• Chemotherapy and Radiation Therapy Usually Not Available
• Financial Constraints

ESCC Survival
5-year survival (US) 20%
5-year survival (China) 20%
5-year survival (Iran) 3%

> 90% 5-year survival < 10%
Poor survival = late Dx, due to late symptoms
Need early detection and treatment
Need to screen asxic adults in HR pops

Poor survival is mainly caused by late diagnosis, which in turn is due to late symptoms. The person on the left is eminently curable, but he won’t come to see a doctor because he has no symptoms, whereas the person on the right comes to the doctor complaining of dysphagia, but this tumor is too advanced to be cured.
To change this situation, we need earlier detection and treatment, which means we need to screen asymptomatic adults in HR pops.
Management Options
• Potentially Curative
– Resection
• Type
• Extent
– Chemo/XRT
• Adjuvant
• Primary Tx
• Palliative
– Chemo/XRT
– Ablative techniques
– Laser Tx
– ETOH injection
– Cryotherapy
– Stenting
– G-tube

Esophageal stent placement without fluoroscopy
1. White RE, Mungatana C, Topazian M. Esophageal Stent Placement Without Fluoroscopy. Gastrointestinal Endoscopy 2001; 53(3): 348-51.
2. White RE, Parker RK, Fitzwater JW, Kasepoi Z, Topazian M. Stents as sole therapy for oesophgeal cancer: a prospective analysis of outcomes after placement. Lancet Oncology 2009; 10: 240-46

Modification to stent delivery technique
1. Mwachiro M, Parker R, Chepkwony R, Burgert S, White R Esophageal stent placement without optical or fluoroscopic visualization. VideoGIE November 2017, Vol 2, Issue 11, Pages 309–311

• >3000 stents placed to date
• Technique that does not require fluoroscopy
• Reproducible, safe and can be used in low resource settings
• Loss to follow up
• To sedate or not to sedate
• The “One stop shop”
• Dealing with very long tumors
• Proximal oesophageal cancers
Survival Following Stenting at Tenwek Hospital
• Stenting alone
– Median Survival 9 months
– Dysphagia score 0-2 at time of death

Complications
• Bleeding
• Tumor overgrowth
• Stent migration
• Perforation
• Stents as a bridge to surgery

 

Fostering Collaboration in Africa

Current participant sites in the African Esophageal Cancer Consortium (AfrECC)

Van Loon et al., Establishment of the African Esophageal Cancer Consortium: A Call to Action. J Global Onc. 2018.

Contributing Institutions to AfrECC

AFRICAN INSTITUTIONS
• Tenwek Hospital, Bomet, Kenya
• Muhimbili University of Health and Allied Sciences, Tanzania
• Addis Ababa University, Ethiopia
• University of Malawi College of Medicine
• University of the Witwatersrand, South Africa
• Moi University, Eldoret, Kenya
• Kilimanjaro Clinical Research Institute, Tanzania
• Kamuzu Central Hospital, Lilongwe, Malawi
• University of Cape Town, South Africa
INTERNATIONAL PARTNERS
• Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute
• Mayo Clinic
• Queen Mary University of London
• International Agency for Research on Cancer, Section of Environment and Radiation
• Lineberger Comprehensive Cancer Center,University of North Carolina, Chapel Hill
• Helen Diller Family Comprehensive Cancer Center, UCSF
• King’s College London

Current AfrECC Priorities
• 1) To implement coordinated multi-site investigations into the etiology of ESCC in East Africa and identify targets for primary prevention.
• (2) To address the impact of the clinical burden of oesophageal cancer through capacity building and shared resources in treatment and palliative care.
• (3) To heighten awareness of ESCC amongst physicians, at-risk populations, policy makers, and funding agencies.

Clinical care collaboration-
Esophageal Stenting in Africa
Current sites
Site Current stent status Fluoro Estimates Projected in first phase
Tenwek Active *No 300 400
Eldoret Intermittent No 50 400
Lilongwe Active Yes 100 400
Daresalaam No Yes – 400
KCMC No Yes – 100
UTH Zambia Intermittent Yes – 100
Morning Afternoon Members
Day One/ Monday Presentation on stent techniques Stent Demo in endoscopy unit ALL
Day Two/ Tuesday Stent Demo in endoscopy unit Stent Demo in endoscopy unit ALL
Day Three/ Wednesday Stent Demo in endoscopy unit Stent Demo in endoscopy unit ALL
Day Four/ Thursday Stent Demo in endoscopy unit Stent Demo in endoscopy unit ALL
Day Five/ Friday The difficult case Joint discussions ALL
End of course Debrief Trainers
Collaboration between AfrECC and CHAI for improving access to stents

