Kenya is making commendable progress in the push to attain universal health coverage (UHC).
UHC is about financial protection and equity in access to quality health services that address the most significant causes of disease and death.
A pointer to the progress Kenya is making in UHC is increased National Hospital Insurance Fund (NHIF) enrollment. In 2018, for example, NHIF membership rose by 23 per cent to 7.7 million, with most of the new members coming from the informal sector.
Kenya National Bureau of Statistics data further shows that payouts by the national insurer increased by an impressive 41.4 per cent to Sh37.2 billion last year.
What this means is that there is a Jua Kali operator or mama mboga somewhere who would have previously been forced to sell household items to get treatment but is now able to access the treatment without financial strain.
To sustain this momentum, the government is setting aside Sh47.8 billion for UHC in the 2018/19 budget—more than half of the approximately Sh90 billion allocated to healthcare. Although UHC accounts for more than 50 per cent of the entire national healthcare budget, there is still a huge gap in terms of funding.
It is key to reiterate that UHC is not only about boosting insurance cover, but also ensuring access to quality services. Access, quality and financing of healthcare — the three key pillars of UHC — collectively require tremendous investment and expertise, which the public sector cannot provide alone.
Historically, this funding and technical skills gap has been bridged by donors. However, this is coming to an end. Today, due to demands for accountability as well as creeping nationalism in donor countries, donors are only willing to invest in programmes that can sustain themselves. In other words, there is a shift from aid led to enterprise-led development.
This has set the stage for the growth of social enterprises. These are basically organisations that combine their primary goal of driving positive social change with the efficiencies and profit-orientation of private sector. However, unlike fully-fledged capitalist businesses, profits generated in a social enterprise are not distributed to directors or shareholders but re-invested in scaling up solutions in order to achieve greater impact.
In Kenya, social enterprises can play a unique role in accelerating the attainment of UHC.
First, the increased public funding for UHC provides a powerful form of risk underwriting for private sector players keen on providing healthcare solutions. This is critical as very often private investors are unwilling to spend in areas where government support in the form of funding, policy and regulation is doubtful or lacking.
Second, Kenya has made considerable steps in advancing the ICT sector. In fact, ICT is currently the fastest growing sector of the economy, having grown 11.4 per cent last year. ICT is important when talking about private investment in healthcare because new technologies allow healthcare providers to scale solutions at a fraction of the cost while not compromising quality.
Third, more Kenyans are embracing entrepreneurship. Entrepreneurship is not about avoiding problems, but confronting them and getting rewarded for solving them. Fewer bigger problems exist in Kenya, and indeed Africa, than lack of access to quality and affordable healthcare.
In fact, Ministry of Health data indicates that the leading reason why Kenyans slide into poverty is medical bills.
Entrepreneurship lends itself well to solving the challenges in healthcare. The good news is that social enterprises provide room for entrepreneurs to solve problems, get rewarded, but still drive social impact. Scottish economist, Adam Smith, famously said, “It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest”.
When people are motivated to make money, they find a solution. When people are motivated to make money and transform lives, they find a lasting solution. The latter is what social enterprising is all about and why it is key in accelerating attainment of UHC in Kenya.
Credit Peter Waiganjo
Dream Becoming A Reality
The residents of Kyukuni Village, Voo Kyamatu Ward, Kitui County had challenges in accessing water before the intervention of the Amref Health Africa Kitui WASH Project. Residents would trek for over 15km in search of water, a situation that not only affected the time women spent doing other economic activities, but also affected school enrolment and attendance among school going children.
According to the Project Officer George Wambua, there were shallow aquifers which were an alternative source of water, but the residents believed that water from this source would only be enough for household use and nothing else. This was a long standing belief that they held, and changing it was an uphill task.
During a baseline survey that was carried out in 1998, water was ranked first on the priority list of needs among communities. For the residents of Kyukuni Village, water was a priority but they did not realize how it could help to change their economic status. “Changing their mind-set to make them see how water could improve their lives economically was a challenging task. However, with continued follow-ups and interactions with the community, we were able to change the community’s way of doing things,”said Mr Wambua.
