A Senior Management Course for Health Managers in Kenya 2 nd EDITION July 2014

A Senior Management Course for Health Managers in Kenya 2nd EDITION July 2014

MODULE 1: Understanding foundations of the health system in Kenya Unit 1.1: Strategic Direction and regulatory frameworks for the health system in Kenya

Purpose • Provide the participant with an understanding of the strategic direction and regulatory framework of Kenya’s health system. It describes the administrative structures of the health system and organization of health services in Kenya and also explores the concepts of health sector reform and regulation of the health system.

Objectives • By the end of this unit, the participant should be able to: • Describe the health policy development process. • Describe the evolution of health policy in Kenya. • Outline various ways through which health care system is regulated • Outline key health sector reforms in Kenya

Overview • This unit will cover the following topics: • National health policy framework: process and evolution. • Regulation of health services and professionals: national and international laws, declarations and regulations related to health. • Health sector reforms: components and characteristics.

Overview (Cont’d)

Session 1.1 Health Policies and Policy Making Process in Kenya

What is a Policy? A policy is defined as a specific statement of principles or guiding actions that imply clear commitment by the government or institutions as basis for consistent decision making and resource allocation to determine present and future.

What is a Health Policy? • Embraces courses of action that affect sets of institutions, organisations, services and funding arrangements of the health care system. • It goes beyond health services, however, and includes intended actions or unintended actions by public, private (including households) or voluntary organisations that have impact on health. • (Walt 1994)

Policy Process: Model Policy Cycle Problem definition/ Agenda setting Policy change Policy formulation Policy evaluation Policy implementation Policy legitimation

Problem Definition This is based on one’s own perspective. • What is a current problem? • Why is it a problem? • Who’s involved?

Agenda Setting • Systemic vs. government agenda: • Systemic: public is aware of and may be discussing; • Government: considered to be those issues and problems that policymakers are addressing at a certain time. • What issues would you consider to be on the government agenda currently?

Policy Formulation • Debate over alternative policy choices. • Importance of policy analysis. • Actors provide their preferred positions. Who’s involved: • bureaucracy • legislature/staff; • interest groups.

Policy Legitimation • Appropriateness of government action. • Important for garnering support. • Deals with two major issues: • Substance of the policy; • Process of adopting the policy.

Policy Implementation • Where actual intervention is seen. • Activities that put programmes into effect: • money spent; • laws passed; • regulations formulated. • Done mostly by executive branch through regulations.

Policy Evaluation and Change • Expected to feed information back into the policy process. • Different types of impacts: • direct vs. indirect; • short-term vs. long-term. • This step is often disregarded in the process.

Policy Instruments • Regulation. • Government management. • Taxing and spending. • Market mechanisms. • Education and information.

Contributions of Health Care Workers to Public Policies • Bring expertise in, and knowledge of, a range of health-related topics and issues; • Help interpret people’s and communities’ needs; • Conduct health research that contributes evidence to policy development through health care knowledge and experience; • Interpret and use the results of research to influence policy; • Communicate policies to communities.

Activity 1.3.6.1: Brainstorming (20 minutes) Participants brainstorm on the process of health policy making in Kenya. Participants discuss for 20 minutes . Copy to TLA unit 1.3.4

Policy Outline

Framework for Defining Policy Directions in Kenya POLICY ORIENTATIONS(& principles) POLICY OBJECTIVES (& strategies) POLICY GOAL Health Financing Efficiency Physical and Financial Access Quality and safe services Eliminate communicable diseases Equity Health Leadership Halt, and reverse rising burden of NCD’s Better Health, In a responsive manner Health Products & Technologies Reduce the burden of violence and injuries Multi - sectoral Health Information People - centered Provide essential medical services Health Workforce Minimise exposure to health risk factors Service Delivery Systems Strengthen collaboration with health related sectors Social accountability Participation Health Infrastructure

Relationships of the Different Policy Directions Orientation 5: H/Infrastructure Orientation 6: Leadership Orientation 4: H/Financing Obj. 1: Communicable conditions Obj. 6: Health related actions Policy Goal: Better Health Obj. 2: Non Communicable conditions Obj. 5: Risk factors & behaviors Orientation 7: H/Information Orientation 3: Medical Products Obj. 3: Violence & Injuries Obj. 4: Medical services Orientation 2: H/Workforce Orientation 1: Delivery Systems

Session 1.1.2 Regulatory framework for Kenya’s health system

Regulation of Health Services Health services are regulated by health laws and commitments on improving health that countries make at international, regional and national forums.