• Training Sites
– Tenwek Hospital
• 300 bed teaching and referral faith based hospital
• Attends to ~ 100000 outpatients and 12000 inpatients
• Placed >3000 stents
• Has got a training program for general surgery, endoscopy and cardiothoracic surgery

Muhimbili National Hospital
• main referral hospital in Tanzania.
• MNH is Tanzania’s largest medical facility, with 1,600 beds.
• In addition to admitting 1,000 to 1,200 inpatients per day and providing care to over 1,000 outpatients per week
• MNH serves as a teaching institution for Muhimbili University of Health and Allied Sciences (MUHAS).
– Setup additional training sites
• Trainers
• Tenwek team
• Local Endoscopic societies
• International Partners
• Mayo Clinic partners
• Boston Scientific
• Opportunities for New Collaborations
• University College Hospital London
Training the Trainers for Endoscopic SEMS Placement
Tenwek Hospital
Bomet, Kenya

Muhimbili National Hospital, Dar es Salaam, Tanzania

• Full Training- sites with no or minimal prior experience with stenting
• Refresher training-
– Sites with prior experience/ low volume active stenting
– Those doing stenting and wishing to learn stenting without flouro
Phase 1 Training sites
• Dar es Salaam
• Lilongwe
• Lusaka
• Moshi
• Eldoret
• Blantyre
• One to two week training periods
• Hands on experience
• Site Follow up visits
Competencies:
• Tumor length assessment
• Guidewire placement
• Tumor dilation
• Stent assembly/ loading
• Stent deployment
• Verification of distances
• Trouble shooting common stent scenarios
• Number of Independent stent deployments
• Development and use of tailored curriculum
• Access to E-learning modules and stent models for training
The future of ESCC care in Kenya
Clinical care:
• Creation of centers of excellence
• Chemotherapy and radiotherapy provision
• Provision of surgical care
• Mentorship and training
• PAACS/COSECSA General Surgery training
• FP training sites
• Nursing and Anaesthesia
• Improving access to care
• Roll out of UHC
• Stent access Initiative project

• Training camps/ workshops
• Consider pre-conferences at the CHAK annual meeting
• Annual or Bi Annual rotating training sessions on basic and diagnostic endoscopy
• Improving early detection of ESCC
• Training of health workers on screening
• Awareness and advocacy projects

Early Detection and Treatment of ESCC
Component
ID of precursor lesions
Primary screen
Endoscopic localization
Staging
Therapy

1. Reduce exposure to known modifiable risk factors

2. Perform case-control and cohort studies to find new modifiable risk factors
3. Use genetics to understand biology (→ risk stratification, new prevention strategies)
4. Develop clinically useful screening tests to identify curable early lesions
5. Expand access to palliative care in HR areas
6.

Parting shot

• Let the tea cool first!
KEY NOTE PLENARY SESSION: ROAD MAP FOR UHC IN KENYA, MODERATED BY DR DAVID KARIUKI, HEAD UHC DEPARTMENT, MOH AND MESHACK NDOLO, COUNCIL OF GOVERNORS
OVERVIEW OF UHC ROADMAP BY DR DAVID KARIUKI, HEAD UHC DEPARTMENT, MOH

The ‘Big Four’ Agenda
Universal Health Coverage Roadmap and Progress
CHAK ANNUAL HEALTH CONFERENCE
AACC DESMOND TUTU CENTRE, WESTLANDS, NAIROBI
24th April, 2019
Outline
1. Introduction
2. Universal Health Coverage (UHC)
○ Country Implementation Approach
○ Role of stakeholders
○ Achievements in implementation and Lessons Learnt
○ Next Steps

INTRODUCTION

1.Presidential prioritization of affordable health care as one of the Agenda towards economic development
2.Important Country Indicators
CATASROPHIC HEALTH EXPENDITURE IN KENYA
• National Average 6.2%- NHA 2012/13
• 25 counties below National Average.
• 2.4 million Kenyans on average are at risk of being impoverished

Sources of Health Financing, Kenya

Source: National Health Accounts (Ministry of Health, 2017)
• High Out of Pocket Payment by Households

WHAT IS UHC?

