HEALTH SUMMIT 1 2025 3.pptx, Health care

Health summit, health care, medicine and health, health awareness, health campaign

1. Delivering Universal Health Coverage

2. 1. HEALTH FINANCING

3. Benefits: Exclusion of some critical services Fund Primary Health Care Fund (PHCF) Social Health Insurance Fund (SHIF) Emergency, Chronic and Critical Illness Fund (ECCIF) Year 1 Outpatient services Inpatient services Maternity Services Optical services minimal tariff Inpatient services Maternity Services Renal care treatment Haematology and oncology services Mental Wellness services Surgical services Medical imaging and other investigations package Selected outpatient services Overseas treatment Emergency evacuation (road ambulance) Stabilization and resuscitation   EXCLUDED IN YEAR 1 End-of-life services Screening & management of pre-cancerous lesions Outpatient services Oral health (dental) services   Critical care (ICU and HDU) Chronic illness Assistive devices Palliative care

4. Establishment of the Benefits Package and Tariffs Advisory Panel (BPTAP) Establishment of the BPTAP to effect the review of the Benefits Package and Tariffs every 2 years. ⁠The UoN through Centre for Epidemiological Modelling and Analysis will host the Panel and Joint Secretariat. The vetting of Nominees CVs is underway Review of MOU is underway, to be signed by 24th February 2025 and ⁠ Gazetment by 28th February 2025.

5. Revision of Benefits and Tariffs Additional funding through supplementary budget of (indicate additional amount) to facilitate: a) An increase in funding for ICU to KES 28K per day from the daily rebate of KES 4480 per day. b) Additional KES 150K to increase the Oncology (Cancer) package from KES 400K to KES 550K per household per year. After review, the revised benefits and tariffs will go through the legal processes for gazettement .

6. Overseas Treatment The SHI Act provides for overseas purchasing of healthcare services not available locally. Requires accreditation, empanelment and contracting of the overseas providers and facilities. We continue undertaking for overseas treatment.. SHA Tariff for overseas is currently KES 500K all inclusive.

7. Means Testing Improvement and Informal sector targeting A new MT algorithm is under development; it will rely more on data triangulation from other existing data bases in Government Agencies for improvement of the accuracy of MT model. The databases include: KNBS, KRA, Immigration Department, Hustler fund/CA, Registrar of Companies, KPLC , IRA, NTSA, Ministry of Cooperatives, Ministry of Land/KIAMIS. Data has been requested. Once the new Means Testing instrument is ready we shall plug in the Insurance Premium Financing to support households with irregular sources of Income. Focus on informal sector enrolment through organized groups include: Cooperatives (), Boda Boda (), Jua Kali (4.3m)Drivers and conductors (1m)

8. Means Testing Improvement and Informal sector targeting A new MT algorithm is under development; it will rely more on data triangulation from other existing data bases in Government Agencies for improvement of the accuracy of MT model. The databases include: KNBS, KRA, Immigration Department, Hustler fund/CA, Registrar of Companies, KPLC , IRA, NTSA, Ministry of Cooperatives, Ministry of Land/KIAMIS. Once the new Means Testing instrument is ready we shall plug in the Insurance Premium Financing to support households with irregular sources of Income. Target: informal sector enrolment through organized groups include: Cooperatives (), Boda Boda (), Jua Kali (4.3m)Drivers and conductors (1m)

9. Key Asks 1.Funds for payment of old NHIF debts including civil servants scheme, to facilitate access to healthcare services. 2. Additional funding for improvement of benefits package. 3. Identification and financing for indigent population-counties. 4. Insurance Premium Financing (IPF) implementation to support the informal sector enrolment. 5. Support in rapid registration initiative for SHA registration and premium payment in the Counties

10. 2. HUMAN RESOURCES FOR HEALTH

11. Community Health Promoters (CHPs) There are 107,831 Community Health Promoters in Kenya The National Government provided 100,000 CHP kits, medicines and supplies and smartphones(gadgets). The National Government allocated resources for payment of stipends to 100,000 CHPs in the Country at Ksh.2,500 per month. County Governments pay a similar amount which totals to Ksh.5,000 per CHP per month. The payments of CHPs across all Counties has been effected up to the month of December, 2024.

12. 8,571 staff transition under the UHC program. Progress on the implementation of the commitments made to doctors,nurses and clinical officers. Public Officers Medical Scheme Fund for public officers.

