Christian Health Association

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CCIH ANNUAL CONFERENCE

• MAY 29-31, 2005 Washington DC
• Christian engagement in health systems
• Wellspring Retreat Center, Germantown

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Challenges of Christian Health Associations in
Africa

• Presentation by
• Dr Samuel Mwenda
• Executive Director
• Christian Health Association of Kenya

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Presentation outline

• Introduction to CHAK
• Historical background of Church health services
  in Africa
• Challenges facing Church health services
• CHAs features, roles, challenges, strategies
  and potential.

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CHAK Background information

• CHAK is an Association of Protestant Churches
  Health facilities programs from all over Kenya
• Was started in 1930s as a Hospitals Committee
  of NCCK.
• Changed to PCMA in 1946 with the sole mandate
  of receiving distributing Government grants to
  Protestant Churches Health facilities
• Acquired the name CHAK in 1982 and expanded
  mandate to that of facilitating the Churches role
  in health. The grants gradually declined and
  completely stopped in 1996.

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Membership 416

• 24 Hospitals
• 43 Health Centers
• 298 Dispensaries
• 51 Churches/church health programs
• www.chak.or.ke

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Church health services in Kenya KEC CHAK

• Health facilities over 880
• In addition Churches run out-reach health
  programs PHC activities
• Total contribution in health care is estimated at
  40
• Nationwide distribution often serving rural
  underserved areas
• Started as part of the holistic ministry of the
  Church with the objective of serving all those
  with need particularly the poor vulnerable.

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Vision of CHAK

• Vision- All member units and the secretariat are
  fully equipped, maintained soundly managed by
  committed, skilled staff, providing
  comprehensive, sustainable and affordable quality
  health services to all, and witnessing to the
  healing ministry of Christ
• Goal Promote access to quality health care

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Key Strategic priorities

• HIV/AIDS prevention, treatment, care and support
  and stigma reduction
• Advocacy representation with MOH and other key
  stakeholders in health
• Capacity building/training
• Networking and communication
• Health Care Technical Support Services (HCTS)
  Medical Equipment repair and maintenance
• Sustainability

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..2

• Governance and management support to Church
  health facilities
• Health care financing through Social Health
  Insurance Schemes CBHFA
• Information Communication and Technology (ICT)
• Quality assurance in health care through
  application of Kenya Quality Model (KQM)
• Promotion of Rational Drug Use and the Essential
  Drugs Concept
• Research, documentation and information sharing

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Health services

• Wide range of diagnostic, curative, preventive
  rehabilitative services provided by member health
  facilities ranging from Dispensaries to large
  referral hospitals
• Services targeted to the most needy underserved
  communities
• Services holistic serving the physical,
  psychological, spiritual social needs

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Training of health workers

• Nurses training in 19 Mission Hospitals
• Elective term rotation for medical students
• Internship training for doctors, nurses
  clinical officers
• Post graduate Family Medicine training for
  doctors in collaboration with Moi University
  Medical School started in Jan. 2005
• Support to CPD through seminars, workshops
  conferences

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Advocacy with government

• For recognition of our contribution in health
  care
• For involvement in health policy making
• For resources to support health care
• For training opportunities
• Strategy proactive engagement with MOH,
  documentation

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Medical equipment repair maintenance (HCTS
Project)

• Medical equipment procurement installation
• Medical equipment repair maintenance through a
  countrywide HCTS project
• Medical equipment spare parts procurement program
  for local overseas sourcing

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Promoting access to Essential Drugs in Kenya
through MEDS

Mission For Essential Drugs Supplies www.meds.or
.ke
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What is MEDS?

• Ownership
• Jointly owned and managed by Kenya Episcopal
  Conference Catholic (KEC) and CHAK
• Mandate
• Provision of affordable, good quality Essential
  Drugs Medical Supplies (Procurement,
  warehousing, quality control, sale
  distribution)
• Training of Health personnel to build capacities
  in Church health facilities in Rational drug use
  stock management
• Pharmaceutical technical support to Church health
  facilities through field Pharmacists.

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Service Distribution

• Over 40 of the population covered
• Serves over 1200 clients
• Church health facilities in Kenya
• NGOs in Kenya and Neighboring countries
• Donor funded healthcare projects
• Government health facilities through their cost
  sharing funds
• Community based health care initiatives
• Other faith based health facilities (Muslims,
  Silks, Hindu etc)

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MEDS capacity Drug Supply System

• Promotes the Essential Drugs Concept guided by
  WHO MOH
• Annual turn-over of over 10m (in addition had
  contract with USAID to supply ARVs worth 7
  million in 2004/5)
• Stocks over 700 items ( Drugs Medical Supplies
  including ARVs).
• Has 7 warehouses has plans for expansion. Has
  staff establishment of 100.
• Stock list reviewed periodically by a Technical
  Formulary Committee
• Over 70 of the supplies are procured locally
  30 are imported directly
• All operations are computerized
• Has a National distribution network promotes
  equity by absorbing distribution costs

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Quality Assurance

• Operates a Quality Control Laboratory (currently
  processing WHO accreditation)
• Regular supplier appraisal
• Screening of items on receipt
• Random analysis of stocked items
• Acquired capacity to do quality analysis on
  generic ARVs with support of USAID
• Client feedback

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Historical background of Church health facilities

• Health institutions were started by the
  Missionaries as part of the total package of the
  Good News Ministry
• Most institutions were started with total or
  significant external funding (their services were
  charitable)
• Many were started by Missionaries who had
  multiple skills/gifts both in the Church ministry
  and medical field

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..2..

