1. “Promoting Access to quality healthcare”
Devolution
of health services in kenya
Issues affecting Faith Based Health
Services
By Dr Samuel Mwenda
General Secretary, CHAK

2. “Promoting Access to quality healthcare”
The Faith Based Health Network in Kenya
• CHAK is a national FBO network of the Protestant Churches’
health facilities, programmes and Medical Training Colleges and
Universities.
• CHAK core functions include; advocacy, health service delivery,
health systems strengthening, partnerships & networking and HIV&
AIDS programmes.
• CHAK collaborates closely with the Catholic Health Commission
of Kenya which coordinates the Catholic health facilities - within the
framework of the Church Health Services Coordinating
Committee.
• The FBOs in Kenya (Christians & Muslims) have a partnership
framework (MoU) with Ministry of Health that guides
partnership engagement, support and accountability. Partnership is
coordinated through the Faith Based Health Services
Coordinating Committee
• FBOs are recognized as key stakeholders in the Health sector
since they contribute about 35% of the health coverage

3. “Promoting Access to quality healthcare”
Devolution
of health services in kenya

4. “Promoting Access to quality healthcare”
THE CONSTITUTION OF KENYA, 2010
has mandated devolution – promulgated
27th August 2010

5. “Promoting Access to quality healthcare”
Constitution of
Kenya 2010
 Counties – 47
 One National
Govt

6. “Promoting Access to quality healthcare”
New Constitution & Health
• Constitution of Kenya, which was promulgated
on 27th August 2010, provides for the right to
health care services. Chapter four (4) on the
Bill of Rights states in Article 43(1a) that every
person has the right to the highest
attainable standard of health, which
includes the right to health care services,
including reproductive health care, and in
Article 43(2), that a person shall not be
denied emergency medical treatment.
Christian Health Association
of Kenya

7. “Promoting Access to quality healthcare”
Implication of devolution to
Health
• According to the Fourth Schedule of the
Constitution, County Governments
are entrusted with all functions
related to health care
• National Government is responsible
for health policy and national referral
health facilities which
Christian Health Association
of Kenya

8. “Promoting Access to quality healthcare”
STRUCTURE OF COUNTY GOVERNMENT
katemburu@yahoo.com
8
DEPUTY GOVERNOR
GOVERNOR
HEAD OF COUNTY
PUBLIC SERVICE
EXECUTIVE COMMITTEE (COUNTY MINISTERS)
COUNTY DIRECTORS (10)
COUNTY ASSEMBLY
- SPEAKER
- ELECTED MEMBERS
• FINANCE & ACCOUNTING
• AGRIC & LIVE STOCK
• ENV & NATIONAL RESOURCES
• HEALTH SERVICES
• EDUC CULTURE, SOCIAL
• PHYSICAL PLANNING/HOUSING
• PUBLIC WORKS &UTILITIES
• PUBLIC SERVICE MGMT
• TRADE, IND. DEV. & REG.
• ROADS & TRANSPORT
COUNTY SERVICE DEPARTMENTS
ELECTED CIVIL SERVANTS APPOINTED DEPARTMENTSKEY

9. “Promoting Access to quality healthcare”
Major changes in Health
• HRH are employed and directly managed by
County including payment of salary
• Prioritization, Planning, Budgeting, resource
allocation are done at County and approved
by County Assembly
• Direct management of Public Health facilities
and health services at the County level
• Counties procure medical commodities
• National manage and fund medical training
and is responsible for emergencies
Christian Health Association
of Kenya

10. “Promoting Access to quality healthcare”
Challenges
• Competing Political vs Technical process
• Transition well planned but not followed
• Establishment of new County Health
Governance structures
• HRH deployment/change of employer
and associated instability
• Delayed enactment of Health Law to
guide alignment to new Constitutional
MandateChristian Health Association
of Kenya

11. “Promoting Access to quality healthcare”
Kenya Health Policy 2014-2030
• Policy Goal
– “Attaining the highest possible standard of health
in a manner responsive to the needs of the
population”
• Policy Focus
– Realization of the right to health – as
outlined in the Constitution 2010
– Devolution of Health services: National
limited to policy, regulation, capacity building and
national referral institutions. County Governments
responsible for health service delivery
Christian Health Association
of Kenya

12. “Promoting Access to quality healthcare”
Kenya Health Policy Objectives
• Eliminate communicable diseases
• Halt and reverse the rising burden of non-
communicable diseases
• Reduce the burden of violence and
injuries
• Provide essential health care
• Minimize exposure to health risk factors
• Strengthen collaboration with other
sectors
•
Christian Health Association
of Kenya

13. “Promoting Access to quality healthcare”
KHP-Health service delivery system
redefined into 4 tier system
• Community services
• Primary care services – Dispensaries,
Health Centres and Maternity Homes of
Government and Private
• County Referral Health Services –
Hospitals
• National Referral Services
This includes all actors in the health system
including FBOs and private sector
Christian Health Association
of Kenya

14. “Promoting Access to quality healthcare”
Role of FBOs in Devolved Health Sector
• Health services delivery through the 4 tiers following the
set policies & guidelines
• Training of health workers through FBO MTCs &
Hospitals
• Community based health promotion and disease
prevention
• Participate in the County and National health referral
system
• MEDS to offer an efficient, competitive and reliable supply
chain for health commodities
• Partner and collaborate in planning, implementation
and monitoring of health programmes
• Support medical emergency response initiatives
Christian Health Association
of Kenya

15. “Promoting Access to quality healthcare”
Issues of concern to FBOs
• Continued access to Essential Public Health
commodities - Vaccines, TB Drugs, HIV test kits, ARVs, ACT
• Enabling policy environment
• HRH - Staff secondment
• Health care financing:-NHIF, Government policy of free
maternity deliveries and PHC services
• Inclusion in planning and resource allocation
• Facilitation in referral system and HRH training
• Access to Donor funding – bilateral & multi-lateral
• Recognition of existing FBO - MoU with MOH and
inclusion in HMIS at county and national level
• Increased burden of taxation, licensing and regulation
Christian Health Association
of Kenya

16. “Promoting Access to quality healthcare”
Way forward for FBOs
• FBOs have to establish strategies and
mechanisms for mutually beneficial
engagement with every county
government
• We need to build evidence to support
advocacy at county level
• We need to find ways of managing and
surviving the competing political
interestsChristian Health Association
of Kenya

17. “Promoting Access to quality healthcare”
THANK
YOU