13. ISSUES RAISED STATUS AS AT 17.2.2025 Outstanding Basic Salary Arrears Internship Harmonization of the terms of service of union members employed by the National Government Post Graduate Studies and Payment of Registrar Fees Arrears Comprehensive Medical cover to union members employed by the National Government Conclusion of pending Collective Bargaining Agreements (CBAs) and Negotiation of New CBAs Kenyatta National Hospital Issues Moi Teaching and Referral Hospital Issues Kenyatta University Teaching Research and Referral Hospital Employment of Additional Doctors to support the Implementation of UHC Promotion of Medical Personnel Intergovernmental Task force Non- Victimization Matter before the courts (11 resolved; 4 remaining) Internship Conclusion of pending Collective Bargaining Agreements (CBAs) and Negotiation of New CBAs Employment of Additional Doctors to support the Implementation of UHC Matter before the courts Implementation of the commitments in the Return to work formula the Doctors

14. ISSUES RAISED STATUS AS AT 17.2.2025 REMARKS Internship The ERLC in Eldoret rendered judgement on consolidated petitions on 17 th October, 2024 upholding the legality of SRC circular. However, the Court observed that SRC rates were at variance with what was provided in the 2017 CBA and directed Ministry Health and KMPDU to negotiate within 90 days on the disputed pay for Medical interns within the framework of new CBA. In order to forestall impeding strike by the doctors in December, 2024, the intern doctors posted in August, 2024 were paid their salaries as per the CBA rates In the meantime 4332 interns who require to be posted in February, 2025 have not effected due to lack of funding, in the FY 2024/2025     The CBA rates were effected in the December, 2024 payroll Emerging issue: There is a cohort II interns comprised of 4332 in all the cadres who are due for posting There is need to resolve payment of Salary/Stipend rates to the interns once and for all Posit to the court that disagreement between Unions and MOH on payment rates of interns (SRC/CBA)

15.   Conclusion of pending Collective Bargaining Agreements (CBAs) and Negotiation of New CBAs Cognizant to the respective independent corporate existence of the various entities under the National Government, KMPDU shall within 90 days from the date of this agreement conclude the CBAs with each of the respective National Teaching and Referral Hospitals while observing Constitutional and Statutory structures.   The employer will on a priority basis seek the advice of the Salaries and Remunerations Commission (SRC) the CBAs in keeping with its constitutional mandate. Concluded: CBA for the Nurses Union CBA for the Clinical Officers Union is ongoing pending Treasury approval The KMPDU is to audit the status of implementation of the 2017 CBA and present a report for deliberation and determination on negotiation of a new CBA

16. 8.  Employment of Additional Doctors to support the Implementation of UHC To facilitate the of this shared aspiration, the Government shall establish mandatory staffing norms for various levels and categories of hospitals within 90 days from the date hereof In furtherance of this national endeavor, the government shall employ 2000 additional doctors from the FY 2025/26 and Thereafter establish a policy for annual recruitment and placement of Medical Doctors, Pharmacist and Dentist in accordance with the staffing norms and standards, fiscal management policies and existing legal framework. The technical working group and steering committee have been constituted to develop the HRH policy which encompasses all aspects of Health Workforce Ministry of Health Staffing Norms and Standards will be reviewed as the policy is developed The employment of the doctors will be done over a period of two (2) years beginning FY2025/2026. The funding will be provided for either in the FY 2025/2026 budget or through supplementary budget. A budgetary provision of Kshs 6 billion is required to cover for the two financial years Hiring of the 2000 doctors will depend on the needs and will be based on the results of a needs assessment that will be done. The hiring will be at various levels including at the Ministry of Health, county governments health facilities and semi-autonomous government agencies such as KNH, MTRH and KUTRRH.

17. 3. HEALTH COMMODITY SECURITY

18. KEMSA’s Mandate Mandate 1. Procurement, warehousing, and distribution of HPT 2. Partner with counties and strategic partners 3. Using LMIS collect, analyze, and provide regular HPT reports to MoH and counties 4. Supports counties in health supply chain strengthening Key Role of KEMSA in UHC Ensure accessibility of affordable and quality HPT to the last mile Extend economies of scale to the counties KEMSA faces challenges in its endeavour to ensure sustainable stock availability

19. Challenges Impacting Stock Availability Stock availability currently at stands at an average of 53% Order fill rate after back orders on average is 65% Constraints affecting stock availability; 1. Emergency Covid -19 HPT procurement strained cash flow 2. Long outstanding debt of Ksh. 6.1 billion affecting cash flow Key Debtors NB: The above has led to a financing gap for HPT procurement Counties Ksh. 3.5 million MoH Ksh. 1.4 billion Development Partners Ksh. 807 million

