THE KENYA EXPERIENCE Venice Meeting 22-23 June

1. THE KENYA EXPERIENCEVenice Meeting 22-23 June PRESENTED BY: RUTH KIHIU GROOTS KENYA ASSOCIATION 2009

2. Outline of Presentation • About GROOTS Kenya • Kenya Context- Basic Stastical Infromation • Study Design and Metholodgy • Challenges of Survey • Key Findings and Results • Recommedations • Conclusion

3. About Presentation • Will be based on the action oreinted research that was carried out by GROOTS Kenya and its member grassroots networks under the Maximizing Positive Synergies Project supported by the WHO. • GROOTS Kenya was part of the civil society consortia and the country partner for Kenya. The conrotia was coordinated by Health GAP.

4. ABOUT GROOTS KENYA • GROOTS stand for “Grassroots Organizations Operating Together in Sisterhood” • It was founded in 1995 as a response to the inadequate visibility of grassroots women in development processes and decision making forums that directly impact them. We are affiliated to GROOTS International and Huairou Commission. • GROOTS Kenya is a network that has membership of over 2000 women-led, community based organizations and self help groups. We have a presence in 6 out of 8 provinces of Kenya • It is also a movement building organization that focuses on facilitating and developing the capacity of grassroots women and their communities to participate in leadership and development processes

5. Kenyan Context Basic Statistical Information Population: Estimated 39 million Infant mortality rate( per 1000 live births):54.7 Estimated adult HIV(15-49) prevelance(%):6.7 People Living with HIV/AIDS 1.2 million 46% in rural have access to safe water (many water-borne causes of diarrhea and parasites)

6. Study Objectives • We had 5 study objectives • Key objectives • Develop an evidence base and country specific recommendations from the perspectives of civil society to inform GHI policies and program in Kenya and beyond • Increase direct engagement by communities and CSO with GHI at the national and international levels in areas such as priority setting and programming, M&E , accountability and accessing funding.

7. Study Design and Methodology • Action oriented research in 10 areas of Kenya between November 2008 and March 2009 • At the onset of the survey , GROOTS Kenya inducted 30 grassroots women leaders fro 6 provinces to orient them to the project and survey methodologies. The women subsequently mobilized and trained 20 leaders(2 from each area) who then formed the research team. This is the team that conduced the survey with the support of GROOTS Kenya and HGAP. • 1438 stakeholders were interviewed including implementing agencies, community health workers and home based care givers, community members and advocates, health professionals and experts, patient groups and person living with HIV and AIDS, MARPS (vulnerable children and youth and widows) and representatives of GHIs and provincial administrators at the local and district levels. • A multivariate qualitative approach was used. This included key informant interviews using a standardized and validated questionnaires, semi-structured focus group discussions , consultations, literature review and field visits • A research team analyzed the data and collated a report. Community feedback forums were then organized and the findings and recommendations were endorsed by 8,000 people.

8. Challenges of Survey 1. Limited time - Unable to reach all regions - Unable to investigate future research questions that arose as result of study 2. Low GHI literacy among respondents and end users - Limited ability to differentiate between effects of GHIs and other health system actors - However, most respondents of all types expressed interest to learn more about GHIs and participate in planning, monitoring and evaluation of GHI programs

9. Key Findings and Results 1. Healthcare Infrastructure and Information Systems • Facilities were in need of renovation and expansion. • In rural areas the long distances from health facilities and inaccessible costs of transport to the facilities was cited as major impediments to accessing health care. • Inadequate medical record-keeping resulted in poor patient and disease tracking, however it was also found that GHIs have strengthened medical record and information systems through trainings and technology 2. Planning and Priority Setting • Some efforts to decentralize health planning • Inadequate involvement of end users and communities in priority setting, planning and coordination. Programs are not always reflective of community priorities and plans - Poor coordination between national and GHI-sponsored health programs resulting in duplication and inefficiency

10. Key Findings and Results Contd,. 3. Health Financing - Unpredictable financing, for example due to delays in the disbursement of funds, especially for programs funding by the Global Fund 4. Inadequate Human Resource for Health • Health workforce shortages at district level and particularly in rural areas. It was additionally found that even in facilitates where GHIs have taken steps to post additional health workers, staff shortage and crushing workloads was found. • Health professionals reported inadequate technical and professional development • +Disease-specific trainings viewed as beneficial • Wages were found to be insufficient to retain health professionals

11. Key Findings and Recommendation Contd,. 5. Community Systems and Strategies - Inadequate investment by GHIs and the government on community systems and strategies that support communities to prevent, respond and mitigate disease burden. Examples of already existing community health systems and strategies include voluntary work be carried out on daily basis by Community Health Workers and Home Based Care Givers. 6. Disease Initiatives and Primary Health Care • GHIs are not comprehensively and systematically supporting primary health care for example in the delivery of essential services including water and sanitation, maternal care for all women and gender based violence recovery prevention and response.

12. Key Findings and Recommendation Contd,. 7. Treatment Standards - In most but not all areas PWLHA are finding its unaffordable and unreliable medicines to treat and prevent OI. - Respondents in some areas also noted limited availability of pediatric ARVs - Inadequate treatment literacy among PWLHA increased drug resistance and exacerbated the problem

13. RECOMMENDATIONS: How can we maximize positive synergies between the health systems and GHIs in Kenya? • Infrastructure and Health Information Systems; - GHIs should invest and sustain a unified electronic medical records and health systems, integrated with an automated inventory and supply system for all public and GHI-supported facilities. • Health Workforce • GHIs should work with GOK to meet national health workforce staffing requirements. • GHI funding should be used to increase production of additional health workers, ensure their retention and equitable deployment • Reduce internal brain drain by harmonizing and topping up salaries - Train, recognize, accredit, compensate and deploy community health workers and home based caregivers

14. RECOMMENDATIONS Contd,. Medical products, vaccines and technologies • GHI should support and establish routine ongoing reviews and updates of national treatment standards of care and practice for HIV, TB, Malaria as well as other OI treatment and public health threats. Leadership Governance and Coordination • GHI should streamline, simplify and harmonize existing parallel systems at national, provincial and district levels into consolidated and independent systems accessible to the general public • Communities should be supported to and meaningfully be involved in planning, coordination and monitoring of GHIs and other health programs Primary Health Care and Community Systems - GHI should increase investment in strengthening primary heath care needs and services that are responsive to the needs of infected and affected communities. These needs and services include child and maternal healthcare, GBV, access to clean water and sanitation, - GHIs should increase investment in community systems and responses that prevent address/curb human rights violations and enhance communities rights and tenure to property, land and housing rights,.

15. In Conclusion… GHIs represent a critical opportunity to invest in effective health system strengthening and community system strengthening Specifically; We REITERATE and CALL ON GHIs, development partners and the Government THAT; 1. Realizing Healthier People and communities DEPEND on Stronger Health Systems 2. Realizing Healthier People and communities DEPEND on Stronger Community Systems and Responses 3. Realizing Healthier People and communities DEPEND on Comprehensive Primary Health Care

16. THANK YOU GROOTS KENYA