KEY RECOMMENDATIONS OF THE MUSYIMI TASK FORCE

1. Health Facilities and Infrastructure

(a) Develop a comprehensive health sector investment plan.
(b) Revise and implement the infrastructural norms and standards.
(c) Develop and implement standardized health facility plans (master plans) for each level of care with the involvement of all stake holders.
(d) Identify, build and equip one hospital in each county to provide referral services.
(e) Treasury to allocate a total of about Kshs 62.87 billion over a period of three years starting with Kshs. 20.98 billions in the next financial year for revitalization of health infrastructure.

 

2. Pharmaceutical Services and Medical Supplies

(a) Introduce a revolving fund for KEMSA to procure EMMS.
(b) The Treasury to allocate approximately a total of Kshs. 48.75 billion covering three years towards procurement of EMMS starting with Kshs. 15.94 billion for FY 2012/13. This will ensure access to the entire Kenya Essential Medicine List (KEML), hence optimize patient outcomes and appropriate medicine use especially for the poor and vulnerable patients. This will also put an end to the perennial shortage of EMMS. KEML includes anticancer drugs, antiretrovirals and anti-tuberculosis drugs.
(c) KEMSA should fast track implementation of the current reforms to ensure focus on Good Procurement Practices and Good Distribution Practices that will guarantee performance. All positions should be competitively filled thereafter.
(d) Enhance the pharmaceutical management information system (PMIS) for accurate and reliable evidence based information for estimation of EMMS needs of the Kenyan people.
(e) Adequate funding for essential stationary and devices for drug administration e.g. prescriptions, treatment sheets, dispensing bottles, dispensing labels etc be provided to ensure appropriate medicine administration practices.
(f) Fast track the current reforms at the Pharmacy and Poisons Board (PPB) with a view to enhance autonomy, professionalism and performance in regulation. All positions should be competitively filled thereafter.
(g) Enhanced pharmaco-vigilance services both voluntary and mandatory for effective monitoring of adverse effects and counterfeit products in the Kenyan market.

(h) Enhanced quality assurance and quality control activities by PPB and NQCL to rapidly eliminate the production, distribution, storage and use of counterfeit medicines in Kenya. This is aimed at ensuring safety and quality of medicines and maximizing patient outcomes from medicine use.

(i) Therapeutic drug monitoring centres and toxicology laboratories in all county level hospitals to enable monitoring of medication therapy for safety, effectiveness and economic use of medicines and to improve toxicological patient management and research.
(j) National Patient Safety Agency: Medication errors are a significant cause of morbidity and mortality. Hence need for an investigating and reporting strategies and tools for mandatory or voluntary reporting. This will greatly improve medication safety as part of continuous quality improvement.
(k) A national therapeutics advisory committee that guides evidence based clinical practice in Kenya. This should be akin to NICE (UK) or National Institute of Health (USA). This will greatly improve patient outcomes.
(l) Medicine and poison information service – an effective evidence based information service that responds to the medicine and poison information needs of the patient, health care providers and the general public.
(m) Pharmaceutical Care defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life needs to be adopted officially by the MOH. This will greatly improve patient outcomes, cost-effective use of medicines and hence the performance of the health system.
(n) Fast track the passing and implementation of Kenya National Pharmaceutical policy (July 2010) already submitted to cabinet in the next 3 months.


3. Availability and functionality of diagnostic equipment
(a) Provide adequate equipment as per standards and norms.
(b) Treasury to allocate an additional Kshs 12.55 billion for procurement of equipment in the next financial year (2012/13 FY).
(c) Enhance maintenance of equipment by providing an additional 10% of the allocation to equipment for maintenance.
(d) Partnership with private sector for lease of equipment as a stop gap measure.
(e) Revise and implement the equipment norms and standards. The proposed list of equipment for county hospitals is provided in Annex B.

4. National Ambulance service
(a) Set up the Kenya National Ambulance Services (KNAS) with county and national coordinating offices within the next 2 years.
(b) Recruitment and training of emergency care personnel. Pre-service training of emergency care to all cadres of medical personnel is paramount.
(c) Adequate funding to enable operation of the service on a 24 hour basis every day of every year. An allocation of Kshs. 1.3 billion is required for procurement of ambulances in the 201 constituencies for the financial year 2012/2013 (Table A4.2)
(d) Provision of adequate funding mechanisms for maintenance of this equipment.
(e) Integration of the KNAS with the disaster and emergency preparedness services.
(f) Provision and maintenance of utility vehicles to mitigate against use of ambulances for utility purposes.