Further Considerations
 Services covered but at what level of quality?
 Strong Health Promotion Preventing diseases before they occur /Arresting health risks –
 Community empowerment/ responsibility for own health
 Focus on Primary Health Care – backed by a functional referral system
ENABLING PROVISIONS, PRINCIPLES
Vision 2030 : Envisions Social Health protection to the population by expanding services to targeted populations leading to A Healthy Nation
Article 43, Constitution of Kenya.
4th Schedule of the Constitution of Kenya, providing the roles of National and County Governments in health care
Principle of Equity- Targeting marginalized, the poor & the vulnerable groups, Implementing pro-poor interventions, Reaching the informal sector

IMPLEMENTATION APPROACH
Universal Health Coverage: Critical Drivers

1.100% population covered by an essential health benefit package
2. Vulnerable populations
3.Hard to reach areas
4.Pregnant women
5.Strengthen & broaden Primary Health Care System
6.Human Resources for Health management and development
7. Ensure availability of medical commodities & equipment
8.Digitize health e.g. supply chain, telemedicine
9.Increase health budget allocation
10.Private Sector investment (PPP) , alternative financing
11.Social health insurance (aspiration)

Approach to UHC-Key Considerations
Identify population to be covered
Design and cost a UHC essential Health Benefit package
Readiness assessment to establish gaps and plan on how to fill the gaps in Human resources, basic equipment, Physical infrastructure, essential medicines, community interventions.
Implementation in Phases; Phase I – 100% health insurance coverage in Four Counties and health system strengthening in remaining 43 Counties
Financing implementation of the benefit package
Strategic reforms- NHIF and KEMSA to align to UHC
Phase II- Scale up across 47 Counties

Approach to UHC

Strengthen Primary health care; The Community Strategy
– Engage community health volunteers (CHV)
– Build capacity of CHV’s and extension workers
– Health education, Community screening
– Enhance services at dispensary and health centres
– Capacity building of human resources for health for
primary health services
– Enhance referral system
– Communities to own health through improved health seeking behaviours

APPROACH – PILOT THEN SCALE UP
Provide access to essential healthcare for all Kenyans
▪ To 100% coverage on essential health services
▪ Provide all the essential public health interventions across all 47 counties
▪ Lower financial barriers
▪ Progressively increase annual budgetary allocation to health from 6.7% by 2021 and beyond

Improve the overall quality of health services
▪ Increase health facility density to reach 2:10,000
▪ Equip the 6,200 public health facilities across the country with basic clinical equipment
▪ Provide Community Health Volunteers with kits
▪ Expand access to essential medicines and supplies
▪ Increase the number of health workers
▪ Dec. 2018
▪ to Nov. 2019
▪ Pilot Phase
▪ Dec. 2019
▪ to Dec. 2021
▪ Full Rollout
▪ Implementation of UHC will be through a phased approach –pilot in 4 Counties
▪ Health Systems Strengthening in 43 Counties
(Apply lessons to the 43 Counties)
▪ Scale up to the remaining 43 Counties

SELECTION OF PILOT COUNTIES
Isiolo: Nomadic (highly mobile) population with high geographical spread as well as a High Maternal Mortality
Kisumu- High disease burden on Communicable diseases including HIV, Malaria, TB
Machakos; High incidents of Road Traffic Accidents (RTAs)/Injuries
Nyeri : High disease burden of Non-Communicable Disease (NCDs) especially diabetes
Main Focus of the Pilot is Health Systems Strengthening (HSS) in respect to availing;
• (HRH); Medicines & Health commodities
• Medical Equipment & General infrastructure
• Governance in health facilities

IDENTIFYING THE BENEFIT PACKAGE

BENEFIT PACKAGE DEVELOPMENT
1. Panel gazetted on 8th June 2018
2. Develop criteria for assessing services and procedures
3. Develop and cost Benefit Package in 60 days
4. Present report to the Cabinet Secretary
5. Framework for reviewing the benefit package
New Health Benefits Package Offers:
1.Emergency Services-New
2.Mental Health New
3.Non-Communicable Diseases New
4. Community Health Services
5.Maternal Health Services (Enhanced )
6.Child Health Services (Enhanced )
7.Major Infectious Diseases(Enhanced )
8.Medical & Surgical Services (Enhanced )

READINESS ASSESSMENT
Health facility density by county /10,000 pop

Health facility bed density/ 10,000 population by county

12/47 Counties above the recommended standard of 18 beds per 10,000 population

preparedness in the phase 1 (4 counties)
County Population No. HHs No. HFs No. of CUs
(Community Units) Gap in CUs No. Beds HF density /10000 pop. Bed density/ 10000 pop.
Kisumu 1,182,320 229,928 231 195 42 1969 2.0 16.7
Nyeri 830,296 236,771 380 251 -85 1731 4.6 20.8
Isiolo 184,768 36,954 57 38 1 297 3.1 16.1
Machakos 1,216,120 243,224 411 74 169 2312 3.4 19.0
CU-Community Units ( 1CU serves 5,000 persons in the population)
HH=Households
HF=Health Facilities

