The role of ministries, departments and agencies (MDAs) in providing infrastructure and service support to UHC

Ministry of Health

The Ministry of Health is charged with formulation and implementation of health policy, sanitation policy, preventive and promotive health services, HIV/Aids and sexually transmitted infections (STIs) programmes, treatment and management, health education, family planning, food and food handling, and health inspections.

Its vision is to have ‘a healthy, productive and globally competitive nation’. This is driven by the mission: to build a progressive, responsive and sustainable healthcare system for accelerated attainment of the highest standard of health to all Kenyans’ (Government of Kenya, 2014).

The Ministry formulated the Kenya Health Policy 2014-2030 whose goal is attainment of the highest standard of health in a manner responsive to the needs of the population. In addition, policy principles and orientations have been formulated to facilitate the development of comprehensive health investments, health plans, and service provision within the devolved healthcare system.

The policy aims to achieve the following:

  1. Eliminate communicable conditions;
  2. Halt and reverse the rising burden of non-communicable conditions;
  3. Reduce the burden of violence and injury;
  4. Minimise exposure to risk factors;
  5. Strengthen collaboration with private and other health-related sectors; and,
  6. Provide essential healthcare.

Role of Kenya Pharmacy and Poisons Board (PPB)

The Kenya Pharmacy and Poisons Board (PPB) plays a pivotal role in promoting UHC. Essential medicines, equipment and supplies are critical for the implementation of UHC . The PPB endeavours to enhance access to affordable and quality medicine. To achieve this, it has been working on developing a framework for regulation of parallel imported drugs (Pharmacy and Poisons Board, 2018). The board says the justification for the parallel importation doctrine is to ensure the poor can access affordable and high quality medicines.

The PPB is the Drug Regulatory Authority established under the Pharmacy and Poisons Act with the following mandate:

Regulation of the practice of pharmacy and manufacture and trade in drugs and poisons;
Implementation of relevant regulatory measures to achieve the highest standards of safety, efficacy and quality for all drugs, chemical substances and medical devices, locally manufactured, imported, exported, distributed, sold, or used, to ensure protection of the consumer as envisaged by the laws regulating drugs in Kenya.

According to the Pharmacy and Poisons Board, pharmacists play a critical role in the implementation of universal healthcare policy, mainly in medicines supply chain management, including procurement, distribution, quality assurance, dispensing and monitoring. However, despite the existence of PPB, there have been private market quality concerns about the medicines and supplies (Mackintosh et al., 2018). A study (Mackintosh et al., 2018) revealed that medicines procured from public wholesalers were found to be of good quality, apart from some equipment and supplies such as gloves, whose quality was wanting. The government has, however, committed to addressing the issue of substandard medicines through calibrating the existing regulatory system and holding criminals who engage in such business to account.

The pharmaceutical industry and stakeholders can work with the government to achieve UHC, through providing access to affordable and high quality medicines and other medical commodities. To achieve this, the PPB has enhanced its market surveillance to ensure only legitimate outlets are allowed to sell medicines and health-related commodities in the country. This has been done through setting up a Health Safety Code, which is accessed via a free SMS code (21031) that can be used by customers to ascertain legitimate pharmacies or chemists validly licensed by the Board (Pharmacy and Poisons Board, 2018). This has helped reduce cases of quacks running illegal pharmacies and chemists, thus endangering lives. The PPB, in delivering its mandate, has cracked down on illegal pharmaceutical businesses. Since 2016, it has closed down 994 illegal pharmaceutical outlets countrywide and arrested 881 suspected offenders (Pharmacy and Poisons Board, 2018). However, the challenge is that the low number of Kenyans going out of their way to confirm that the medicine they are purchasing is from legitimate pharmacies, is low. There have been cases of people falsifying medicine by replacing originals with fakes, which are then repackaged and sold as genuine.

Kenya has a Pharmaceutical Sector Development Strategy and support for local pharmaceutical manufacturers to embrace Good Manufacturing Practices (GMP) through the GMP Kenya roadmap initiative, which has 35 participating members. If well implemented, the strategy is expected to promote best practice in the local pharmaceutical manufacturing industry and improve quality healthcare.

