Musa Gitau Road, OFF Waiyaki Way Lavington, Nairobi
(+254) (20) 4441920 / 2660372 / (+254) 722 203 617 / (+254) 733 334419
PCEA Kikuyu Hospital launched its Strategic Plan 2023-2028 and Vision 2050 in a colorful event held at Weston Hotel in Nairobi. The plan which has the theme “Customer satisfaction and innovation for sustainability” has four strategic priority areas:
The four strategic priority areas are supported by seven strategic goals and eight strategic objectives. The Strategic Plan is expected to move the hospital forward in the next five years despite the challenging economic times. The longer term Vision 2050 was used to inform the five-year plan.
A world-class mission hospital
The preferred mission hospital in Kenya and beyond.
To provide quality, affordable healthcare and training services driven by Christian values.
Board Chair Mr David Kimani acknowledged that the hospital had lagged behind in infrastructure development and modernization of equipment, adding that the plan would guide the hospital through a growth trajectory that would address these and other areas.
The plan was developed through a bottom-up approach involving the Board, management and staff of the hospital. It echoes the needs of the hospital clients and commitment of the staff to deliver high quality and affordable health care over the next five years, including respect, protection and promotion of patient rights.
In implementation of the strategy, the hospital has committed to continue working with its partners including CBM, MBF, WRF, Samaritan’s Purse, MOH, County Government of Kiambu, CMMB and CHAK to positively impact the lives of its clients and catchment community.
The hospital is currently divided into four units: General, eye, orthopedic/rehabilitation and dental. It also operates a school of nursing and a satellite clinic in Matasia, Ngong.
AIC Litein Hospital held its first mental health conference on October 17-19, 2023. The conference, whose theme was ‘Hope for recovery’, aimed at equipping health workers to provide quality care to mental health patients.
The three-day intensive training and information sharing forum focused on treatment of mental health patients, psychotherapy using EMDR, Christian faith integration in counseling and EMDR, strategies of self-empowerment for the unemployed client, suicide prevention an after care, national drug addiction update from NACADA, financing for mental health services, in addition to other topics.
CHAK General Secretary Dr Mwenda
speaking during the AIC
Litein Mental Health Conference.
Financing mental health services
CHAK General Secretary Dr Samuel Mwenda gave the participants an overview of national policy changes in the run-up to the launch of Universal Health Coverage (UHC) Programme by President William Ruto during Mashujaa Day celebrations on October 20, 2023. The President launched the national UHC programme at the Wilson Kiprugut Chumo in Kericho County. Dr Mwenda expressed confidence that mental health services would be covered by the social insurance fund expected to be used by all Kenyans.
Treatment of mental health conditions
Participants were taken through theory and practical sessions on medical treatment of different mental conditions. The sessions covered various psychiatric disorders, examination, diagnosis, treatment, prognosis, diagnostic and therapeutic challenges.
Eye movement desensitization and reprocessing (EMDR)
Theory and practical EMDR training sessions featured through out the conference. Participants were taken through creating a safe place, water bath technique, principles of brain habit changes, among other EMDR techniques. Live and video demos of practical EMDR sessions were used to enhance learning and participants given an opportunity to practice the newly learned technique.
Empowerment in unemployment
During this session that examined the effects of unemployment on mental health, participants were also taken through strategies for empowerment in the face of the current difficult economic times.
Among the strategies identified were:
During the session on suicide prevention, participants heard that 90 per cent of individuals who commit suicide have visited a health facility within the last one year. Health workers therefore needed to be alert to signs of suicide, including verbalizing such an intent, withdrawal and isolation, increased use of alcohol and drugs, among others. Where such signs and symptoms were identified, the health workers were asked to take the necessary treatment measures.
Participants listen keenly to presentations at the conference.
National drug addiction trends
NACADA prevention coordinator Wendy Waithaka updated the conference participants on national drug and alcohol addiction trends. Both children and adults were affected by drugs and alcohol.
