ANNUAL REPORT 2021
Introduction
About PHM-Kenya
The People’s Health Movement-Kenya (PHM-Kenya) exists to track, defend and
promote the realization of the constitutional right to health for all now as enshrined
in Article 43 of the Constitution of Kenya. PHM-Kenya believes that Primary Health
Care (PHC) is the key to achieving healthcare for all, and challenges governments,
partners and all duty bearers to take bold steps towards reducing health and health-
related inequalities.
PHM-Kenya is part of the People’s Health Movement (PHM), a global network of
grassroots health activists, professionals, researchers, civil society organizations and
academic institutions concerned about growing health inequalities. Inspired by the
People’s Charter for Health, PHM-Kenya is committed to the promotion and
realization of Comprehensive Primary Health Care and addressing the Social,
Economic, Environmental and Political Determinants of Health.
In 2020, PHM Kenya conceived a Strengthening and Accountability for UHC Project,
supported by Open Society Initiative for East Africa OSIEA to push for a people-
centered Universal Health Coverage (UHC) in Kenya hinged on genuine health
reforms. The project is also to address UHC related concerns by enshrining a strong
accountability system that will counter-check national and county government
activities, ensure community involvement, demand for quality and timely services and
track finances utilized in the realization of the right to health. It brought about several
organizations (Amnesty International Kenya, KELIN, Hakijamii, HERAF, National
Taxpayers Association, White Ribbon Alliance, OSIEA, Centre for Women
Empowerment and Technology) within the PHM Kenya movement as project steering
committee to collectively work in implementing the grant.
Specifically, this project aims to:
1. Harmonize and coordinate civil society efforts towards demanding for national
and county government accountability in the implementation of UHC;
2. Strengthen community voices in demanding for inclusion and participation of
vulnerable, indigenous and marginalized groups in need of health care;
3. Induct and enlighten media on the ongoing violations in the health care systems
to enable highlight these violations at national and international spaces; and
4. Mobilize and allow for wider, more inclusive agitation of health rights from other
bodies beyond civil society.
Project Steering Committee
This project is being rolled out jointly among more than ten civil society organizations
that forms the Project Steering Committee, and it includes PHM Kenya; Amnesty
International Kenya, KELIN, Hakijamii, HERAF, National Taxpayers Association,
White Ribbon Alliance, OSIEA, Centre for Women Empowerment and Technology,
and Supporters of the Youth Worldwide. The mandate of the Project Steering
Committee:
i. Support, monitor and steer the project
ii. Approve implementation plans
iii. Receive and approve work plans and progress reports
iv. Approve any changes in budges, objectives, strategies, counties and cluster of
activities
v. Participate in regular meetings as convened by PHM Kenya.
IMPLEMENTED ACTIVITIES IN 2020.
a) Dissemination of the UHC related (Infotrack) Opinion Survey in five counties.
The People's Health Movement- Kenya (PHM-Kenya) contracted Infotrak Research
to conduct a study which sought to capture public views and perception on
affordability, accessibility and quality of healthcare services, provision and payment
of healthcare services, household expenditure on healthcare, distance from the
nearest health facility and penetration of medical cover. PHM wanted to interrogate
the UHC Pilot to understand if it is in line with the needs of the people consuming the
services.
The results of the survey pointed to key governance issues including the lack of
effective citizen participation, poor planning, policy gaps, accountability challenges,
and resource utilization.
PHM Kenya then convened town hall meetings between September and November
2020 with stakeholders in Machakos County, Isiolo County, Kisumu County, and
Nyeri County and additional two counties outside the UHC pilot, that is Mombasa and
Makueni counties to disseminate the findings on the UHC perception by citizens. The
meetings sought to devise a way forward on achieving a transparent, accountable,
and people-centered Universal Health Coverage in Kenya.
A total of 291 participants were mobilized and participated in the meetings held in the
6 counties having key representation from civil society organization, media groups,
and ministry of health, Community health Strategy Units, religious institutions and
organizations, administration, and grassroots community members.
Workshop Objectives
All the dissemination meetings had the same objectives:
1. To disseminate the findings from the survey on citizens perspectives with UHC
2. To share experiences from clients on UHC, the challenges and expectations for
the National roll-out.
