by Lorraine Anyango.
Medicines used to treat chronic disease have been taking a large proportion of total volume in the health facilities in Kisumu County in the last four months.
It’s further expected that chronic disease medicine volumes will increase dramatically if continued access is provided under the Universal health care program.
This is according to a recent medicines situation report submitted by the County Pharmacist dated March 18th 2019.
The chronic disease medicines are regularly provided and used for the lifetimes of individuals who need them.
Additional problems of affordability that faced people living with chronic diseases due to the lifelong nature of treatment and the frequent need for combination therapy have been reduced and nearly eliminated since the launch of the UHC pilot program in the county.
Pre- UHC pilot program, was characterized with low availability of medicines in the public sector, and patients were often forced to purchase some of the essential medicines in the private sector. This has however changed. High medicine prices were largely responsible for increase the cost of treatment.
During the same period, Kisumu County decided to decentralize their procurement process in an effort to meet local needs through increased local involvement, accountability and flexibility.
Kisumu County has shifted from push to pull distribution systems thereby creating the need for health facility data for distribution planning and ordering.
Under UHC, Kisumu country was allocated 510 Million shillings for health products and technologies and basic equipment.
Even with this allocation, Kisumu County department of health has faced challenges when attempting to address the medicines supply gap.
The challenges arises due to the county level budget for procurement of health products for primary health care not being maintained, so as to complement support from the national government.
Kisumu county government owes KEMSA a total of Ksh 77,526,555.98 in unpaid invoices for essential medicines and medical supplies delivered to Kisumu county health facilities, even though KEMSA has made efforts it may not always manage 100% fill rate.
Essential medicines and medical supplies that were supplied at the inception of UHC pilot have been used by most facilities well within the period ending 14th March 2019 with some stocks still in place although a few of the facilities have reported stock outs of some of the commodities.
KEMSA, however, failed to supply some essential medicines up to date, and these have been stocked out in nearly all the facilities. The most significant ones include ceftriaxone 1g injection, albendazole 400mg tablets, nifedipine 20mg SR tablets, chlorhexidine digluconate 7.1% for cord care, benzyl penicillin 5mu inj, phenobarbitone inj. and ampiclox 500mg capsules.
“There’s need to budget for county level procurement of stocked out medicines since such a situation is bound to occur again.” Dr Lawrence Otieno the County pharmacist notes.
Pharmacy workforce shortages constitute a major capacity limitation to the provision of pharmaceutical services and access to medicines in Kisumu County. The county currently has 46 pharmacists and 35 pharmaceutical technologists against a minimum requirement of at least 70 pharmacists and 190 pharmaceutical technologists.
“Recruitment of additional pharmacy workforce should be considered when developing medicines policies and pharmaceutical services and integrated into broader human resources for health strategic plans.” Dr Otieno adds.
The relative contributor to the county burden of disease of HIV/AIDS, TB and malaria, is relatively is huge in Kisumu county. The implications for the delivery and use of pharmaceuticals are profound.
However medicines for HIV/AIDs, TB and malaria drugs are supplied by the national government through KEMSA free of charge to the county. Whereas antiretrovirals and TB medicines are supplied on monthly basis, antimalarials and family planning commodities are supplied on quarterly basis.
In February 2019, the Health Information Systems department at the Ministry of Health introduced data sets for reporting of tracer essential medicines and non-pharmaceuticals onto the DHIS2. Kisumu county department of health is keen to embrace the usage of this reporting platform as it will give a clear visibility of the medicines availability across the county health facilities. Consumption reports from the month of March going forward will be submitted through DHIS2 rather than excel based emails.
Analysis of consumption is complicated by the diversity of commodity management systems used by health facilities. The need for more comprehensive information system is particularly acute in low level health facilities especially those that do not have trained pharmaceutical personnel.
As the county shifts from the Excel based reporting to the DHIS2 platform for reporting of tracer commodities, there’s need to support the sub county pharmacists to adequately tackle the challenges involved with reporting.
Kisumu County’s investment in community and primary health care.
About 2500 community health workers (CHW) are set to benefit from 45 million shillings set-aside by the county government of Kisumu as stipend.
The amount has been budgeted to cover for 6 months stipend before the next financial year commences. Each of the CHW’s will be receiving Ksh 3000 on a monthly basis.
Governor Peter Anyang Nyong’o will on 12th of April launch the payment at Angola hospital in Kisumu East Sub-county, during which he will pay off the first batch of 16 million shillings to the CHW’s.