Health Laws • Health law refers to a statute, ordinance or code that prescribes sanitary standards and regulations for the purpose of promoting and preserving the community's health. (Black's Law Dictionary, 8th ed., 2004). • Health law covers a wide range of legal concerns for the entire health field.

Origins of Health Laws • The health laws originate from: • International agreements or declarations which each state party domesticates and prepares legislation. • Constitution of a particular country. • Many of the health laws are standard and aim at promoting good health.

Role of Health Laws • Assist countries in the development of regulatory frameworks to promote good health. • Form the legal frames for technical corporation in promoting good health. • Regulation of registration of medical products.

Comprehensive Health Legal Framework • Assist countries in the development of regulatory frameworks to promote good health. • Form the legal frames for technical corporation in promoting good health. • Regulation of registration of medical products. HEALTH RELATED LAWS SPECIFIC LAWS GENERAL HEALTH LAW • Economy and employment • Security and justice • Education and early life • Agriculture and food • Nutrition • Infrastructure, planning and transport • Environments and sustainability • Housing • Land and culture • Population Health Financing • Legal provisions on: • Overall purpose of health legislation • Scope of health legislation • Health services • Health risk factor services • Harmonising with content of existing health related laws. Health Leadership Health Products Health Information Health Workforce Service Delivery Health Infrastructure REGULATIONS Source: Government of Kenya, KHSSP, 2012 - 2017

The Constitution of Kenya, 2010 • The Constitution of Kenya 2010 has provisions that have an impact on health in Kenya • Two critical chapters, the Bill of Rights and the Devolved Government, introduce new ways of addressing health problems and have direct implications for the Health Sector’s focus, priorities and functioning. • The Bill of Rights provides guidance to the Health Sector on the definition and policy implications of the content of the right to the highest attainable standard of health. It uses the standards and principles of International Human rights instruments in defining the content of this right.

The Constitution of Kenya, 2010 (Cont’d) • The Chapter on Devolution provides guidance on how a the health sector will be organised for health services delivery. • To effectively implement devolution as envisaged in the Constitution of Kenya 2010, the health sector will need guidance on the following: • Organisation and management of county health services; • Criteria for transfer of health related functions to county governments; • County health facilities, assets and liabilities;

The Constitution of Kenya, 2010 (Cont’d) • Management of shared responsibilities between national and county governments; • Procurement of health commodities at the county; • Planning, budgeting and monitoring and evaluation at national and county levels; • Merger of ministries and other health related functions; • Health Sector stakeholder partnership arrangements.

Constitution Implementation: Ongoing Legislations

Progress so Far in Implementation of the Constitution • Health Sector Position Paper on constitution implications in Health (2011) developed; • Health Policies: Approved by Cabinet • Kenya Health Policy: Sessional Paper No.6 of 2012 • Universal health care coverage in Kenya: Sessional paper No.7 of 2012 • Pharmaceutical policy: Sessional paper No.4 of 2012 • Kenya Health Sector Strategic Plan 2013–17 (draft) developed (awaiting county consultations)

The Proposed Health Act, 2012 • An Act of Parliament to consolidate the laws relating to health to provide for: • regulation of health care services and health care service providers; • establishment of national regulatory institutions to coordinate the inter relationship between the national and county health institutions; • establishment of a coordinating agency of professionals within the health sector; and • attainment of the basic right to health and for connected and incidental purposes.

The objectives of the Proposed Health Act, 2012 • The objects of this Act are: • to enable the realisation of the rights to health as provided for in the Constitution of Kenya, 2010; • to provide uniformity in respect of health services across the nation.