3. To hear from duty – bearers on the roll-out plan on UHC.
4. To come up with an action plan to jointly advocates for a rights-based,
transparent, and accountable National roll-out
Highlights from the dissemination forums
Nyeri County
In Nyeri, the need to engage the public before the launching of the second phase of
UHC was emphasized. There was also need to improve how health funds were
managed at the county level. More County Specific focus research should be
undertaken to understand the unique challenges and learning points of UHC
implementation. Furthermore, both the Executive and assembly needed to upload
relevant health reports and information to the website to allow the public and
stakeholders ample time to engage and give feedback in matters of health. Also,
there is a need to have a county sector working group to feed the fiscal strategy
papers and annual development plans.
Kisumu County
In Kisumu during the roll-out of the UHC program, consultations with healthcare
practitioners in the four pilot counties were limited. Several practitioners confirmed
that they were not consulted when the program was being rolled out. For those who
were contacted, the consultations revolved around issues relating to how best the
Ministry of Health could position itself as the supplier and on the common challenges
encountered by patients.
However, UHC was commended as a good initiative and stakeholders were of the
view that it can be sustained only if the challenges being encountered in the pilot
phase are addressed moving forward. Corruption was cited as a significant threat to
the successful implementation of the UHC. In particular, the provision of healthcare
services in Kisumu was reported to have generally improved in different areas
including access to drug supply and the variety and quality of services availed to the
general public.
Public healthcare facilities covered by UHC include Jaramogi Oginga Odinga
Teaching and Referral Hospital (Referral hospital), Lumumba Hospital (Sub-County
hospital), Kisumu County Hospital, Migosi Hospital (Sub-County hospital), Ahero
(Sub-County hospital), UTRH, Railways (Dispensary) and Nyahera (Sub-County
hospital).
Healthcare service provision in the county is being hampered by:
Inadequate human resource capacity and management;
Lack of sufficient medical equipment and supplies in healthcare facilities at any
given time;
The unpredictability of industrial actions by healthcare practitioners, e.g., strikes
and go-slows;
High patient to low doctor ratio because of an upsurge of the patients in
healthcare facilities;
Increased staff workload resulting in poor healthcare service delivery;
Delayed supply of drugs to public healthcare facilities; and
Increased waiting time per patient because of high patient volumes.
Machakos
In Machakos, closing remarks was done by Deputy Speaker, MCA Hon. Paul Nzaui
Museku. He confirmed to the participants that all the required legal amendments and
budget approval for health will be taken seriously by the County Assembly and will be
approved. He further told the participants that the County Government will partner
with National Government to continue strengthening UHC, and thanked the
participants for coming and looked forward to improved health service delivery
through collaborations to roll out UHC.
Isiolo County
In Isiolo, there was an emphasized need for the UHC conversations to continue
beyond the dissemination to increase awareness. Citizens and CSOs were
encouraged to keep engaging the county on health issues. They said that for public
participation to be sustained, every available opportunity to feedback and demand for
accountability should be taken advantage of. There was also a plea to the
Government to open up space and avenues for discussions including online
platforms and they proposed that moving forward with the UHC project, to be paid
through NHIF.
Mombasa County
The Mombasa county government is currently looking at various models that
remunerate community health volunteers like in India where the CVH's remuneration
comes from the sale of products and services to the government. Such kinds of
transactions can be beneficial not only to the government but also to the CVH. It was
noted that inclusivity is the overall objective when it comes to accessing health
services in any institution be it private or public. It was affirmed that the UHC program
intends to do the same by ensuring that access to health services does not financially
constrain anyone.
Makueni County
In Makueni, there was a call for a revolution in the way health services were
delivered not only in the county but also in the country. This was reflected on the
What Women Want campaign that revealed what women and girls value most when
seeking reproductive and maternal health services; access to water and sanitation in
health facilities was the number one demand closely followed by respectful and
dignified care. Angela Nguku WRA-Kenya Director cautioned that the delivery of
UHC would fail if the principle of equity was overlooked because UHC was promised
on ensuring no-one is left behind in the access to healthcare. She reiterated the need
for health services to be acceptable in line with the culture of the community
members, citing the experience of women in Lamu County who avoided seeking
maternity services at the health facility because being attended by male nurses was
perceived as culturally inappropriate. She further noted that the County Government
had a good public participation track record and should continue to listen to and act
on their citizen demands and include all stakeholders in discussions towards
achieving UHC for all. In addition, it is important to design a county-specific survey to
help in getting feedback from the public on the working of UHC and possible future
interventions.
b) Media Appearance
On 11 th December 2020, PHM-Kenya marked the International Universal Health
Coverage Day in Nairobi. The event saw 124 members of PHM-Kenya gather to
review the gains, challenges and way forward post the UHC pilot phase.The
event was highlighted in KTN News and on Standard newspaper article.
