The development of the model was done under the leadership of the Department of Standards & Regulatory Services (DSRS) with support from GIZ (formerly GTZ). This model was piloted with mixed results.

In 2003, the National Hospital Insurance Fund (NHIF) took up the KQM as a tool to improve quality in NHIF accredited facilities. This tool, with adaptations, is still in use by the NHIF for quality improvement. GIZ provided technical assistance in the development of the KQM training manual, which to this date is used by the National Hospital Insurance Fund to train facility workers on KQM. 
The KQM was then reviewed in the year 2007-2009, renamed the Kenya Quality Model for Health (KQMH), and expanded to cater for clinical care, management support and leadership. This review was a participatory process that also had technical support from GIZ.

The new model addresses the inadequacies identified in the first KQM and articulates quality standards and checklists for Kenya Essential Package of Health (KEPH) levels 2, 3, 4, 5 and 6. During this time, GIZ also supported the DSRS in undertaking a design and feasibility study on health services accreditation in Kenya. The study made recommendations on moving the health sector towards a full health facilities accreditation system.

A national quality model is one of the building blocks to the development of a national accreditation system. 
The speakers at the launch congratulated the Ministries of Health on this important milestone and expressed support in utilizing this model at health facility level.

The Quality Management Technical Working Group is currently finalizing a dissemination strategy that will allow cascading of the KQMH to various de-central levels and ultimately to health facilities. This will empower frontline health service providers offer quality health services that are responsive to the needs of their clients.

An important aspect raised at the launch was that during the period taken for development of a sector standard for quality, many other approaches and models have been introduced. There is now a need to harmonize these approaches and for key stakeholders to embrace and utilize the KQMH in order to have a single standardized national quality model.

GIZ Health Sector Programme continues to support the government in this area and in discussion with the Ministries of Health is developing the Integrated Quality Management System (IQMS). IQMS is a tool that is based on the Kenya Quality Model for Health and provides a practical means for health facilities to assess the quality of outpatient/ ambulatory care. Given that a majority of those seeking care do so in the outpatient setting, this is an important adjunct in the road to providing the highest attainable standard of health for all Kenyans.

The Bill of Rights in the Kenyan Constitution provides that “every person has the right to the highest attainable standard of health”. Implicit in this right is the need to provide quality health services that are accessible to the population. The National Health Sector Strategic Plan II prioritizes Quality Assurance and Standards as a support system that facilitates the development and use by all health professionals of clinical standards, protocols and guidelines and ensures strengthening of the clients’ rights.

“We are active not only at the national level providing advice to the national government, but we are also active at the more local level, for example the district or the counties…” Dr. Guenther Taube – Director, Education, Health, Social Protection and Human Capacity Development, GIZ Headquarters.

According to Dr. Taube, this multi-level approach of the GIZ Health Sector Programme and indeed of the German Development Cooperation is one good practice that enhances bilateral cooperation.

He was speaking during an interview after a two-day visit of the GIZ Health Sector Programme in Kenya. Mr. Jomy Attumalil, an assistant to the Managing Director Adolf Kloke-Lesch accompanied Dr. Taube to Kenya.

The full video interview can be viewed on the link embedded within this post.

The German Development Cooperation through the GIZ Health Sector Programme is working with the National Gender and Equality Commission (NGEC) to update the country’s gender profile. GIZ commissioned a consultant to undertake a study with the aim of updating the Gender, HIV/ AIDS and Health sectors of the Kenyan Gender Profile and subsequently the development of policy briefs from the findings of the study. The findings from the report aim at capacitating the NGEC and its  stakeholders to assume a strong advocacy role in the area of gender HIV and AIDS.

A UNAIDS report (2008) on the global AIDS epidemic shows that two thirds of all caregivers for persons living with HIV/AIDS are women. This is in addition to many other tasks such as cooking, cleaning, and caring for children and the elderly that women perform within the household. In spite of this, health policies shun from inclusively targeting women’s various defining needs, hence the need for analyzing gender based discrimination and vulnerability in Kenya beyond the socio economic, political and legal context.

Specific objectives of the report which is hoped will be adopted by the government include:

• Lobby Kenya health system actors to drop the tedious bureaucratic supplies and chain in procuring drugs especially HIV/AIDS related.
• Lobby for fragmentation of health services in government hospitals i.e. Family planning and HIV/AIDS services to be offered within one shop.
• Lobby for support from other development partners i.e. financial and technical to allow for gender mainstreaming in the health system.
• Push for government holistic approach of tackling HIV/AIDS to also factor in sexually transmitted diseases, which increase vulnerability to HIV/AIDS infections.
• NGEC to ensure that report gets to the end user who is the Kenyan government to allow for implementation.
• Highlight the existing health gaps that exist within the marginalized groups and what can be done to improve their uptake of health services.
• Encourage more government fund allocation to the health sector to ensure projects are sustainable in the event of private partners and donors’ pulling out.