Kenya Medical Supplies Authority (KEMSA)

The Kenya Medical Supplies Authority (KEMSA) is a State corporation under the Ministry of Health established under the KEMSA Act. The agency was established in February 2000 following the recommendations of a health stakeholder’s forum on strategies for reforming the drug and medical supplies systems, (Amemba, 2013). It is a specialised medical logistics provider for the Ministry of Health, public health facilities, and programmes.

The KEMSA Act in section 4 (1) outlines the functions of the Authority as follows:

  1. Procure, warehouse and distribute drugs and medical supplies for prescribed public health programmes, the national strategic stock reserve, prescribed essential health packages and national referral hospitals.
  2. Establish a network of storage, packaging and distribution facilities for provision of drugs and medical supplies to health institutions.
  3. Enter into partnership with or establish frameworks with county governments for purposes of providing services in procurement, warehousing, distribution of drugs and medical supplies.
  4. Collect information and provide regular reports to the national and county governments on the status and cost effectiveness of procurement, the distribution and value of prescribed essential medical supplies delivered to health facilities, stock status and on any other aspect of supply system status and performance which may be required by stakeholders.
  5. Support county governments to establish and maintain appropriate supply chain systems for drugs and medical supplies.

KEMSA is driven by the mission to provide reliable, affordable and quality health products and supply chain solutions to improve healthcare in Kenya and beyond. Section 4 (2) of the KEMSA Act  vests powers of determining the requirement of drugs and medical supplies in public health facilities in the Cabinet Secretary in consultation with KEMSA and county governments (Government of Kenya, 2013).

The agency plays a big role in implementation of UHC through procuring and supplying medical products and technologies countrywide. In January 2020, KEMSA signed a partnership deal worth Ksh120 million per year based on performance with the Postal Corporation of Kenya (PCK) to use their networks to deliver products and technologies. PCK has countrywide networks with a fleet of vehicles, motorcycles and strategic warehouses in each region and therefore has the capacity to deliver Health Products and Technologies (HPTs) to the last mile. This is part of the agency’s preparedness to take UHC to all counties. However, despite these efforts, KEMSA is also faced with inadequate pre-procurement planning issues, which have occasionally led to non-payment of suppliers. According to Amemba (2013), the agency needs to develop a risk management strategy to address any loophole in the supply chain.

Kenya Medical Research Institute (KEMRI)

The Kenya Medical Research Institute (KEMRI) is a State corporation established under the Science and Technology (Amendment) Act 1979. In addition to the institute being a State agency, it maintains strong collaborations with related regional and international organisations. The Science and Technology Act 1979 was amended to the Science, Technology and Innovation Act 2013, making KEMRI a national body mandated to carry out health research that can be applied towards policy change in the management of health delivery systems. KEMRI’s mission is: to be a leading centre of excellence in human health research. The specific programme areas KEMRI focuses on include research development on public health and health systems, traditional medicine and drug development; biotechnology; infectious parasitic diseases; non-communicable diseases; and sexual, reproductive, adolescent and child health. The institute also specialises in policy analysis, research foundation and advocacy; and training in health policy issues. The institute also conducts research on how best to implement UHC, assess emerging challenges, and find ways that they can be addressed. Such research can be instrumental in guiding policy-makers on how best to implement UHC.

National Hospital Insurance Fund (NHIF)

Prior to the establishment of the NHIF through the National Hospital Insurance Act, the Fund had been under the Ministry of Health. The NHIF’s mandate is to ‘facilitate access to quality healthcare through strategic resources pooling and healthcare purchasing in collaboration with stakeholders’ (Government of Kenya, 2018:1). One of the roles of NHIF is to provide social health insurance to it members. Provision of social health insurance is also highlighted in Kenya’s Vision 2030 as one of the requisites for achieving UHC. To do this, the government has been reforming the NHIF to make it one of the key drivers of UHC. These reforms are spelt out in the NHIF Strategic Plan 2018-2022 as follows:

  • Structural changes aimed at making the Fund more effective and responsive to its clientele’s needs;
  • Reviewing contribution rates;
  • Introduction of outpatient and non-communicable diseases (NCDs) in the health cover package;
  • Developing strategies to increase enrolment of members from both formal and informal sectors of the economy;
  • Sustained reforms and realignment of the NHIF strategy to enhance efficiency.