On 9 th December 2020, through Daily Nation journalist that had been working
with PHM-Kenya on UHC implementation in Kenya, a 4 pages feature story was
printed on the state of UHC in the country.
On the 18 th of November 2020, PHM-Kenya held a press briefing to highlight the
high costs of COVID 19 testing, lack of NHIF coverage for COVID 19 test and
the plight of health care workers. The brief was captured by KTN news and a
newspaper cutting in the Standard Newspaper.
On 8 th October 2020, during the dissemination forum in Nyeri County, the media
houses were part of the participants. Citizen television conducted a live interview
with the Steering committee on UHC implementation in the county and country at
large.
On 22 nd September 2020, during the Kisumu dissemination forum participants
who consisted of different CSOs within the county released a press statement
demanding changes on UHC project implementation. These were highlighted by
a number of local stations within the region.
c) Website development
PHM-Kenya has contracted consultant who is currently working on the organisation’s
website.
d) UHC day celebration
PHM-Kenya marked the International Universal Health Coverage Day in Nairobi.
The event saw 124 members of PHM-Kenya, from different counties and in different
lines in the health sector, gather to review the gains, challenges and way forward
post the UHC pilot phase. Goal of the event was;
1) Mark the International Universal Health Coverage Day
2) The event aims to review the gains, challenges and way forward post the UHC
pilot phase.
3) Use the event to mobilise for PHM more people and bring them on board
Outcome of the event
Take away from the event included the need to look at the issues from the
perspective of the community, and the need to speak in one voice for UHC to grow.
Dan Owalla noted with concern the needs of Community health workers. He
reiterated the demand of the participants that the government to consider supporting
the health workers by providing them with work related equipment and remuneration
and that the CHVs are not only volunteers but also part of Health fraternity that hold
important role in the community. He urged the participants to continue networking in
order to succeed to have CHVs included as health personnel, and continue to
strengthen their voice. As a follow up, PHM-Kenya will commemorate the World
Health Day in 2021, April 7 th and issues raised in the discussion will form the petition
that will be presented on that day.
IMPLEMENTED ACTIVITIES IN 2021
Media engagement: PHM Kenya conducted several media engagements activities
in 2021, to highlight the urgent pressing need of a people centered UHC/NHIF during
this COVID-19 strange times and how it hugely impacted on people living in urban
low income and rural areas when it come to the cost of testing and treatment of
symptoms related to Covid-19. And activities that aimed at encouraging communities
to turn up for vaccination by and by the media so far in relation to covid-19 and the
UHC programme by providing them with useful information and demystify the existing
myths, and at the same time create a demand for government to provide vaccines to
a larger population and not just wait for donations. Community vernacular radios
were included in the media engagements to reach out to larger rural masses. (
https://youtu.be/je853PvpKmY, https://youtu.be/x_-M2PcGfm0,
https://youtu.be/8Y7LEdEBU9E,
https://twitter.com/tv47ke/status/1420428561677262853, https://youtu.be/2m-
rcfC5oRA, https://youtu.be/xPo-uJY7zho, https://youtu.be/kW2fNtkf32Y,
https://youtu.be/dNH5lAsfGQ4, https://youtu.be/_tKxba8ozMU,
https://youtu.be/C5Hw_mnaODs, https://youtu.be/DFFnBvpkKtw,
https://youtu.be/VclmcEcyMJg, https://www.standardmedia.co.ke/health/health-
science/article/2001420690/oxygen-maker-to-double-production-as-covid-19-fuels-
demand, https://youtu.be/ZJnkeMBdrmM, https://youtu.be/je853PvpKmY,
Mathare residents express COVID-19 vaccination fears, some believing it will affect their reproductive health.#TV47News @MusaSalahO pic.twitter.com/r1y09pvglt
— tv47 (@nftaIienfrens) August 19, 2021
https://youtu.be/iTfEWgTfLRI,
https://www.facebook.com/944483272230492/posts/4799573696721411/,
https://youtu.be/MELubo4kQIU)
Mobilization to bring more persons on Board – Courtesy meetings with
KMPDU, Community Health Volunteers, other Medical Bodies of Nurses,
Clinical Officers, like minded CSOs especially PLHIV, Key Pops, persons with
Disabilities and SRHR groups. PHM Kenya added the Social Justice Centers
across the country to be part of the PHM Kenya Movement through their
Article 43 cluster that works of social economic rights.
Public Interest Litigation: PHM-Kenya through KELIN has initiated a
process to gather evidence via Community Health Volunteers involved in the
UHC data collection for what is termed as vulnerable and poor households.