• Most were started in remote locations with no
  alternative providers, motivated by the desire to
  promote equity access and hence had no
  competition.
• Government provided grants which gradually
  reduced and ceased in 1996 in Kenya
• Standards for health care were not very demanding
  or strictly monitored by MOH - (hence use of aids
  workers trained on the job was common and there
  were no risks of litigation)

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Historical sources of support for church health
services in Kenya

• Donations from local sister churches abroad
• Missionary expatriates eg doctors,nurses,administr
  ators paramedical staff
• Government grants
• Government seconded staff
• Donated drugs, medical supplies medical
  equipment
• User fees/patient fees was the least
  significant source of funding

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Current sources of support (Kenya experience)

• User fees/patient fees (contributes over 80 of
  recurrent expenditure)
• Donations but now targeted to capital
  development or designated programs
• Missionary expatriate workers - (1-2 of total
  personnel establishment)
• Government seconded staff - (2 of the
  professional staff)
• Government supported Medical supplies eg
  vaccines, TB drugs, STI drugs, FP methods and HIV
  test kits ARV drugs and occasional equipment
  vehicles
• Donations of drugs, medical supplies equipment
  (very irregular)
• Financial sustainability is a major challenge
  (huge accumulated debt burden and declined
  utilization)

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Current scenario facing Church health services in
Kenya

• Decline in utilization due to cost barrier
  (50-60 bed occupancy)
• Dependence on patients fees for financing of
  operations
• Burden of accumulated debts (20-40 of expected
  revenue)
• Burden of managing HIV/AIDS patients
• Increasing cost of providing services
• Threatened sustainability mission

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Thank You
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CHAS IN AFRICA

• Features, functions, challenges strategies

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CHAs are National networks providing 20-45
of national health care
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Shared features of CHAs

• Ecumenical nature promotion of ecumenical
  collaboration ( Protestants Catholics together
  or separately)
• National networks
• Membership by Churches Church sponsored or
  affiliated health institutions programs
• Core mission is the promotion of Church Health
  Ministry
• Recognition and engagement by Governments (MOH)
• Have secretariats to coordinate day-to-day
  activities
• Accountable to member institutions member
  Churches
• Resources are from members, partners programs

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Functions of CHAs

• Advocacy representation
• Policy development dissemination
• Networking communication
• Capacity building
• Drugs medical supplies procurement
  distribution
• Technical assistance to member health units
• Ecumenical collaboration

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..2.. Functions..

• Resource mobilization
• Database management
• Service mapping
• Research, documentation information sharing
• Governance management support
• Program development implementation technical
  support
• Medical Equipment procurement maintenance
  support.
• ME

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Challenges facing CHAs in Africa

• Financial sustainability most CHAs are largely
  donor supported
• Data collection response rate is low leading to
  incomplete databases.
• Communication/information sharing within the
  network/with other stakeholders both nationally
  internationally
• Recognition support by government lack of
  MoU/Legal framework

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challenges

• Limited human resource capacity
• Brain drain staff turn-over
• Staff motivation, development retention
• Demands by member units that outstrip available
  resources
• Competition - from international FBOs NGOs
• Health Sector Reforms decentralization
• Governance/management some have beuraucratic
  systems which are not efficient

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Challenges

• Government policies regulations
• Autonomy of management in member health units
  CHAs have no direct control
• Devastating impact of HIV/AIDS
• Emerging re-emerging disease conditions
  disease outbreaks
• Annual membership subscription payment

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challenges

• Inadequate involvement in policy formulation at
  decentralized levels of government
• Poverty equity justice a major problem
• Slow response to the dynamic changes in the
  environment
• Diversity of membership eg interdenominational
  ideological differences
• Poor infrastructure especially in the rural areas
• Poor communication facilities in rural area
  facilities

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challenges

• Achieving adequate community involvement
  ownership
• Increase in sophistication of demands by clients
  as education level increases
• Access to drugs especially ARVs
• Some employees lacking on Christian vision
  integrity
• Accurate regular updating of service mapping

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Strategies to address the challenges

• Regular review of identity, relationships
  mandate
• Membership subscription to strengthen ownership
• Strategic planning through a participatory
  process that ensures that aspiration of members
  are given priority consideration
• Proactive advocacy with government other
  stakeholders for resources involvement in
  policy formulation
• Develop MoU with Govt/MOH that defines roles,
  responsibilities obligations (mutually
  negotiated) and lobby for its implementation

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strategies

• Maintain credibility by good governance
  provision of good quality services
• Promote collaboration networking
• Create structures fora for dialogue
  information sharing with members
• Maintain transparency accountability to
  members, partners governments.
• Ensure equitable distribution of resources
• In resource generation, nature partnerships with
  mutual goals

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strategies

• Develop effective mechanisms of communication
  within the network with other stakeholders
• Promote information sharing learning from one
  another.
• Maintain information gathering, processing,
  database management dissemination
• Map out or update the distribution of our
  services to serve as an advocacy tool and to
  guide resource allocation
• Establish drug procurement distribution
  agencies which also promote quality assurance,
  Essential Drug List concept Rational Drug Use

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strategies

• Build capacity of the secretariat to cope with
  the demands but also tap human resources from
  within the network
• Support by government with personnel secondment
  and training
• Constitution/Policy review to have more inclusive
  governance efficient systems of management
• Ensure professional management of the secretariat
  member institutions for efficiency
• Networking with other CHAs for peer learning
• Support by WCC, Health Healing Program and
  other partners in facilitating networking
  linkages

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CHAS MEETING IN MALAWI 2004 facilitated by WCC
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CHAs are vital in facilitating profiling
Churches provision of health services in Africa.

• They should be strengthened and supported to face
  the challenges
• Thank you for your attention!