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Access Accelerated Stakeholder Collaboration in Kenya: Day 2 in Review

Our “Building Solutions to Patient Challenges in Non-Communicable Diseases” event concluded after a second day of elevating patient voices to enable them to define their own needs for NCD prevention, treatment and care, while challenging all to avoid quick-fix, standalone solutions. Today focused specifically on how to invest in sustainable long-term solutions and bring sectors together to have a greater collective impact.

More than 275 people attended the convening from civil society, government, industry and patient advocacy groups.

How Women Can Lead

There was a specific focus on the context of Kenya with an engaging conversation between three County First Ladies: Mrs. Stella Samboja, Mrs. Nazi Kivutha and Mrs. Elizabeth Maiyani.

Mrs. Stella Samboja of Taita Taveta shared her efforts to break down myths and misconceptions about NCDs as diseases of the rich or a result of a curse. A participant agreed, saying “ignorance may be the biggest risk factor for NCDs” in Kenya.

Mrs. Nazi Kivutha shared experiences of MakueniCare – an innovative county-level health care scheme in Makueni – and investments the county has made in a trauma center, and women and children hospital.

Mrs. Elizabeth Maiyani, who is also the head of the County First Ladies Association, captured the spirit of the group when she asserted they wouldn’t “just sit pretty” in their roles, but drive progress on NCDs. Echoing this, Dr. Eva Njenga of NCD Alliance Kenya noted women “often don’t know our worth, but we are gatekeepers for health.”

The First Ladies from Taita Taveta, Makueni and Nakuru counties spoke about their efforts to combat NCDs (left) and panelists spoke about public-private partnership for public health (right).

What is Needed for Sustainable Financing

Sustainable financing is vital in a country where 84 percent of funding for health is out-of-pocket. Although it was noted that funding for NCDs should be easy to mobilize as so many decision makers suffer from them, this funding must be carefully managed. An influx of donor funding can have unintended impacts as governments shift health care resources to other priorities. Donors can avoid this by requesting governments put up matching funds and championing local ownership.

Realizing efficiencies must also be part of our solutions. World Bank Private Sector Lead Andreas Seiter remarked, “it’s not enough to collect the money, which is difficult in largely informal economies; you have to spend it wisely and efficiently.” He shared ideas around mobile data collection and even artificial intelligence to automate more routine health tasks.

There is a clear economic case for addressing NCD care. Menassie Taddese, Regional Lead, Africa and Middle East at Pfizer noted 7 percent of Kenya’s GDP is affected by workers who suffer from NCDs. Taddese noted, “the idea of prosperity without health cannot happen.” A recent World Bank study found that every 1 Kenyan schilling that is invested results in 4 schillings in return.

Charles Ngoh, Head of Access and Policy at Roche, noted that price is not the only barrier, “if we keep focusing on price, we are missing the wider patient journey and the challenges along the way.” He said, “Even if you provide drugs for free, it doesn’t guarantee that patients get treatment.” We need to look at the whole system and the multitude of barriers that exist.

For people living with NCDs, Mary Amuyunzu-Nyamongo of the African Institute for Health and Development, noted sustainable financing simply means “can I get access to care at the nearest facility? And can I access these services without being forced to sell my land or fundraise to get to India for treatment.”

The need for data and measurement emerged as a cross-cutting theme. Khama Rogo of the World Bank, noted “people can get the impression there is one solution and it will be a silver bullet. The money is there, but if we don’t know how much and where, we can’t coordinate flows of money.” Kenya is a digital savvy economy – there is an opportunity to leverage that savviness for health care.

PATH hosted a workshop on working together to efficiently use resources and have the greatest impact while ensuring alignment with Kenya’s NCD strategy (left) and audience members had ample time to ask questions and engage in a dialogue with speakers (right).

Challenges and Opportunities in Multi-Sectoral Collaboration

During a panel discussion on the challenges and opportunities of multi-sectoral collaboration, Niraj Doshi of Takeda said that we have a common vision and by working together and breaking down silos we can realize the African saying: “the spiders tangle their webs together to bring down the lion.”

The challenge of speaking the “right language” and making the business case was discussed in detail. Dorcas Kiptui of the Ministry of Health noted “it’s important to make the business case for public health, but you also need people to do research to provide evidence for the policy we are proposing.”

Partnerships allow the health care system to scale-up to address the breadth of NCDs. It is vital to break down barriers and increase health care capacity. “If I treat someone with cervical cancer, but they die of hypertension, I have done nothing” said Dr. Chite Asirwa. “The population is our patient, not just the individual in front of me.”

While discussing if there are some “off-limits” partners, such as soft drink manufacturers, the discussion centered on conflict of interest. World Heart Federation CEO Jean-Luc Eiselé cautioned, “We shouldn’t be shy about discussing conflict of interest, but should focus on common goals and the value for each partner.” He continued, “If there’s no economic growth and mutual value, it’s not sustainable.”

NCD Alliance delivered a moving call to action and a comprehensive advocacy agenda focused on empowering people living with NCDs.

The Call to Action

World Heart Federation, PATH and the NCD Alliance met in concurrent workshops throughout the two days. They shared a call to action for the community moving forward.

NCD Alliance delivered a moving call to action and a comprehensive advocacy agenda focused on empowering people living with NCDs and engaging all sectors in real solutions. Their passion was clear as they declared that, unless we take action, more people will suffer and die. They called on all stakeholders to put people first and catalyze change so together we can forge a healthy future for Kenya.

World Heart Federation shared their discussions with the Kenyan Cardiac Association. They presented a four-point agenda that included increased task sharing in cardiac care, a national registry for NCDs, and the taxation of alcohol, tobacco and sugar to fund NCD treatment, and keeping the patient voice in all decision making.

PATH focused their workshop on a key issue: how we can work together to efficiently use resources and have the greatest impact while ensuring alignment with Kenya’s NCD strategy. They are working on a tool to assess and visualize NCD activity across Kenya so we can better understand current activity and gaps, and avoid duplication.

The Ministry of Health reaffirmed Kenya’s commitment to Universal Health Care and addressing NCDs. The national government develops policies, but implementation occurs at the county level. Participation of county representatives in this event was key. They closed by noting the time is ripe and Kenya is a place where there is an openness of ideas, collaboration and partnership.

Our “homework” for Access Accelerated is clear. We commit to supporting partners to elevate the voices of people living with NCDs. We will work with our members and partners to bring a united response, avoid duplication and address NCD issues at a systems level.

Throughout the day, there was a productive, and sometimes challenging, exchange of ideas and solutions. At the heart of these discussions lies an enduring commitment to keep people living with NCDs at the center of all strategies, activities and efforts while advancing more effective collaboration across sectors. Together, we can realize our common vision of a world where no one dies from a preventable and treatable disease.

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