In trying to make a case for using water to improve the community’s economic status, the project started by developing a small farm around the Miembeni giant well situated in Zombe/ Mwitika Ward. The well serves a group of 12 families who decided to change their traditional way of doing things. They decided to extend water use from domestic to other economic activities including horticulture farming and poultry keeping.
According to Mr Mutua, one of the beneficiaries of the project, a number of giant wells were commissioned along the Thua River through the support of Amref, but only a few of the groups seriously engaged in intensive farming.
“You would find a group of 15 households doing small scale farming that was not enough to support the whole group, but yet the well had sufficient recharge of about 10m3.
This means they only utilised 30% of the water in the well leaving 70% not utilised”, said Mr Mutua. He added that when his group realized that they were sleeping on gold about two years ago, they started serious farming activities around their water points. The group now owns a two-acre piece of land that can be utilized freely by the group.
Kitui East has been hard hit by the regular occurrence of drought due to erratic rainfall. For the last 10 years, the rainfall pattern has been unpredictable. The rainfall onset has been delayed every year, and when it has rained, rainfall has also not been adequate. The only remaining option is to use water from the well to grow crops that can feed their families and have some left overs to sell for economic sustainability. This is what Mr Mutua the chairperson, encouraged his group to do.
“We started our farming in a small way by cultivating very basic crops just enough to feed our families. Little did we know it was our turning point as a group,” said Mr Mutua.
Mr Mutua added that they upgraded their activities by growing cash crops like tomatoes, onions, water melons and carrots. The first group was successful and made good profit. On sharing the profit among the 15 households’ after all necessary deductions, each was able to get Kshs 5,000. This enabled members have cash to do other things like paying school fees and other bills. The community members had longed for.
“God is great, our dream has come true,” said one of the group members.
Additional activities carried out using water from the well include poultry farming. This is another project that has had multiple benefits to the family. The groups now have eggs that they use to feed their children, thus preventing diseases associated with poor feeding. They also sell the birds to make good money for the household use.
The project though funding from Amref Italy has built 50 giant wells to support 20,500 people with agricultural activities and 218,940 people with access to safe water and sanitation. The project is committed to make safe and affordable drinking water, hygiene and sanitation a reality for the people of Kitui County.
This CSIR Female Researcher Is One Of Few Stem Cell Reprogramming Experts In South Africa
Dimakatso Gumede, CSIR Researcher.
Only a handful of people in South Africa have mastered Stem Cell reprogramming and Dimakatso Gumede (34) is one of them. As the CSIR’s candidate researcher of the Bioengineering and Integrated Genomics Research Group, she works on creating disease models of the innate immune system to study unique African gene variants that lead to elite controllers that naturally control viral load levels without antiretroviral therapy.
By using induced pluripotent stem cell technology, the CSIR research group also creates“mini liver”models in order to determine the adverse drug affects in the South African population.
“The African population is known for its genetic variation, which often affects the way in which an individual responds to particular medication. For example, while an aspirin may work effectively for 70% of the population, it is possible that the remaining 30% may experience adverse effects. Therefore, as part of CSIR’s Bioengineering and Integrated Genomics group, we are looking to create effective and personalised medication for those who do not respond positively to the drugs that have been distributed for the general population,” says Gumede.
Gumede, who is a PhD scholar of the University of Cape Town (UCT), recently submitted her doctoral thesis. She studied the role of a gene mutation that causes skin and lung fibrosis, using a scientific method called induced pluri-potent stem cells. This approach produces any cell type in the body, such as skin or lung cells, which, in this case, provides insight into how an inherited dermatological condition is associated with lung fibrosis – a condition caused by uncontrolled scar formation that affects the organ and air sacks.
However, this was not Gumede’s original project. Initially, her PhD project was on cardio genetics, and she was working with the late Prof. Bongani Mayosi and Dr. Gasnat Shabooden at the UCT Hatter Institute for Cardiovascular Research in Africa.