RESOURCE ALLOCATION CRITERIA
STEP 2: IDENTIFICATION & STEP 3: WEIGHTING OF VARIABLES
NO. VARIABLE WEIGHT ASSIGNED % WEIGHT
1 Equitable share 0.25 25%
2 Population 0.15 15%
3 Poverty index 0.15 15%
4 Disease burden 0.10 10%
5 Out patient Utilization (Average. no of visits) 0.10 10%
6 Average distance to facility 0.10 10%
7 Health workforce density 0.05 5%
8 Total inpatient days (Inpatient workload) 0.05 5%
9 Crude Mortality Rate 0.05 5%
TOTAL 1.00 100%
NB: Weights for various Criteria were informed by existing Evidence and best practices across the World (CARA; Health Policy Initiative 2009; South Africa; Nigeria;)
STEP 4 ALLOCATION OF FUNDS & STEP 5; COMPARISON WITH FOREGONE REVENUE (FIF)
COUNTY TOTAL ALLOCATION
ISIOLO 725,719,086.40
KISUMU 876,121,179.21
MACHAKOS 787,524,789.15
NYERI 780,801,105.83
TOTAL 3,170,166,160.59
ROLE OF STAKEHOLDERS IN UHC IMPLEMENTATION
ROLE OF PRIVATE SECTOR
(INCLUDING FAITH BASED ORGANIZATIONS
▪ Health service provision through the private health facilities
▪ – Capacity building of health workers
▪ – Health products and supply chain; manufacturing, sales and distribution
▪ – Physical infrastructure /health facilities
▪ – Financing towards health care
▪ – Health insurance
▪ – Community Advocacy and awareness of UHC
▪ – Collaboration and dissemination of information
▪ – Participation and contribution in UHC Coordinating mechanism
UHC COORDINATION STRUCTURE
• UHC OVERSIGHT COMMITTEE
• NATIONAL UHC STEERING COMMITTEE
• HEALTH FINANCING>> HUMAN RESOURCE>> SERVICE DELIVERY>> LEGAL>> COMMUNICATION

Other sectors/Ministries

Financing,, Legal Reforms in PFMA etc
Public Private Partnership (PPP)

State law
Legislation and amendment of Acts
Devolution
County Engagement on Universal Health Coverage priorities & contributions

ICT
Infrastructure & innovation, NIIMS
Agriculture
Food and Nutrition security
Ministry of Roads & infrastructure
Provide passable roads to facilitate service
Labour
Human Resource , registration of Pensioners, Elderly and Indigents
Interior
Mobilization, sensitization and advocacy for UHC; Health risks, PHC & Referral , Security including for health products; advocate for NHIF uptake

Education
Mobilization and enforcement of NHIF registration through Schools and Colleges
Capacity building of Human Resources for Health, school health programs
Water
Safe water and improved sanitation
– Provide safe water to 37% of health facilities without water in pilot counties
Energy
3 phase power, stable and reliable power supply
-Provide power to 50% of health facilities without power in pilot counties
ACHIEVEMENTS IN IMPLEMENTATION AND LESSONS LEARNT

UHC ACHIEVEMENTS
 UHC launched on 13th December 2018 in 4 selected Counties
 UHC coordination structures in Pilot Counties put in place
 County UHC Road maps and Annual Work Plans developed
 Three joint monitoring visits have been undertaken-December 2018, January 2019 and Feb/March 2019
 58 facilities jointly assessed on implementation in the four Pilot Counties (Nyeri 17; Kisumu 14; Machakos 17; Isiolo 10; and 10 Community Units
 Essential medicines and non pharmaceuticals have been received by health facilities in the 4 counties

REGISTRATION TO UHC
Population Total Population per County Total HH per County (approx.) Population Registered per County by
1st April 2019 % of the population registered by 1st April 2019
Kisumu 1,145,747 273,350 930,307 81% 81%
Nyeri 829,843 232,678 695,408 84%
Machakos 1,289,200 316,102 1,066,108 83%

Isiolo 191,627 37,437 157,399 82%
TOTAL 3,456,417 859,567 2,849,222

UTILISATION – OPD SERVICES

NEXT STEPS

Reflections for consideration
● Inequity in health outcomes within and across Member States persist
● Still persisting high burden of ill health and death
● Dual burden of communicable and noncommunicable conditions
● A lot of effort needed to sustain gains in communicable conditions
● Changing context
● Demographic changes: Youth bulge, ageing populations
● Economic changes: Economic growth, driven by specific sectors (or populations)
● Social / cultural changes: Urbanization, informal settlements,
● Environmental changes: Climate change and effects on development

Reflections for consideration
■ Health Work force: skewed skilled health workforce distribution
■ Health Infrastructure: inadequate infrastructure and skewed distribution of available infrastructure within the sector institutions.
■ Health Leadership & Governance: in the context of devolution.
Low coverage in health services
 Strengthen county supply chain management system
 Establishment of quality assurance and an accreditation system
 Promote implementation of Universal Health Coverage
Fast-tracking the passing of relevant legislation on health issues
Continuous engagement with all relevant stakeholders
Declining donor commitment due to classification of Kenya as a lower middle income country
Porous borders leading to increase in emerging and re-emerging Diseases
Re-emergence of neglected tropical diseases e.g. elephantiasis, Kalaazar.
Epidemiologic transition (lifestyle diseases) e.g. cancer, hypertension and other NCDs.