An information request letter has been submitted to Nairobi County
Government signed by KELIN and PHM as we move to kick start a legal
proceeding against the discriminative, unfair and uninformed way of selecting
Kenyans to benefit from UHC. The right to health belongs to everyone, UHC
is universal and cannot be implemented selectively, an affidavit has been
drafted to enjoin an ongoing case in the courts of law. Additionally, PHM-
Kenya has enjoined an ongoing case as an interested party on COVID-19
vaccines accountability through an affidavit. Accordingly, these were the
orders issued by the court:
1.The proposed interested party (PHM) to serve all parties within the next seven
days
2. The parties to file their responses within fourteen days
3.The Application by PHM to be heard on the 5th February 2022
Community mobilization and dialogue forums on UHC
One of the key goals of this project was to mobilize grassroot communities,
strengthen their capacities and fully involve them in movement building and
advancing the community-led UHC dialogue on Primary Health Care. PHM-Kenya
recognizes the importance of communities and their participation in making decisions
that impact on their daily lives.
Eleven (11) community mobilization, engagement and dialogue forums were
done across different counties including Nairobi, Mombasa, Kisumu and
Isiolo. These forums brought together diverse participants including women,
social justice centres, youth, people with disability, opinion leaders and local
leaders to discuss UHC, reflecting on the survey and coming up with
collective action points to influence and shape a people’s UHC agenda. This
includes the need to focus on Primary Healthcare and incorporation of
Community Health Volunteers into the system. Over 550 people participated
in the dialogue forums.
The specific locations were Mlango, Kibra ,Kayole, Dandora ,Nyalenda,
Kinyango Eastleigh, Mathare, Mukuru, Mombasa , Isiolo and Githurai. Several
online meetings were held with different groups to tackle emerging issues on
health including the intersection between sovereign debt/loans and their
impacts on government ability to invest in healthcare and achieve UHC.
Another discussion focused on the deficiency of medical oxygen and the
implication on households amid COVID 19 pandemic.
National Health Care Conference: PHM Kenya, Amnesty International
Kenya and the Kenya Medical Practitioners and Dentist Union organized a
national health conference that brought together stakeholders from the
national and county governments, health professionals, Human rights
defenders and community health volunteers to address the gaps in our
healthcare system during the pandemic. In the speakers engaged with the
four main principals of the right to health namely Accessibility, affordability
availability and acceptable quality. The objective of the conference was to
firmly address the challenges faced by frontline health workers in Kenya
amid a pandemic, access the impact of Covid-19 on the access of
healthcare system, avail a platform for dissemination of information on
the mass rollout of vaccines in Kenya and provide a platform for
meaningful engagement between the government and the public
especially grassroots movements and CSOs on ensuring equitable and
sustainable access to health.
Studies: PHM Kenya and OSIEA commissioned a study on the Systematic
review on financing options for UHC in Kenya and Uganda that was
implemented by E&K consultancy.
https://docs.google.com/document/d/1FbtAYHxmKy6wXwsYgtZZUQFach6RK
kDt/edit,
https://docs.google.com/document/d/1YS8dyhTIGOHTKsLH3Q42HclVIrL1Qx
7EQ2eNRqIg6ak/edit, and another that was implemented by Infotrak on
Health survey from the demand side in Kenya.
https://docs.google.com/document/d/1tseOhvoLHcXMwe_OpuvFqypG_i
wu1ndh/edit, PHM Kenya was also involved in the study of Impacts of
Privatizing Healthcare in Kenya, that was conducted by the Centre for Human
Rights and Global Justice in New York School of Law & Economic & Social
rights Centre. file:///C:/Users/HP/AppData/Local/Temp/Report_Wrong-
Prescription_Eng_.pdf
PHM Kenya with support from Medico international, again conceived Promoting the
Role of Citizen led-UHC in Kenya in overcoming Covid-19 impacts. Through the
People’s Health Movement, the project proposes to work with a team of coordinated,
pro-active, fearless and flexible individuals and organizations that can be on the front
line in implementing an accountability platform for UHC. The project will be
implemented in two counties selected based on historical marginalization, high
poverty levels and disease burdens. Kisumu and Isiolo Counties because of the poor
informal settlements hosting up to 60% of the urban populations and historical
marginalization, high poverty and illiteracy levels respectively.
Implemented activities
Project inception meeting with movement members: A Two-day
introductory meeting for the Overall PHM Kenya Coordinating Mechanism to
ensure a common understanding of accountability, governance and Health
rights advocacy was held. This meeting was held to ensure we have
congruence and convergence on what is transparency, accountability and the
issues around health discourse are.