5. Staffing levels using norms and standards
(a) Fill the existing vacancies to mitigate staff shortages in health facilities.
(b) Revise and implement the staffing norms and standards.
(c) Increase Government Recurrent budget allocation to health Ministries from the current Kshs 20 billion to about Kshs 39.75 billion in FY 2012/13 to reduce vacancy ratio. Therefore approximately Kshs. 19.75 billions will be required to recruit additional staff in the next financial year.
(d) The ministry implements strategies that promote equitable distribution of human resource for health. The task force recommended use of incentives such as hardship/rural allowance, harmonised house allowance, priority in scholarships, housing, security, etc to promote equitable distribution of health workers in rural and hardship areas;
(e) The ministries strive to provide competitive remuneration, benefits and working environments that promote voluntary retention of doctors and health workers in public service. The establishment of a Health service commission was recommended as the best strategy to achieve this.

6. Training of health personnel including specialist training
(a) Provision should be made to train 2,204 health staff (various cadres) in various specialities;
(b) That government ensures that the infrastructure development matches the human resource development;
(c) Increase budgetary allocation for training to about Kshs 387 million in the next financial year to cater for training needs;
(d) That the ministries provides and facilitates fellowship opportunities for doctors willing to sub-specialise;
(e) That the government actively pursues the WHO resolution on Human Resource for Health on bilateral agreements between the donor and recipient countries.

7. Compensation of registrars on training
(a) Registrars work as per the curriculum contact hours. Any hours worked above these curriculum hours should be appropriately compensated;
(b) While there may be various modes of compensation, the task force recommends that self sponsored registrars be considered for financial compensation.
(c) To comprehensively address the issues of Registrars, a Sub-committee be constituted immediately (not later than end of 31st January, 2012) comprising of representatives from the universities, referral hospitals, Government, Union and Registrars to address the following issues:
    i ) Determining the extra hours worked;
    ii ) Recommend appropriate financial compensation;
    iii ) Analyze cost implication and budgetary provision;
    iv ) Recommend appropriate date of implementation.

8. Management in Public Health Institutions
(a) Conduct an independent task analysis study to determine the requisite skills required for one to perform the duties of facility managers. This would guide any future appointment of officers to these positions
(b) Enhance the leadership and management competencies of medical personnel through continuous training to equip them with the skills to effectively perform at management positions.

9. Health Service Commission
(a) Carry out a constitutional amendment to enable formation of the Health service Commission with the involvement of all stakeholders.

10. Underfunding of the health sector
(a) Treasury to allocate additional funds for the two Ministries to implement a three year (2012/13-2014/2015) health stimulus package amounting to approximately Kshs. 217 billion.
(b) The treasury to increase progressively, at 2% per annum, the budgetary provision to the Ministries of health until we achieve the Abuja Target of 15%.
(c) For sustainable and affordable health care in the country, the Ministries of health to fast track implementation of the recently developed health financial strategy.
(d) That 1% of the total health budget is allocated to Research.
(e) Enact a national social insurance (NSHIF) bill to minimize the risk of financial catastrophe due to health spending and improve access within the next one year.
(f) Phase out cost-sharing as a financing mechanism over the next three years.
(g) Improve governance and regulatory framework to avoid wastage and increase performance.

11. Strengthening performance management in the ministries
(a) There is need to strengthen performance based management system.
(b) Encourage a culture of integrity by all staff in the health sector during training, recruitment and in-service. Strict vetting on the appointment of officers into service by the two ministries;
(c) Enforcement to the fullest extent of the law on officers caught stealing of property and supplies from public health facilities. e.g. medicines, equipment etc.

Despite the gains the health sector has made over the last 10 years, the sector remains heavily underfunded. The treasury needs to allocate at minimum an additional Kshs. 217 billion over the next three years to revamp health infrastructure, equipment, human resources and essential medicines and medical supplies. This will significantly improve access to quality health care services in the country and also accelerate the attainment of vision 2030 and the MDGs.


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