NEXT STEPS (PILOT COUNTIES)
 Human resource placement by the County
 Operationalize Community Health Units (Identify, train CHW) including the uptake and utilization of Community health volunteers
 Improve infrastructure especially at PHC level and invest in equipment Institutional reforms to support UHC (NHIF)
 Evaluation of Pilot Phase to inform scale-up: Mid term evaluation due in 3 months time
 Review readiness for UHC roll out in all Counties
 Contextualize UHC Road map at the County level
 Advocacy for UHC

Attainment of 100% Universal Affordable Health Coverage

The next topic was UHC Roll out, County Experience which was moderated by Meshack Ndolo from Council of Governors

UNIVERSAL HEALTH COVERAGE (UHC) ROLLOUT: PILOT COUNTY GOVERNMENTS’ PERSPECTIVE
CHRISTIAN HEALTH ASSOCIATION OF KENYA AGM
Venue: Bishop Desmond Tutu Conference Centre, Nairobi
Date: April, 24th, 2019

• KENYA VISION 2030: – Equitable, Affordable and Quality Health Care to the Highest Standards.
• THE CONSTITUTION OF KENYA 2010: The Right to health, including the right to Emergency care and reproductive health – Devolved System of Government.
• THE HEALTH ACT, 2017
• THE KENYA HEALTH POLICY 2014-2030:- Supports implementation of various MTP III priorities in the Health Sector and is expected to lead to the achievement of Universal Health Coverage.
• SUSTAINABLE DEVELOPMENT GOALS (SDGS) NO. 3
• ASPIRATION OF AFRICA UNION AGENDA 2063
BACKGROUND
Universal Health Coverage is a National Agenda for All
Its about leaving no one behind in access to quality health care
 County Governments are committed to UHC as contained in the Medium-Term Plan III “Big Four”.
 Counties are strengthening Primary Health Care (PHC) systems for UHC in order to increase coverage, access to quality of healthcare
 The Counties have allocated financial resources for UHC, assigned human resources, provided leadership and governance
 UHC is being piloted in four counties i.e. Nyeri, Kisumu, Machakos Isiolo.
 Faith-based health care providers have a long history of partnership with the Government and must be part of the UHC journey

UHC Contextual Issues
• Defining the Health Benefit Package for UHC as a Policy Document to guide Counties and stakeholders
• Costing the UHC services in the including Health Technology Assessment (HTA) and pricing
• Determination of the financing model to adopt
• Allocation of necessary budget to finance the UHC
• Define modalities for delivering services
• Clarity for purchasing commodity and supplies