Stakeholders at the meeting further proposed amendments such as the inclusion of already existing HIV/AIDS interventions nationally and at community levels.

It was clear at the end of the meeting that policies towards a healthy gender sensitive nation are required if the country is to progress in this area.

The German Development Cooperation through the German BACKUP Initiative provides comprehensive support for gender-responsive HIV programming to partners who demonstrate a commitment and an interest towards gender-sensitive HIV responses.

Through its mandate and its position of being host to representatives from all the core ministries, the NGEC has a unique position to spearhead gender HIV and AIDS advocacy and to inform coordinated action.

Response towards and prevention of Gender Based Violence (GBV) in Kenya is bound to improve after the National Gender and Equality Commission (NGEC) disseminated a road map of set standards in the field of GBV. The new developed National Training Curriculum on Sexual and Gender Based Violence (SGBV) disseminated in April is expected to guide multi-sectoral trainings towards reducing SGBV. The curriculum is also expected to contribute towards quality assurance in handling SGBV cases and guarantee compliance with national and international standards.

The curriculum focuses on five key areas (modules): definition of key terms and concepts in SGBV; types, causes, magnitude and consequences; multi-sectoral prevention and responses to SGBV; policy legal and institutional framework and monitoring and evaluation of SGBV interventions. The curriculum specifies the objective, content and duration of every module, with the whole training expected to take 40 hours.

Participants at the dissemination meeting acknowledged the curriculum adding that to enhance the process, a collection of good practices on the trainings should be collected and published on www.gbvkenya.com. The curriculum was disseminated to stakeholders including the Teachers Service Commission, the two Ministries of Health, the Lang’ata GBV working group among others.

The NGEC, established in 2003 under the Ministry of Gender, Children and Social Development, works as a constitutional commission since last year with expanded mandate to target women, men, people with disabilities, children, youth and marginalized groups. The commission embarked on developing the national curriculum after realizing that there was specific need in addressing Standard Operating Procedures (SOPS) for clinical management of rape, assessment for shelters among other issues.

The German Development Cooperation is a strong player in Kenya in addressing GBV. KfW (German Development Bank) and GIZ Health Sector programme are providing financial and technical support for quality comprehensive GBV service delivery in the health sector. The GIZ Good Governance/Access to justice project is providing technical assistance to the TFSOA. GDC agencies are currently collaborating in establishing two GBV service networks in Kenya, focusing in Nyanza and Nairobi where they shall implement an accreditation system and financing mechanism for GBV. GDC will be working closely with the TFSOA and Ministry of Public Health and Sanitation in addressing challenges from the report.

Curriculum will soon be also available at www.gendercommission.org

Biafra Medical Clinic has offered recurrent free medical camps in their community for several years now, however this latest camp was done in cooperation with TUPANGE, a Kenyan urban reproductive health initiative in family planning counseling and treatment. TUPANGE is a five-year project started in 2010 to prioritize family planning as a routine service offered to every client, with an emphasis on the urban poor. This initiative seeks to change the perception of family planning among the urban poor, ultimately gaining acceptability and seeing family planning as part of a healthy lifestyle. Four university students pursuing related interests also received coaching from Biafra staff during the medical camp.

It is hoped that through the Kenya Urban Reproductive Health Initiative (KURHI) project a transformative and sustainable effort resulting in a 20 percentage point increase in contraceptive prevalence among selected urban centers may be attained. TUPANGE aims to improve the understanding of family planning choices for Kenyans in the urban setting, including where to access family planning services and the accompanying confidence to seek out and utilize these FP services. KURHI hopes to increase uptake and access to quality family planning services for Kenya’s urban population. In collaboration they hope to increase and sustain contraceptive among this group.

Improving access to modern contraceptives, particularly long-acting methods is a key objective of the German Development Cooperation through the GIZ Health Sector Programme. The Programme supports district governments to increase knowledge on long-term contraceptive methods, their advantages and disadvantages in relation to the woman’s need. This will then contribute to the achievement of the Millennium Development Goal 5, the improvement of maternal health.

Muslim Welfare Society founded the Biafra Medical Clinic in 1997. The outpatient medical services are for all, irrespective of religion or tribe. Concentration is given to those with low socio-economic status in Eastleigh / Kamukunji, east of Nairobi.

The Taskforce on the Implementation of the Sexual Offences Act (TFSOA) and stakeholders in the field of Gender Based Violence (GBV) launched the report on April 2, 2012 after a workshop on implementation of SOA held in May 2011. The launch was officiated by the honorable Attorney General, Prof. Githu Muigai whose official speech was read at the meeting by a representative from his office.

