The ‘Big Four’ Agenda: President urges local leaders to start with health
Addressing more than 5000 delegates at the 5th Devolution Conference on April 25, Kenya’s President, Uhuru Kenyatta, urged county government officials to join forces with the national government to deliver on the so-called ‘Big Four’ Agenda – manufacturing, food security, housing and healthcare – to accelerate the country’s social and economic development in line with Vision 2030. Acknowledging the breadth and complexity of this agenda, the President then issued a call to action: Begin the transformation with healthcare, he said; of the four priority areas, this is the one that troubles Kenyans most.
The President’s assessment rang true for the representatives of county governments, civil society, the private sector and the development community who had gathered in Kakamega County for the annual event. Only one out of five Kenyans is covered by health insurance and the quality of services in both the public and private sector requires further improvement. Under the devolved system of government, Kenya’s 47 county governments are responsible for realising the vision of equitable and affordable health care guaranteed to all Kenyans by the Constitution. Since 2013 county government officials have been working to set up systems for planning, budgeting, implementing and monitoring the delivery of health care services which meet the needs of their citizens.
Germany has been supporting this process. On behalf of the German Ministry for Economic Cooperation and Development (BMZ), the German development agency GIZ has been working closely with the health departments in Kisumu, Kwale, Siaya and Vihiga counties to strengthen accountability and good governance in the health sector.
County partners present their experiences
With health squarely in the spotlight, the Devolution Conference provided a perfect opportunity for representatives from German-supported counties to share with counterparts from other parts of the country some of the promising approaches they have been testing out to improve the delivery of health services in their counties.
According to Dr Heide Richter-Airijoki, the head of the GIZ-implemented support to the Health Sector Programme, after five years of devolution, there are a lot of lessons which are ready to be shared – and possibly implemented elsewhere. ‘In each of the counties where we work, health departments have been testing out ways to foster greater accountability in the health sector,’ says Richter-Airijoki. ‘One of the objectives of our programme is to see these approaches replicated elsewhere in the country.’
At a booth in the exhibition hall organised by the Health Sector Programme, officials from Kisumu, Kwale and Vihiga counties were on hand throughout the conference to present and answer questions about four specific approaches of which they are particularly proud. Close to 1,000 participants visited the booth over the four-day period, including several governors and deputy governors and members of county assemblies.
‘There was a lot of positive feedback,’ said Hellen Musumba, a technical advisor with GIZ based in Kisumu. ‘Officials from other counties saw that these approaches were complementary – and that they could potentially benefit from all of them.’
Steering quality improvement efforts
Ms Triza Ireri, the head of nursing at the Tiwi Rural Health and Training Center, and Mr Dima Galole, of the Kwale County Health Department, presented Kwale County’s approach to implementing employee satisfaction surveys in hospitals and health centers. Since 2015 these surveys have been helping facility managers and quality teams to identify areas for improvement and to tackle issues affecting staff performance. ‘The people we spoke to were really interested in the link between the employee survey and improved service delivery,’ said Dima Galole. ‘We were able to convey how the survey can lead to basic workplace improvements which then benefit the overall quality of care.’
Ms Jane Owuor, the Reproductive Health Coordinator for Kisumu County, coordinates the process of maternal and perinatal death reviews in the county, ensuring that each and every death is fully investigated in order to find out what went wrong and how it can be prevented from happening again. She explained to visitors how doing this regularly, in a ‘no blame’ environment, has led to improvements in the quality of maternity services, more effective referral practices, and enhanced teamwork throughout the health system.
Also from Kisumu County, Mr Dominic Wamamba, an epidemiologist with the County Health Management Team, took visitors through the process of designing and implementing a large-scale digitally-administered client satisfaction survey to gauge the public’s views about health service delivery. These annual surveys have helped authorities in Kisumu to prioritise areas for investment and improvement, and to track changes in public attitudes over time.
Promoting direct engagement between citizens and health providers
Since 2015 the Vihiga County Health Department has been organising annual health exhibitions in which members of the public can interact with public and private health service providers, government officials, NGOs and development partners, and also receive free medical services, such as screenings for HIV and chronic diseases.
‘The secret to the county health exhibition is providing a platform for personal engagement between citizens and health partners,’ says Mr George Odunga, the Health Promotion Officer for Vihiga County, who presented the approach at the conference. After learning about the exhibitions, the Governor of Vihiga, Dr Wilber Ottichilo, pledged his intention to attend, as did representatives of a number of other counties curious to see this approach in action.
Toolkits under development to support replication
The representatives from Kisumu, Kwale and Vihiga counties were gratified by the interest shown in their work. Approximately 1,000 information leaflets about the featured approaches were distributed, and many visitors left their contact details with requests for further information. With support from GIZ, toolkits are currently being developed for two of the approaches – the employee satisfaction survey and the client satisfaction survey – and will be distributed later this year.
In his opening remarks, President Kenyatta observed that ‘the Devolution Conference gives us an opportunity as leaders to combine our strengths for the good of the country.’ The very successful ‘horizontal learning’ which took place at this year’s event demonstrated what this can look like in practice.