UHC Pilot in 4 Counties by MoH
AS OUTLINED BY THE MINISTRY OF HEALTH
• Active purchasing: removal of user fee at level 4 and 5 facilities as Counties strengthen Levels 2 and 3
• Disbursement of Conditional Grants to Counties
• Supply of Commodities through KEMSA
• Defining policies, guidelines on referral systems, quality, standards, M&E and resource mobilization
Experiences from the 4 pilot Counties
Emerging issues that require significant collective attention
• Funds disbursement – Conditional Grant in the Middle of Financial Year
• Supplies and commodities to counties – some commodities not in KEMSA
• Human resources for health – deployment, gaps determination and recruitment where necessary, adequate management and planning
• Public infrastructure including registration of citizens, response and public information
• Influx of patients from neighboring counties – not totally unexpected
• Data generation and use for planning and decision making – M&E critical
• Application of technology to ease service delivery, uptake, referrals etc.
• Some facilities e.g. JOOTRH reporting decline in revenue for some services
• Inadequate coordination with other service providers like FBO and private sector
Opportunity for impactful UHC
HEALTH WORKFORCE (right numbers, right skills, motivation
HEALTH SERVICE DELIVERY : quality healthcare — kindness, cleanliness, care
LOGISTICS (Kenya has a bulk supply chain in KEMSA & MEDS that should be strengthened
And also to leverage on vibrant private sector suppliers and strength regulatory mechanisms to assure quality of commodities supplied);
GOVERNANCE investing in leadership, management & governance is critical; planning
HEALTHCARE FINANCING (private, FBO and public sectors need to create synergies for achievement— share health facilities, innovations).
Lessons Learnt /Recommendation/ Conclusions
• THE HEALTH BENEFITS PACKAGE OF UHC SHOULD BE THE GUIDING POLICY FROM MOH
• THE COUNTY GOVERNMENTS NEED POLICY TO GUIDE UHC IMPLEMENTATION
• WHATEVER UHC FINANCING MODEL ADOPTED SHOULD BE SUSTAINABLE FOR KENYA
• CLARIFY THE RELATIONSHIP BETWEEN THE NHIF REFORMS AND UHC AND WHETHER UHC WILL BE TAX-BASED FINANCED (AS BEING PILOTED) OR INSURANCE BASED COVERAGE
• MOST COUNTIES ARE CURRENTLY FACING SIGNIFICANT CHALLENGES WITH KEMSA
• COUNTIES NEED SUPPORT TO THEIR LEVEL 5 HOSPITALS FOR IMPROVE ACCESS TO REFERRAL HEALTH FACILITIES AND SOME HAVE INVESTED HEAVILY IN THEM
• COLLECTIVE ATTENTION TO ALL ASPECTS OF HUMAN RESOURCES FOR HEALTH AND HEALTH SYSTEMS IN GENERAL
• PARTNERSHIP ON UHC WITH KENYA FAITH-BASED HEALTH SERVICE PROVIDERS
• POLICY FRAMEWORK AND CLARITY OF STANDARDS AND GUIDELINES AND EXPECTATIONS
• STRENGTHENING PRIMARY HEALTH CARE AND SYSTEMS TO DELIVER SERVICES
• FRAMEWORK OF ENGAGEMENT AND COORDINATION IN SERVICE DELIVERY RECOGNIZING COMPARATIVE ADVANTAGE – IN THE COUNTIES
• SUPPLY OF COMMODITIES AND HEALTH PRODUCTS
• SHARING OF HUMAN RESOURCES FOR HEALTH – SPECIALIZED SERVICES
• COORDINATED DEVELOPMENT PARTNER ASSISTANCE FOR VALUE ADDITION AND SYNERGY
• CONTINUOUS DIALOGUE AND CONSULTATION – COUNTY HEALTH STAKEHOLDERS FORUM

Day three which was the last started with devotion by Rt Rev Bishop Michael Sande who is also the Trustee and Chairman MEDS .
EFFICIENT AND QUALITY MEDICINE SUPPLY CHAIN SERVICE
This was presented by Dr Jonathan Kiliko who is the Head of Customer Service
MEDS: Efficient, Affordable and Quality Supply Chain Services – Health Products & Technologies
CHAK Annual Health Conference &
Annual General Meeting
Thursday, 25th April, 2019
AACC Desmond Tutu Conference Centre – Waiyaki Way, Westlands

Presentation Outline
1. MEDS in Brief
2. Efficient and Quality Medicines Supply Chain Services
3. Role of MEDS in Universal Health Coverage
4. Key Challenges & Future Outlook/Aspirations of MEDS

1. MEDS IN BRIEF

Strategic Direction
Corporate Identity: Mission for Essential Drugs and Supplies (MEDS) is a faith based, not-for-profit organisation was established in 1986 by Christian Health Association of Kenya (CHAK) & Kenya Conference of Catholic Bishops (KCCB).
Vision: A Faith Based Organization leading in Promoting Healthy lives
Mission Statement: To provide quality and affordable Health Products & Technologies, Quality Assurance and Health Advisory Services.
Core Values: Integrity, Innovation, Customer Focus, Partnerships, Teamwork

Governance Structure
Hierarchy Positioning
Board of Trustees Top most Body
Drawn from Churches Top Church Leadership
General Secretary (CHAK & KCCB) are Joint Secretaries
MD in attendance at Boar of Trustees’ Meetings
Board of Directors Report to Board of Trustees
Church Leadership & Secretariats (CHAK & KCCB)
– MD Secretary to Board
Managing Director (MD) – Report to Board of Directors
– Appointed by Board of Trustees
Management Committee – Report to Managing Director
– Appointed by Board of Directors
Management Team
Non-Management Staff

Organogram

Key Facts
WHO ARE WE? CERTIFICATIONS
Registered Trust of Churches in Kenya ISO 9001:2015 Certification
Faith-based, not-for-profit Ecumenical Partnership of Churches under CHAK (Protestant) & KCCB (Catholic) Quality Control Laboratory
WHO (World Health Organization) pre-qualification
Over 32 Years Experience: Supply Chain, Health Advisory Services & Quality Assurance Services US-OFDA* pre-qualified distributor
*Office of US Foreign Disaster Assistance
Play Complementary Role to Government Supply Chain (KEMSA) ECHO/European Union
European Civil Protection and Humanitarian Aid