The report represents a compilation of stakeholder discussions and recommendations on measures to be taken across sectors (health, legal, community) and geographic locations (rural, urban) in addressing GBV prevention and response in Kenya. It also documents key successes in addressing GBV as well as glaring gaps. The launch therefore, provided an opportunity to jointly define priority areas to be tackled by government and non-government agencies including development partners working in this area.

Challenges highlighted for the health sector include: Lack of a national budget line to facilitate consistent supply of post rape care commodities to facilities; disparity in resource allocation and service delivery; lack of standardization of service delivery and forensic examination procedures; inconsistent and un-coordinated data collection; limited use of the post rape care (PRC) form that is not yet gazetted; capacity gaps among healthcare workers on management of GBV and duplication of functions by ministries of health challenging coordination.

Challenges within the criminal justice system included prosecution challenges such as capacity gaps and lack of witness protection; forensics challenges such as one government DNA laboratory for the entire country with poor equipment and backlog of evidence; judicial challenges such as capacity gaps and lack of standardized procedures and guidelines for handling sexual offences; prison and probation challenges such as lack of rehabilitative programs and prevention strategies such as database management. The report further highlights weak linkages between medical and legal fields as well as poor collaboration and coordination among GBV actors in Kenya.

The TFSOA is working with stakeholders to address the challenges. The German Development Cooperation is a strong player in Kenya in addressing GBV. KfW (German Development Bank) and GIZ Health Sector programme are providing financial and technical support for quality comprehensive GBV service delivery in the health sector. The GIZ Good Governance/Access to justice project is providing technical assistance to the TFSOA. GDC agencies are currently collaborating in establishing two GBV service networks in Kenya, focusing in Nyanza and Nairobi where they shall implement an accreditation system and financing mechanism for GBV. GDC will be working closely with the TFSOA and Ministry of Public Health and Sanitation in addressing challenges from the report.

The detailed report is available upon request.

The German Development Cooperation through the GIZ Health Sector Programme promotes innovative initiatives anchored at improving health and human rights for all.

The Health Sector in Kenya has primarily been funded by the private sector (e.g. expenditures financed out of pocket and by private insurance). However, the private sector contribution of the total health expenditure has decreased from 54% in 2001/2002 to 37% in 2009/2010 with a decline in out of pocket (OOP) expenditure from 43% in 2001/02 to 24.5% in 2009/10.  This reduction in the number of households paying cash or in-kind payments to access health services is positive as it has a direct impact on social protection particularly of the poor as they are considerably vulnerable to catastrophic effects of out of pocket spending on health.

Donor contribution (e.g. expenditures financed by grants or loans from international donors) has doubled from 16% 2001/2002 to 35% in 2009/2010 with a focus on HIV/AIDS and TB. The public sector contribution (e.g. expenditures financed through governmental bodies or social insurance funds) has remained constant at 29% over the same period resulting in a continued reliance on the private sector and donors to principally finance the health sector.

According to the Kenya National Health Accounts (2009/2010), a comprehensive system that tracks resource flow in the country’s health sector there have been significant gains over the past decade in the Total Health Expenditure which has increased by 44% from Ksh82.2 billion (US$1,046 million) 2001/2002 to Ksh122.9 billion (US$1,620 million) 2009/2010. The Total Health Expenditure per capita has also increased from Ksh 2,636(US$ 34) 2001/2002 to Ksh 3,203(US$ 42) in 2009/2010.  Although the per capita health expenditure has increased it is still significantly low and falls short of the amount needed to provide an essential package of services for all Kenyans.

The Total Health Expenditure on Priority areas, 2009/10 Source: Kenya National Health Accounts 2009/10

Nevertheless, despite the fact that the government has not made significant progress increasing the allocation of government revenues to health, it has made efficiency gains by prioritizing health spending.

The German Development Cooperation has partnered with the government to achieve the objective of providing good quality affordable healthcare for all Kenyans, ensuing in the reduction of health inequities and reversing the negative trend of health outcomes. However, to achieve the ‘Abuja Declaration’ target, the government needs to prioritize and increase health allocations of government revenue

The overall objective of the third Kenya National AIDS Strategic Plan (KNASP III) for the period 2009/2010 to 2012/2013 is to align the national response to emerging evidence on the epidemic, both nationally and geographically, and further harmonise the mobilisation, allocation, utilisation and accountability of resources to the response plan. KNASP III is the overarching strategy for all HIV and AIDS interventions in Kenya, with the vision of ‘An HIV- free Society in Kenya’. One of the main aims of KNASP III is to ensure effective sectoral mainstreaming of HIV, resonating with outcome 2 on HIV mainstreamed in sector- specific policies and sector strategies.