The remuneration is in line with the promise given by the County Government of Kisumu as an appreciation for the services rendered by the health volunteers who are equally distributed and designated at the units.
Kisumu’s county government had committed to pay stipends following a community health policy that was reviewed by the council of governors.
As part of capacity building for volunteers and CHW’s, a 13 module curriculum was also developed including 6 basic and 7 technical manual for the community volunteers.
This step will go a long way in the impact created by Universal Healthcare (UHC) which is linked directly to health at the household level through primary health care.
Primary health care encompasses correct health seeking behavior, the correct knowledge about health and wellness, use of clean water for drinking, proper house hold hygiene and excreta disposal and adequate nutrition of a balanced diet, child immunization and monitoring of pregnant women and sufficient mental health and stability and oral health. (Continuum of health care)
One of the challenges under UHC was the decision to pay community health workers a stipend as a way of appreciation to their work in promoting health and providing services to communities.
Numerous arguments and counter have been advanced on the ability to sustain the payment to community health workers since the onset of their usage in 1978 when they started working as volunteers known as CHV’s.
The Kisumu county government realizing their immense value has taken a bold step to begin paying this providing remuneration that will go a long way in incentivizing this cadre of workers to have faith and perform better in their work places.
In Kisumu County the CHW’s form the largest single health work force and have been delivering services pro- bono.
It’s a major land mark in history that the governor will unlock the door of non -payment to this faithful and dedicated workers.
Apart from the stipend the county government is embarking on programs to develop their income generating base to guarantee their adherence and sustainability to the work as well as their medical cover under NHIF.
Angola health center, situated in Kisumu East sub county is a shining example of an integrated development program where practical skills are offered to the community especially the vulnerable groups and knowledge and appropriate attitude change is exchanged and grounded .
Angola is one of the designated places benefitting from food security programs and enterprise programs, clean water provision, early child hood development and youth stroke adolescent empowerment.
The overall result is predictable development of all age groups. This programs will adapt well to the new dispensation of making the villages centers and engines of development within the sub counties in particular and the county overall.
“It our intention to replicate this model in all the sub counties in Kisumu.” Governor Nyongo says.
The community unit structure comprises CHCs, CHVs, CHWs, households, and affiliate health facilities. The nearest health facility is the community’s link for seeking all health services.
The community unit, which draws its membership from the catchment area, is led by the CHC and office personnel to support the CHVs in their community-related health work. Post- devolution, there is increased investment by counties on the community strategy, with revision of the strategy designed to reach communities mainly through employed staff with the support of volunteers (5 CHWs from 2 per 1000 HHs). A community health policy has been drafted and is being reviewed by the Council of Governors.
It seems that all basic preparations have been made and what is remaining is getting consensus and endorsement by MOH and counties with agreed design changes if necessary and scale up to ensure that Kenya is investing more on prevention and promotion. Currently, there are 4587 community units established with 4048 CHWs and 90758 CHVs, and only 7 counties met average of deploying 2 CHWs per county.
There is however need to re-examine and strengthen the community strategy as a means of reaching the community. This should include the mobilization of additional resources for community based interventions and leveraging the use of community health workers in enrolling the population on to the National Hospital Insurance Scheme.
Comprehensive and integrated care for the bulk of the assorted health problems in the community is more efficient than relying on separate services for selected problems, partly because it leads to a better knowledge of the population and builds greater trust.
By Lorraine Anyango
Kisumu Deputy Governor, Dr. Ochieng Owili, joined Ambassador of the Kingdom of the Netherlands, H.E Mr. Frans Makken for a luncheon meeting at the Capital Club East Africa in Nairobi for a discussion on the Kenya Pooled Water Fund joint initiative.
The discussions focused on ways of opening new funding window for Water Service Providers. Kisumu County government is seeking partnerships for funding to expand water supply within the County.
The meeting was attended by among others Governor Ole Tunai of Narok County, Eddy Njoroge the chairman of KPWF, Embu and Nyeri County Government representatives and USAID officials.
The Governor of the Central Bank of Kenya Dr. Patrick Ngugi Njoroge called on the Kisumu Governor, Professor. Anyang’ Nyong’o at his office.
The purpose of this visit was to deliberate on how the County Government of Kisumu and the Central Bank of Kenya can improve services rendered to the County. These included: fast tracking the processes of money transfers, promotion of SME’s among many others.
The County Minister for Finance, Nerry Achar on his part, lauded the Central Bank Kenya for their cooperation with the county
Also present was the Central Bank of Kenya Board Chairman, Mr. Mohammed Nyaoga among other board members.