Core Functions
Supply Chain: provision and distribution of reliable, quality and affordable Health Products & Technologies – Essential Medicines, Medical (non-pharmaceuticals) and Medical Equipment/Devices

10,000 Square Metres State-of-the-Art Warehouse

MEDS CATALOGUE

CATEGORY NUMBER
Formulary Approved 1892
Supplementary List 422
Project Stock 200
Total 2515
CATEGORY No
Medical Equipment & Devices 125
Logistics Structure
• MEDS is one-stop shop for all clients in Kenya
• MEDS uses 3rd party distributors/transporters to deliver consignments to door-step at no extra cost
• Diocese, other middle level or institution expected to assist health facilities in debt management and solving governance issues

2. Quality Assurance Services (QAS): QC Laboratory that ensures stringent quality assurance mechanism for quality products

MEDS QUALITY CONTROL
LABORATORY

PRE-QUALIFICATION BY WHO (WORLD HEALTH ORGANISATION) in 2009
• Operating at International standards in Fight Against Sub-standard Counterfeit Medicines
• Qualifies to be used by United Nations Organisations
• 1st Faith-based
• 1st Non-Public in Kenya
• 4th in Sub-Sahara Africa

MANUFACTURERS / DISTRIBUTORS INSPECTION

MEDS Pharmaceutical Technical Committee Inspect Manufacturer in India
3. Health Advisory Services (HAS): Training/Capacity Building & Client Support Services – majorly on Treatment Updates and Health Commodity Management

HAS – Range of Services
• Annual Training Programme
• Regional Training Interventions
• Facility Based Training Intervention
• Mentorship & on-the-job coaching
• Consultancy services
• Health Sector Policy formulation
• Industry Management and Regulations
• Public Health Management
• Strategic Partnership in project Implementation
• Capacity building/Training

2. EFFICIENT AND QUALITY MEDICINES SUPPLY CHAIN SERVICES

Key Competence Areas
 Quantification: Formulary committee for product selection and forecasting; with a Medicines & Therapeutic committee for quantification
 Procurement: Large quantities that attracts bulk discounts without Government subsidies
 Storage capacity: High and well organized warehousing and inventory management- 10,000 square metres
 Quality Assurance: Good – backed with WHO pre-qualified QC laboratory
 Distribution & logistics management: Centralized and effective (doorstep delivery) => Pull System
 Strategic Information: Continuous feedback from clients and market players
 Training/Capacity Building & Client support – supply chain function is supported by capacity building programmes and field visits to clients.

MEDS Capabilities
 Principal Recipient of USAID/PEPFAR 100 Million Dollars for Procurement and Distribution of HIV/AIDS Commodities for 5 years
 MEDS Supply Chain – Annual Turn-over of KES 5 Billion
 Quality Systems – Policies/Procedures leading to international recognition – (ISO 9001:2015; Pre-qualifications – WHO for QC Laboratory; USAID/OFDA; ECHO/European Union)
 Capacity Building – Over 30,000 HW Trained; Facility Based Training
 Technical lead in Supply Chain component => CHAP Uzima & Afya Jijini
 Manufacturers Inspections/Direct Importation of Commodities

3. ROLE OF MEDS IN UNIVERSAL HEALTH COVERAGE
Continuous Engagement
 Continuous engagement with clients for reliable, quality and affordable supplies
 Continuous lobbying for government support to Faith Based Organizations
 Widespread Network – Involved in all 47 Counties
 KEMSA Partnership – Supply of UHC Commodities; MEDS Quality Control Laboratory Testing Commodities
 Pending MOU between KFBHS Consortium and Government – National (MOH) & COG

Partnership with County Governments
 MEDS facilitated first meeting of County Executives for Health (CECs); during which an Interim Coordinating Committee was formed
 44 Counties have continued to benefit from MEDS supply chain since January 2014.
[Pending 3 Counties: => Mandera, Nairobi, and Tana River].
 In April 2014 MEDS hosted a Health Commodity Management and Leadership Training for the County Pharmacists.