The National AIDS Control Council together with its stakeholders and partners last year carried out the Mid Term Review (MTR) of the KNASP III. The main aims of the MTR process were to review effectiveness of KNASP III and accomplishments against the identified objectives, targets, indicators and available evidence; and to assess changing environment in policy, governance, funding and map out future direction. The MTR was further expected to establish the extent to which KNASP III was serving its intended purpose in guiding the national HIV response and programming, and the degree to which the current results are attributable to KNASP III.

The results of the MTR were presented to the National MTR Consensus Conference that took place at the Kenya School of Monetary Studies Nairobi from December 19 -20 2011. The Conference attended by approximately 250 participants representing the nine NACC regions, implementing organizations, public and private sectors, Civil Society Organizations and development partners, provided key stakeholders the forum to discuss, validate and endorse the findings and recommendations of the MTR. It also provided the platform for stakeholders to discuss the changing context for national response; and build consensus on the key recommendations for the future.  A High Level meeting of key stakeholders and decision makers then followed the Consensus Conference held on 24^th January 2012.

Recommendations from MTR, the high level resolutions, together with gaps identified in the current National Plan of Operations (NPO) were used in the designing of the new two-year NPO whereby the four Pillars of KNASP III convened consensus and validation meetings with their stakeholders to agree on activity/result area with a clearly agreed Lead Organization, Time Frame, Level of activity (National or County) and the Proposed Source of Funding.

The thrust to mainstream HIV into various sectors was necessitated by the fact that in the early days of the epidemic, the response was largely from the central level, where efforts were mainly health sector led. The response has however evolved to a more multi- sectoral effort coordinated by national HIV/AIDS councils or commissions, with greater responsibility for implementation being devolved to the individual sectors and the decentralised levels. The shift to multi- sectoralism has largely been a reaction to the need for scaling- up and expanding HIV/AIDS responses in the face of the depth and the scope of the impact of the epidemic on affected societies.

KNASP III seeks to achieve the following results by 2013:

1. Reduced number of new infections by at least 50%

2. AIDS-related mortality reduced by 25%

3. Reduction in HIV-related morbidity

4. Reduced socio-economic impact of HIV and AIDS at household and community level

KNASP III

Article written by Vaida Kontrimaite and Sabine Rundgren

Participants who attended the QPSS Health Care Programme at SBS

Reliable access to quality, safe and affordable essential medicines and medical supplies remains a key challenge towards an efficient, quality healthcare system in Kenya. One of the strategic thrusts of the Ministry of Medical Services (MoMs) is to address this challenge. To this end, the German Development Cooperation has partnered with German healthcare products company B. Braun Melsungen to transform the quality of medical devices and general health service provision in the Kenyan health sector. To begin with, the partnership has collaborated with the Strathmore Business School (SBS) to train about 60 senior and mid level health managers on improving the quality of medical devices procured and health service provision in the Kenyan health sector.

Through the GIZ Health Sector Programme, about 27 mid-level healthcare managers were taken through the Quality Patient and Staff Safety Health Care Program. The training was held at the Strathmore Business School 0n March 12-16 2012. The uniqueness of this program is that it seeks to create an appreciation of the inter-linkage of the different disciplines in delivering quality health care to the patient and ensuring that clinicians, as well as patients, work and are served in secure environments.

This course follows an earlier one held in December 2011 that sensitized senior leadership on the inter-relation of the different sectors of the health industry in contributing to patient and staff safety.

Participants at the Quality Patient and Staff Safety Healthcare Program were provided with operational leadership knowledge and skills aimed at ensuring and improving on patient and staff safety using conceptual as well as case based methods. This gave the participants the theoretical underpinning and principles, as well as a “practical feel” to the various concepts.

Dr Majid Twahir, the course leader, presented a convincing case of the superior link between an institutions vision, mission and culture and the extent to which patient and staff safety measures were implemented. Dr George Njenga presented a thoroughly enriching, engaging and challenging discussion on the role of leadership in driving quality. He strengthened the argument that an Institutions position on quality was greatly determined by how important leadership took this issue and how well it got ingrained within its mission and vision.

Kerstin Heimel, who served as an external resource from B. Braun Melsungen, drew clear linkages between usage of quality medical equipment and a reduction in the overall health care delivery costs. 
 Some of the other courses offered during the five days training included: Designing and implementing quality patient and staff safety initiatives, Principles of Procurement, Corporate Governance and quality, Role of Government and Statutory bodies, Health facilities management and its relationship to quality and staff safety, Pharmaceutical procurement in Kenya, Role of leadership in driving Quality and best guidelines in procurement of pharmaceutical devices.

Evaluation of the workshop was positive, with participants highlighting that they had benefited from the training, had become more knowledgeable, and had developed a change of mind-set; they could make change as leaders in ensuring quality patient and staff workers safety. The participants will be expected to integrate the learnt concepts in designing and undertaking a transfer project at their stations of duty.
 A second module to this training will be held between the 23rd and 27th of April with a focus on practical concepts.