The Agricultural Society of Kenya (ASK) is in the process of modernizing Kisumu showground through development and implementation of a master plan to guide developments.
This will be realized through interaction, development collaboration based on mutual understanding between the County and the ASK.
It’s against this backdrop that ASK Board Members called on Kisumu Governor, Professor Anyang’ Nyong’o at his office.
Some of the improvements and investment projects that are envisaged in the master plan includes;
- . Improvement of infrastructure within the showground and it’s surrounding.
- Exposition hall and conference center.
- Sporting arena
- A business incubation center.
- A recreational facility.
- In offensive light industries (value addition).
- A hotel
Establishment of these facilities will go a long way in attracting more events to Kisumu due to availability of facilities, boost urban tourism, boost local revenue, and create employment opportunities thus uplifting the status of Kisumu County.
Farmers are set to experience a reduction in crop production losses, following the launch of the Plant Clinics Programme that tailored to help small holder farmers with the opportunity to diagnose plant pests and diseases as well ways of management for improved crop productivity.
While he officially launched the Programme, Kisumu County Deputy Governor Dr. Mathew Ochieng Owili noted that food security remains a priority for the County and Kenya at large.
He reiterated Kisumu Governor’s commitment to put all structures in place to ensure the situation of food insecurity is alleviated even as he urged the farmers and stakeholders to make use of the Clinics to get the right information concerning pests and diseases and best agricultural practices.
Dr. Owili also issued a directive to the County Department of Agriculture to put into place a Programme that will ensure proper information dissemination to all local farmers thus ensuring adequate access to necessary information.
The County Minister for Agriculture, Livestock, Fisheries and Irrigation Gilchrist Okuom on his part, assured the partners that the County will address the issue on staff attrition by ensuring a smooth skills transfer. He however sent a special plea to the local agrovets not to sell expired or unnecessary pesticides to the farmers but instead allow them to buy the recommended products by the plant doctors.
The launch of the Programme will allow small holder farmers access valuable information, share experiences on various crop challenges as well as update themselves on modern technologies they can embrace to ensure increased crop production for improved livelihoods.
The farmers will also be able to access extension services at designated markets across the seven Sub-Counties using modern technologies thus ensuring timely management of crop pests and diseases, a key component in the reduction of crop production losses.
The Plant Clinics will be operational every month in the following centres: Nyamasaria market – 1st & 3rd Thursday of the month, Daraja Mbili market- 1st & 3rd Tuesday, Kombewa market -1st & 3rd Friday, Rabuor market – 1st & 3rd Wednesday, Ombeyi Market – 1st & 3rd Wednesday and Katito market – 1st & 3rd Thursday of the month.
The event was made possible by the Kisumu County Government through the Department of Agriculture with support from Self Help Africa and the Centre for Agriculture and Bio-Science International which was instrumental (CABI) in the training of the plant doctors.
By: Nancy Juma
Kisumu County through the Ministry of Health and Sanitation, yesterday sensitized key stakeholders on the Universal Health Coverage (UHC) implementation at Acacia Hotel in Kisumu.
Kisumu is one of the four Counties identified for piloting of the UHC program. The others include: Machakos, Nyeri and Isiolo.
According to the County CEC for Health and Sanitation, Dr. Rosemary Obara, the main objectives for the sensitization was to equip leaders and partners with the needed knowledge on implementation of the UHC program, facilitate exchange of views and also ensure access to quality health services for all without financial hardships.
She reiterated the fact that all stakeholders including the Members of the County Assembly, County government , National government together with the private sector need to work together to realize affordable health care.
UHC has three key elements: equity in access to healthcare in terms of geographic coverage and the range of available health services; high quality health services; and financial protection against any hardship to users of health services which may arise from out-of-pocket payments.
Dr. Obara also highlighted key areas the county has achieved in terms of improving access to health care. One being operationalizing maternity theaters in all sub counties to reduce referrals and mortalities.
The mobilization started officially in November last year. The County has so far registered 306,697 households with a total of 887,038 persons being captured which reflects 75% above the estimated number of 250,000.
The County director, Dr. Dickens Onyango, highlighted that since the mop up exercise began, the County has had an influx in the number of people seeking for health services in the County hospitals increase significantly with 82% increase in outpatient workload.
The County was allocated Kshs. 217,383,080 in the first half, and it has already spent Kshs. 158,242,582 which reflects 72.79% expenditure of its allocation in just the first quarter.