Training: capacity building training in Isiolo for community health workers on
rights based approaches to UHC and strengthening primary health care who
will be engaged in conducting community scorecard.
Study: PHM Kenya has engaged a consultant to conduct a model
community scorecard to gauge the level of service delivery vis a vis the
aspirations of UHC in Isiolo County
Community Engagements Forums to Address Vaccines Hesitancy: The
myths, narratives and vaccine hesitancy is also a big challenge especially
given the fact that nurses, doctors and their essential service providers
feared being vaccinated. In part, the vaccine hesitancy is occasioned by
misinformation, the lack of involvement and participation of different groups in
Covid 19 management strategies. Even with vaccines available, Kenya would
still potentially face the tragedy of community vaccine apathy and hesitance.
The information gap, lack of participation and involvement of key groups
including youth, people with disability, lack of accountability and transparency
and the absence of a monitoring mechanism for Covid 19 vaccines and
budgets are issues that must be tackled urgently. PHM-Kenya is leading a
coalition of members and allies to address some of these issues. And
conducted three community forums in urban informal settlements in Nairobi
(Mathare, Mabatini and 4A) to address community vaccine apathy, hesitancy
and demystify the myths and narratives on vaccines through robust
community engagement and provision of timely, reliable and updated
information on Covid 19 vaccines and vaccination.
ARCHIVEMENTS
a) Successfully disseminated the citizen perception survey in 6 counties
engaging with civil society, policy makers at the county level, communities and
shaping discussions on UHC at county level. This has empowered citizens and
evoked conversations regarding the modela and sustainability of UHC the counties
that were visited.
b) Membership and movement visibility: PHM-Kenya has become more visible
at different levels and in several counties over the last 2 years. Additionally, the
membership has grown fivefold with many groups expressing interest to join the
movement and contribute to advancing collective health related positions.
(c) Consolidation and harmonization of different stakeholders to advance collective
positions on accountability and transparency on UHC. Many stakeholders including
communities, social justice centers, unions, coalitions, activists are connected via
PHM and are asking questions related to the budget making process, procurement at
county level, interrogating supply chains, participating in policy making decisions and
increasingly having dialogue with their leaders to address the impediments to UHC.
(d) Established solid working relationships with county governments. As the sole
service providers and policy makers at the county level, this gives us leverage to
influence the discourse of policy discussions related to health and UHC in particular.
e) For sustained discussions and engagement on UHC and other health related
issues, we have established and strengthened our relationship with the media to
continue articulating and amplifying our voices and airing our demands.
f) We have linked our members in different counties with the media and county
governments which is relevant shaping and contributing to conversations shaping
healthcare in counties. The media will continue to highlight the violations and expose
the weaknesses and vices within the healthcare system.
Challenges
a) Challenges associated with grant hosting that made it impossible for PHM-
Kenya to robustly and timely respond to urgent needs of members and events that
needed immediate interventions.
b) The breakout of COVID 19 pandemic and the related management measures
made it impossible for PHM-Kenya to implement the project as initially envisioned. It
slowed down implementation and more often made us shift budgets and change
activities.
c) Transitions in member organizations impacted negatively on decision making with
the movement because of the lack of needed quorum to make decisions.
Remedy for challenges
In managing the above challenges, the following strategies were employed by PHM-
Kenya;
PHM-Kenya had to devise ways to navigate the financial hosting challenges in a
number of ways. One, we started to plan our activities much earlier to avoid
inconveniences. Secondly, some members had to source for funds from other
avenues to fund urgent actions and then request for reimbursement. To sustainably
deal with the hosting challenge, PHM-Kenya has now developed its financial and
procurement manuals which will address the policy gap and will be entering into an
agreement with member organizations with clear terms of reference. Additionally,
one of the conditions for a member to host PHM-Kenya’s grant will be the need to be
flexible and less bureaucratic to respond to urgent and emerging issues.
To navigate the COVID 19 situation, the movement came up with a number of
options. First we decided to shift a number of our activities from physical to online
depending on the nature of the activity. For physical activities, we drastically reduced
the numbers to avoid creating an environment for the spread of the virus and lastly
we had to invest more in the media to sustain and make our work visible. regards to
the high staff turnover in our member organizations, we realized that is a challenge
that is beyond us, however, we are working on ensuring that membership of the
steering committee is entrenched in organizations, not individuals. In so doing,
anyone in a member organization can represent the institution in meetings. It does
not have to be specific individuals. We shall however be exploring this with members
to find a more reasonable way forward
Documents to download