Launch of the MEDS – County Governments
Partnership Initiative

* Saw over 50% attendance by the Counties – Ministers of Health/ CECs – August 2013

4. KEY CHALLENGES & FUTURE OUTLOOK (ASPIRATIONS OF MEDS)
Challenges facing MEDS
1. Uncoordinated Quantification and procurement of Health Products and Technologies => frequent Out of Stock Situation
2. Credit Risks (high debt levels) – Delays in releasing NHIF funds and funding from National Treasury/mixed priorities at County level
3. Limited access to donor funding for Health Products & Technologies
4. Common Characteristics of MEDS Clients
• Operate in difficult-to-reach & hardship areas
• Serve low income/poor patients => More than 56% (national figure) earn < US$ 1 per day
• MEDS serves disaster stricken areas and neighbouring countries
Challenges – CHAK Health Facilities
• Stagnating or declining support from CHAK health facilities
 2018 HSS Support Hospitals = 12/50; H/Centres = 15/58; Dispensaries = 8/56
 2018 Sales KCCB = 1,352,310,750 while CHAK = 388,830,122
• Participation during Regional Client Forum and 2-day training sessions
• Attendance during MEDS Days and other forums like CEOs’ Workshop

MEDS Future
• Implemented 5 year strategic plan (2018-2022)
• Focus of the Current Strategic Plan:
1. Performance Improvement
 Shift system to reduce turnaround
 Digital investment
2. Diversification
 Kisumu Branch
 Medical Equipment
 Microbiology laboratory
3. Partnership
 Clients, suppliers and other key stakeholders
 Multinational Companies => Access Products
 Manufacturers & Banks => Medical Equipment

 Strategic partners => South Sudan & Somalia

The next topic was Innovative and secure cash management solution at the point of service presented by Dennis Owino Senior Manager Transactional Banking NIC Bank

CASH MANAGEMENT CHANNELS

DENNIS OWINO| SENIOR MANAGER• TRANSACTIONAL BANKING
AGENDA
1. CASH MANAGEMENT SOLUTIONS
2. CASH DEPOSIT SOLUTION
3. INTERGRATED PAYBILL SOLUTION
CASH MANAGEMENT SOLUTIONS
Payments and Collections

CASH DEPOSITA

Cash Deposita – Overview

Functionalities

• Ability to reject counterfeit notes
• Provides a printed receipt per deposit
• Provides a supervisor receipt indicating all previous deposits
• Provides a CIT receipt indicating value of canisters removed
• Direct communication to NIC through SIM card transmission
• Intra day credit into the customer’s account
• Web based MI system-TMS to view real-time transaction status

Benefits

Value Additions

• Risk transfer from the time notes are deposited into the machine
• Electronic tracking of cash deposits and transactions
• Enhanced reconciliation process
• Detection of counterfeit notes

• Role Based – Users are predetermined by the client, created and assigned credentials
• Inbuilt alarm – This goes off anytime e.g. on banging or prolonged safe door opening
• Audit Trail – The machine captures and serially records all activities
• Control – Remote monitoring and control is available via a web portal provided to the owner of the business/the machine
• Installation – The machine is screwed to the ground; the safe component is bomb proof, fire resistant and bullet proof
• Customizable – Machine components can be customized

• Volume of receivables analysis to determine model requirements
(D2400,D3600,D6000,DTBS10000)
• Confirmation of deposit access cards
• Installation space
• Access to uninterrupted power source (UPS)
• Contract sign off for deposita and cash in transit services
• Training of staff and provision of authorized personnel to operate machine
• Internet Point
• CCTV
• Panic button(optional)

• This is a collection solution that provides our customers with a means to receive funds into their current accounts through mobile channels.
• Customer’s current account held at NIC Bank is credited real-time and details can be viewed via NIC online Banking. We will also provide a SIM card for receiving alerts for incoming funds

Reconciliation
• Customers are able to download statements containing full details of the payments remitted or collections received via the NIC online banking platform or through a SIM card that will be issued to you
• Account Validation – upon payment the system can validate the account
• Real time notification to the customer’s ERP System – notifications of paybill payments are sent real time
• The Mpesa credits in the account will capture Mpesa reference number and the additional narration as entered by the remitter
Bank Charges – No separate fee for this service to the collection account. Prevailing account tariff apply

THANK YOU

The last before the AGM and business Meeting was Strengthening CHAK Network through collaboration with Churches Health Department and was presented by James Maina RCC Chairman Central/ Naorobi/ South East and Coast Region and Dr Samuel Mwenda General Secretary CHAK
STRENGHTENING CHAK NETWORKS THROUGH COLLABORATION WITH CHURCHES HEALTH DEPARTMENTS
PRESENTED BY: JAMES MAINA AND DR SAMWEL MWENDA

 National Health Coordination
 Regional Health Cordination
 Local Churches

 Participation in RCC activities
 CHAK Membership/Annual subscription enforcement
 Purchasing from MEDS
 Experience sharing/Benchmarking for best practices
 County engagement
 NHIF Accreditation
The meeting ended by the AGM and Business meeting