Other presentations included Health and Nutrition Contingency Plan 2019, Systems Responsiveness to UHC which included cost containment measures and UHC dashboard.
The county is looking forward to addressing human resource deficits which has been brought about by the high enrolment of residents on the program, ensuring adequate commodity supplies in laboratory and pharmaceuticals, expand capacity of existing facilities and also to ensure funds flow, efficiency and accountability.
Other key stakeholders who attended the sensitization were representatives from the National government Ministry of Health, Kisumu County Assembly, and Members of the Health Committee, NHIF, and Community health workers among others.
By Enose Ambani and Felix Nyabala
INTERNATIONAL HOUSING CONFERENCE IN KISUMU
Kisumu County played host to the three day International Housing Conference held at Grand Royal Swiss Hotel.
The conference that was presided over by the Kisumu Governor, Prof. Anyang’ Nyong’o flanked by his Deputy Dr. Mathew Owili, focused on the implementation of adequate and affordable housing which is one of the Big Four agenda
The Governor reiterated on the importance of maintaining green space in the County as development takes place, since it is the only way of ensuring that residents of Kisumu have habitable homes
In line with the theme ‘Adequate and Affordable Housing for all’, the noble initiative links different international development partners, the county government of Kisumu and the civil societies to collaborate in the delivery of the key objectives to this agenda.
In respect to the Universal Declaration of Human Rights, every person has a right to accessible ,adequate housing and sanitation as stipulated in the Kenyan constitution article 43(1-b). This can be attained when the County Government is fully involved as the national government plays the role of policy direction to ensure residents finds quality life and human dignity.
The social expectation of the Kenya vision 2030, adequate housing is given weight to entirely change the face of this nation. It is envisaged that by that then, Kenya will be an urban country, where a lift to livelihood is to be loud.
The conference made the following resolution,
There will be an improved system of community mortgage programmes that will help in land acquisition through the community association based on the concept of the community ownership.
Adequate housing is a basic human right that ensure their peace and dignity. This focus on initiating affordable housing especially for the poor.
Effort to strengthen the non-profit community-based organisations to ensure community stewardship.
The need to enlarge public awareness on their rights and lastly the implementation of the housing agenda.
The conference aimed to address and provide strategies that can be used worldwide in thirst to achieve affordable housing.
The calls on Sugar Companies Privatization continues to gain momentum as stakeholders try to find a lasting solution to the ailing sugar industry.
Currently, the sugar industry faces a myriad of challenges which include: experiencing loses, slowed down operations due to deplorable state and lack of modern equipment, late payment of sugar cane farmers, late harvesting of cane as well as corruption that has made sugar production unsustainably expensive.
In a consultative meeting held at the Grand Royal Swiss Hotel, brought on board Rt. Honourable, Raila Odinga, CS agriculture, Hon. Mwangi Kiunjuri, Chairman Council of Governors. H.E. Wycliffe Oparanya ( Kakamega), H.E Zachary Obado ( Migori), H.E Cornel Rasanga ( Siaya), H.E. Stephen Sang’ ( Nandi), Professor Hamadi Boga, Privatization Commission, Senators, MCAs, among other leaders from the sugar growing region to chart the way forward
The Ministry of Agriculture disclosed in a report that about 1.9 billion has been disbursed to pay farmers debts even though the sugar sector still faces a multiple of financial challenges.
On his part, the Rt. Honourable, Raila Odinga, underscored the urgent need to find a lasting solution to the problems facing the sugar mills to ensure sustainability and profit realization in their operations.
“The sector cannot be revived through accusations and counter accusations, we should be prepared to take bold steps” said Rt. Hon. Raila
Some of the resolutions made during the meeting include:
That, in view of urgent need to revitalize the public mills and the industry at large, the Privatization Commission identifies strategic partners in the next 120 days.
That, County Government to represent the interest of farmers on matters privatization.
That, a special Committee be set up by the Ministry of Agriculture, Livestock and Irrigation to come up with a revival strategy for revitalization of Mumias Sugar Company
That, the Sugar Industry Task force to complete its work within the next 14 days
That, the remaining 808 million owed to farmers be captured in the supplementary budget.
That, the Ministry of Agriculture to provide leadership in bringing together relevant government departments and agencies to address financial requirements of the public Sugar Companies, particularly debt write off.
That, the Sugar Act be reinstated to provide independent sugar regulatory body and sugar resource body.
That, the Sugar Regulations be gazette to provide a conducive business environment for the Sugar Sector.
By: Emily Mikwa