“While I was busy with my initial research project, the late Prof. Mayosi suggested that I shift the focus of my project to the study of a rare genetic condition that is associated with lung, skin and muscle fibrosis. I was excited because not only was it a ground-breaking research project that would serve as a massive breakthrough for the South African medical science sector, but it would also provide me with the opportunity to apply my cell biology expertise,” says Gumede.
With the assistance of Prof. Susan Kidson and Dr Robea Ballo, Gumede focused mainly on the cell biology of the rare skin condition in question. She learnt a great deal about reprogramming skin cells into pluripotent cells to understand what causes this gene mutation, how this rare skin condition develops at cellular level and how or why it affects organs such as the lungs and muscles and prevents them from functioning properly.
“I discovered that the gene mutation that causes this condition accelerates cell division, which contributes to fibrosis in the affected individuals and is also associated with cancer progression,” says Gumede.
Further, according to Gumede’s Principal Investigator at the CSIR – Dr Janine Scholefield, her ability to not only master but, explain highly technical and advanced science in isiZulu and Sesotho is what makes her so highly prized at the CSIR.
“She has mastered the craft of communicating her work fluently in isiZulu, Sesotho and English which is so important. With science and technology shaping our lives daily, it ought to be accessible to all, especially young people wanting to pursue a career in science. Having a young black woman who is at the top of her game and is able to make the work we do relatable is what will continue to inspire young girls entering the science field. It also makes her even more invaluable to the CSIR and the scientific community at large” added Dr Scholefield.
With the skills that she has gained, she aims to use her PhD to further establish the stem cell platform for precision medicine, drug screening and, possibly, commercialisation in the CSIR. She also intends to use the stem cell and genome engineering platforms to find new approaches to eliminate HIV reservoirs in infected persons and, hopefully, also contribute in finding key therapeutic strategies that resolve excessive scar formation in heart and lung conditions, which are a great burden of disease worldwide.
The African Union Appoints Amref Health Africa Global CEO to Board of Africa Centre’s for Disease Control and Prevention (Africa CDC)
NAIROBI, 8 August 2019: Amref Health Africa Global CEO and Co-Chair of UHC 2030 steering committee, Dr Githinji Gitahi has been appointed as a member of the Governing Board of the Africa Centre’s for Disease Control and prevention (Africa CDC).
Dr Gitahi will join the Governing Board of the Africa CDC pursuant to article 10 of the statute of the Africa CDC. Dr Gitahi was appointed by the Commissioner for Social Affairs, Her Excellency Mrs. Aminra Elfadil of the African Union Commission.
The Africa CDC supports all African countries to improve surveillance, emergency response, and prevention of infectious diseases. This includes addressing outbreaks, man-made and natural disasters and public health events of regional and international concern. It further seeks to build the capacity to reduce disease burden on the continent.
“I would like to extend my gratitude to the African Union and specifically to H.E Mrs Elfadil for this appointment. I am honoured to be nominated to this position that is geared towards strengthening and transforming the health in Africa. I look forward to sharing my expertise and skills as we work towards achieving Universal Health Coverage and achieving health security in Africa,” said Dr Gitahi.
The Africa CDC is also a specialized technical institution of the African Union that serves as a platform for Member States to share knowledge, exchange lessons learnt and build capacity.
This appointment comes after his nomination as the co-chair of the UHC2030 Steering Committee in December 2017. UHC2030 is a World Bank and World Health Organization (WHO) forum for achievement of universal health coverage (UHC) by 2030 and has membership across countries, private sector and civil society organisations.
About Amref Health Africa
Amref Health Africa, headquartered in Kenya, is the largest Africa based international non-governmental organisation (NGO) currently running programs in over 35 countries in Africa with lessons learnt over 60 years of engagement with governments, communities and partners to increase sustainable health access in Africa. Amref Health Africa also incorporates programme development, fundraising, partnership, advocacy, monitoring and evaluation, and has offices in Europe and North America as well as subsidiaries; Amref Flying Doctors, Amref Enterprises and the Amref International University.
Credit: Amref Health Africa
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