The objectives of the Proposed Health Act (Cont’d) The Act aims to achieve the following objectives: • Establish a national health system which encompasses public and private providers of health services at the national and county levels and facilitate, in a progressive and equitable manner, to ensure the highest attainable standard of health services; • To set out the rights and duties of the various organs within the national health system;

Objectives of the proposed Health Act (Cont’d) (c) To protect, respect, promote and fulfill the rights of all persons living in Kenya to the progressive realisation of their right to the highest attainable standard of health, including reproductive health care and the right to emergency medical treatment; (d) To guarantee the people of Kenya an environment that is not harmful to their health; 38

Objectives of the proposed Health Act (Cont’d) (e) To protect, respect, promote and fulfill the rights of children to basic nutrition and health care services contemplated in Articles 43(1) (c) and 53( l)(c) of the Constitution of Kenya 2010; and (f) To protect, respect, promote and fulfill the rights of vulnerable groups in all matters regarding health as defined in Article 21 of the Constitution of Kenya, 2010.

Components of the Health Act Definitions Rights and duties Roles and functions of the two-tier government Establishment & functions of the Kenya Health Services Authority Human resource planning and capacity building Inspectorate agencies

Components of the Health Act (Cont’d) Public health facilities and private public partnerships Definition and governance of health professionals Control of medicines and medical products Procurement, supply of medicines, vaccines, medical devices, appliances and materials Promotion and advancement of public and environmental health Mental health

Components of the Health Act (Cont’d) Traditional and complementary medicine Human blood, blood products, tissues and gametes Control of dangerous drugs, narcotics and psychotropic substances Health financing and health insurance The role of private sector Promotion and conduct of health research E- health Inter- departmental collaboration Transitional and miscellaneous provisions

Health Act: Rights and Duties Every person has the right to: • Standard of health; • Reproductive health; • Emergency treatment; • Health information; • Informed consent; • Information dissemination; • Confidentiality; • Health care provider; • Duties of users; • Complaints.

Health Act: Right to Standard of Health Right to: • the highest attainable standard of health which shall include progressive physical and financial access to promotive, preventive, curative and rehabilitative services; • be treated with dignity, respect and have their privacy respected in accordance with the Constitution and this Act.

Health Act: Right to Reproductive Health Right of: • men and women to be informed about, and to have access to reproductive health services, including safe, effective, affordable and acceptable family planning services, except elective abortions; • access to appropriate health-care services that will enable parents to go safely through pregnancy, childbirth, and the post-partum period, and provide parents with the best chance of having a healthy infant;

Health Act: Right to Reproductive Health (Cont’d) • Access to treatment by a trained health professional for conditions occurring during pregnancy including: • abnormal pregnancy conditions, such as ectopic, abdominal and molar pregnancy, • or any medical condition exacerbated by the pregnancy to such an extent that the life or health of the mother is threatened, • All such cases shall be regarded as comprising notifiable conditions.

Health Act: Right to Emergency Treatment Every person has the right to emergency medical treatment. No person shall be denied emergency treatment by the health service provider of first contact. Emergency medical treatment shall include pre-hospital care; or stabilising the health status of the individual; or arranging for transfer in cases where the health provider of first call does not have facilities or capability to stabilise the health status of the patient (s).

Health Act: Right to Emergency Treatment (Cont’d) Any medical officer who fails to provide emergency medical treatment while having ability to do so commits an offence and is liable, upon conviction, to a fine not exceeding Kenya Shillings One Million or imprisonment for 12 months or both. Any medical institution that fails to provide emergency medical treatment while having ability to do so commits an offence and is liable, upon conviction, to a fine not exceeding Kenya Shillings Three Million without prejudice to any other punishment prescribed by law.

Health Act: Right to Health Information • Every health care provider must inform a user or, where the user is a minor or incapacitated, the guardian: • of the user’s health status except in circumstances where there is substantial evidence that the disclosure of the user’s health status would be contrary to the best interests of the user; • of the range of promotive, preventative and diagnostic procedures and treatment options generally available to the user; • of the benefits, risks, costs and consequences generally associated with each option;

Health Act: Right to Health Information (Cont’d) • of the user’s right to refuse recommended medical options and explain the implications, risks, and legal consequences of such refusal. • The health care provider concerned must, where possible, inform the user as contemplated in subsection (1) in a language that the user understands and takes into account the user’s level of literacy. • Where the user exercises the right to refuse a treatment option, the health provider may at his discretion require the user to confirm such refusal in a formal manner.

A Senior Management Course for Health Managers in Kenya 2 nd EDITION July 2014