The NHIF’s estimated principal membership in the financial year 2017/2018 was 7.65 million people, up from 4.45 million in 2013/2014 (see Figure 1 above), which translates to 27.5 million principal contributors and their defendants. This is equivalent to over 50 percent of health coverage (Government of Kenya, 2019; NHIF, 2018).

However, Kenya is still far from the main goal of UHC, which is to achieve 100 percent health coverage. The Fund aims to achieve over 70 percent coverage by the end of the Medium-Term Plan 3 period. This growth in membership has enabled the Fund to inject Ksh33 billion into the health sector, with the amount expected to hit over Ksh100 billion by 2022. Within the sub-Saharan Africa region (SSA), Rwanda leads in enrolment in health insurance, with a community-based health insurance cover of over 75 percent of the population, according to a UNDP report published in 2019.

The Fund also plays a key role in social health protection, assisting poor and vulnerable people by implementing a Health Insurance Subsidy for the Poor (HISP), Older Persons, and Persons with Severe Disabilities Programmes (OP&PWD). In the financial year 2016/2017, 160,422 households benefited from HISP, along with 41,666 older persons and persons with severe disabilities (Government of Kenya, 2018). Further, the NHIF launched the Linda Mama, Boresha Jamii Programme (free maternity) aimed at ensuring safe delivery for pregnant women in October 2016. The Fund entered into an MOU with the National Government in February 2017 and started implementing the programme to registered mothers in May 2017. The programme covers all registered mothers (395,918 registered, with 223,459 deliveries by 2018) who are not covered by the Fund’s Supacover insurance. The benefit package includes antenatal and postnatal services at all contracted healthcare providers (NHIF, 2018). The Fund also provides health insurance to secondary school students through the Edu-Afya Programme.

The Fund faces the following challenges, as outlined in its strategic plan 2018-2022:

  1. Inadequate legal framework;
  2. Inadequate organisational capacity;
  3. Inadequate stakeholder engagement;
  4. Inadequate coverage of certain demographic groups;
  5. Resistance to change/reforms; and,
  6. Inadequate provider accreditation and payment systems.

Way forward

  1. Expand physical health infrastructure, rehabilitate existing ones and adequately procure medical equipment to conform to the current norms and standards for health sector infrastructure. In addition, procure adequate ambulances to ensure timely and efficient transfer of patients within the WHO-set standard.
  2. Ensure provision of basic water and electricity (grid or generator) services.
  3. Build more health facilities at all levels, e.g. medical clinics, dispensaries, health centres and hospitals. This will assist lower level facilities to implement KEPH and UHC.
  4. Develop technical capacity for human resources in the health sector, both at national and county levels, to support MES and health services delivery.
  5. Train an adequate workforce in all cadres to conform to the current norms and standards, and ensure equitable distribution across the country to enhance UHC and guarantee high quality of service.
  6. Procure adequate ambulances at national and county levels to facilitate emergency evacuation of patients.
  7. Ensure availability of guidelines on identifying and managing drug use problems at all health facility levels, especially at lower institutions.
  8. Build diagnostic capacity through training of relevant staff and procurement of modern diagnostic equipment at both national and county levels.
  9. Develop disease outbreak preparedness plans  in all health facilities at both national and county level.
  10. Put in place adequate and proper pharmaceutical commodity storage facilities to guarantee high quality of these commodities up to the set expiration date.
  11. Ensure proper disposal of sharps and medical waste to minimise infections among health workers, patients, the general public and children.
  12. Establish systems to monitor the quality of care at health facilities and include patient feedback, supportive supervision systems for health workers, and verification of health workers’ licences.
  13. Encourage and support health facilities to establish quality improvement teams.
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