20. Pending Bills & Projected cashflow needs 3. Delayed payments to suppliers with Ksh. 1.8 Billion being over 90 Days FY 24/25- KEMSA Payables & Cashflow needs as at 17 th February 2025 CATEGORY Invoiced Amount Total pending bills 2,435,096,774     HPT in pipeline pending deliveries (LPOs already issued) 2,141,594,474 Procurement for FY2024/25 (Tender awards done) 3,973,487,911 Projected cash flow needs 8,550,179,158

21. Ask to the counties Settlement of outstanding bills by Counties to restore financial stability 2. CoG to concur on direct remittance of debt from TNT to KEMSA in concurrence with COB 3. CoG to concur on net off by SHA to KEMSA for SHIF and PHC HPT debt 4 . Concurrence that KEMSA remains the first-choice supplier for all public health facilities

22. 4 . COMPREHENSIVE AND INTEGRATED HEALTH INFORMATION SYSTEM

23. Objective ; National comprehensive Integrated Health Information Management System that will enhance efficiency in heath service delivery, provide for data portability and visibility to the citizens MoH has contracted Consortium led by Safaricom to deliver an end-to-end digitalisation of health care. This includes;

24. Status Update as at 17 th Feb , 2025

25. Asks to the counties Signing of InterGovernmental Participarting Agreements Conduct baselines assessments per county on what is available in the counties Uploading all the Health Care Workers to Health Pro

26. Implication of change in United States Policy

27. Background Global fight against HIV, TB, Malaria, is mainly supported by PEPFAR, PMI, Global Fund, and UNAIDS; all deriving significant funds from USG. Kenya relies heavily on these donor-driven vertical health programs . The Stop Work Order disrupted USG funding worth 30.922B (HPTs - 24.9B, HRH - 5.84b, HMIS and HSS) Additional multilateral funding including for vaccines, nutrition, family planning worth KSH17.2B (GF & UNFPA) also at risk. Public health crisis may result from service delivery disruptions as commodity security, HRH, and health data systems are affected.

28. Status of Programs HIV/AIDS : 1.4M Kenyans live with HIV and on ART. A risk projection of 58,495 new infections by 2030 if donor funding is reduced. TB : 23,500 TB annual mortalities among them 20,000 attributed to HIV. Malaria: 12,000 deaths per year (2022) with projected increase in climate change. Family Planning : 6.2M clients rely on FP annually with a gap of 40% still unreached. Vaccine and Immunization : Coverage currently at 77%; Program currently under transition from donor to government funding.

29. 1. Essential Commodities USG contributes KSH24.9B to Kenya’s KSH79.8B health commodity need . Recommendation : Engage in diplomatic interventions for clarity/waiver/orders/continuity of funding. Allocate 24.9 B for commodities previously funded by USG. Disburse 2B allocated and allocate additional 2.5B for the vaccines to avert funding freeze by GAVI the Vaccine Alliance

30. 2. Human Resources for Health (HRH) 41,547 PEPFAR-supported staff affected . Recommendation : Maintain 11,059 front-line health workers as identified by the County Governments and MoH at a cost of 5.84B and; Approve a comprehensive HRH restructuring and alignment with public health systems.

31. 3. Health Data Systems USG funds KSH139M for critical health databases namely Kenya EMR,MFL, KHIS, Damu Ke, Chanjo Ke, Afya Ke and the LMIS used by KEMSA. We are transitioning this into the health digitization project.

32. Other Critical Programs beyond USG Funding 1 . Blood Transfusion Services KSH2.8B World Bank support ending in March 2025. Recommendation : Secure alternative funding to prevent maternal mortality increases. 2. Immunization and Vaccines KSH11.6B required; GAVI & USG support at risk . Recommendation : Disburse KSH2B immediately , allocate KSH2.5B for GAVI compliance . 3. Family Planning Budget required 2.4B; USG 598M, GoK 508M with KSH1.74B funding gap . Recommendation : Allocate KSH598M for continuity and consider KSH1.74B in FY2025/26. 4. Nutrition KSH4.96B required; KSH2.88B from USG at risk . Recommendation : Replace USG funding with domestic allocation.

33. Summary of Financial Impact of USG Order Description  Amount in Kes. Human Resources for Health  Ksh.5.8 Billion Per annum Health Products and Technologies (HIV, TB & Malaria) 12.26B Other Health Products and Technologies - Oxygen, laboratory, cervical cancer and COVID-19  3.7B In-country distribution costs of commodities supported by US Government  2.26B Data Systems 139M Blood and Blood products  2.7B Family Planning 598M Nutrition 2.88B Vaccines 585M TOTAL 30.922B

34. Asks to counties Retraining of all health care workers for integration of the vertical programs. Restructure HRH and integrate vertical programs into Universal Health Coverage service delivery. Counties to set aside funds to aid transition from the donor funded programs