1	CCIH ANNUAL CONFERENCE MAY 29-31, 2005 – Washington DC Christian engagement in health systems Wellspring Retreat Center, Germantown
2	Challenges of Christian Health Associations in Africa Presentation by Dr Samuel Mwenda Executive Director Christian Health Association of Kenya
3	Presentation outline Introduction to CHAK Historical background of Church health services in Africa Challenges facing Church health services CHA’s – features, roles, challenges, strategies and potential.
4	CHAK Background information CHAK is an Association of Protestant Churches’ Health facilities & programs from all over Kenya Was started in 1930’s 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.
5	Membership 416
6	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.
7	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”
8	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
9	…..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
10	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
11	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
12	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
13	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
14	Promoting access to Essential Drugs in Kenya through MEDS
15	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.
16	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)
17	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
18	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 ARV’s – with support of USAID Client feedback
19	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
20	…..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)
21	Historical sources of support for church health services in Kenya Donations from local & sister churches abroad Missionary expatriates eg doctors,nurses,administrators & paramedical staff Government grants Government seconded staff Donated drugs, medical supplies & medical equipment User fees/patient fees – was the least significant source of funding
22	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)
23	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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26	CHA’S IN AFRICA Features, functions, challenges & strategies
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28	Shared features of CHA’s 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
29	Functions of CHA’s Advocacy & representation Policy development & dissemination Networking & communication Capacity building Drugs & medical supplies procurement & distribution Technical assistance to member health units Ecumenical collaboration
30	..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. M&E
31	Challenges facing CHA’s in Africa Financial sustainability – most CHA’s 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
32	…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 FBO’s & NGO’s Health Sector Reforms & decentralization Governance/management – some have beuraucratic systems which are not efficient
33	…Challenges… Government policies & regulations Autonomy of management in member health units – CHA’s have no direct control Devastating impact of HIV/AIDS Emerging & re-emerging disease conditions & disease outbreaks Annual membership subscription payment
34	…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
35	…challenges… Achieving adequate community involvement & ownership Increase in sophistication of demands by clients – as education level increases Access to drugs especially ARV’s Some employees lacking on Christian vision & integrity Accurate & regular updating of service mapping
36	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 it’s implementation
37	…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
38	…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
39	…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 CHA’s for peer learning Support by WCC, Health & Healing Program and other partners in facilitating networking & linkages
40	CHA’S MEETING IN MALAWI 2004 – facilitated by WCC
41	CHA’s 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!