In Kenya over 39 per cent of deaths annually result from NCDs and more than 50 per cent hospital admissions are due to NCDs (MoH, 2020). Major risk factors for NCDs are:
1. Harmful use of alcohol
2. Tobacco use
3. Unhealthy diets
4. Physical inactivity
The Kenyan National Commission of Human Rights estimates that 25 per cent and 40 per cent of outpatients and inpatients suﬀer from mental health. The most frequent diagnoses of mental illnesses made in general hospital are depression, substance abuse, stress, and anxiety disorders.
The National Survey on the Status of Drugs and Substances of Use in Kenya, 2022, identified the following new and emerging drug trends:
1. Smokeless tobacco – snuﬀ, tamboo and ndovu ( kuber forms), nicotine pouches
2. Electronic delivery systems – shisha pens, e-cigs, vapes
3. Cannabis edibles – cookies, “mabuyu”, candies
Lowest age for initiation to drugs and alcohol was as follows:
CHAK MHUs were given an opportunity to speak on their mental health programmes. It was a moment of pride as Tenwek Hospital, PCEA Kikuyu, AIC Litein, PCEA Chogoria, AIC Kapsowar, among other CHAK members spoke on their efforts towards the mental health of their clients. Mental health programmes in CHAK health facilities have grown tremendously over the last five years. Most of the health facilities now include a mental health counsellor in their ward rounds.
In the recently launched CHAK Strategic Plan 2023-2028, mental health is domiciled in the NCDs programme.
Expanding access to HIV prevention, care and treatment services
CHAK’s two main HIV/AIDS projects, USAID Jamii Tekelezi and CHAP Stawisha, are designed to accelerate progress towards HIV epidemic control. USAID Jamii Tekelezi project supports 200 health facilities in Meru, Nyandarua, Tharaka Nithi and Embu counties, while CHAP Stawisha supports 38 facilities spread across the eight counties of Embu, Meru, Laikipia, Tharaka Nithi, Machakos, Makueni, Kitui and Nyandarua.
These projects implement comprehensive HIV prevention, care, and treatment services in collaboration with CHAK member health units, county governments and other implementing partners. Together the CHAK HIV projects support over 92,750 persons living with HIV (PLHIV) on life-saving antiretroviral therapy (ART).
All programmatic interventions are aligned to the national HIV Prevention and Treatment Guidelines. As part of sustainability and transition, CHAK implementation is anchored on a county-owned, county-led, county-managed HIV service delivery strategy that emphasizes coordination, integration, and collaboration.
CHAK HIV projects partner with respective county governments through Memoranda of Understanding (MOU). These create an enabling environment for integrated service delivery, mainstreaming of HIV services into primary health care, and stimulate a sense of ownership that fosters incremental transfer of service delivery functions to the counties.
Crucial program interventions included scale up of differentiated service delivery (DSD). Adolescent girls and young women (AGYW) and men are targeted with HIV self-testing, index testing, social network services (SNS), PrEP, and intimate partner violence (IPV) screening.
Women of reproductive age (WRA) are provided with integrated HIV and family planning services that also incorporate cervical cancer screening and treatment. The key populations (KP) are reached through involvement of KP-led civil society organizations and peer snowballing. To improve continuity of treatment, fast-track (a form of DSD) and community ART models are deployed, with over 80 per cent of the treatment cohort receiving multi-month ART prescriptions. Adolescents and young persons are targeted with intensified psychosocial and adherence support such as operation triple zero (OTZ) with demonstrable sustained improvements in viral suppression from 72 per cent at OTZ baseline to 89 per cent.
In leadership and governance, CHAK supports the Faith Sector Working Group stakeholder coordination, with engagement of the Council of Governors and the Office of the President towards integrated, stronger, and resilient systems in faith-based implementing mechanisms.
Enhanced economic resilience, caregiving, and protection capacity of households and caregivers – USAID Jamii Tekelezi OVC
Kenya’s population is estimated to be 47.5M, with 67 per cent aged 29 years and below. Children in Kenya total 19 million, of who 40 per cent are below 14 years. An estimated 2.8 million children in Kenya are orphans and over 0.5 million of this population are orphaned due to the HIV epidemic. The 2019 Kenya Population and Housing Census estimated the population of Orphans and Vulnerable Children (OVC) aged 0 – 17 years in Meru County to be 12,124. Children orphaned due to HIV are often considered more vulnerable as they face high rates of poverty, disease, stigma and discrimination, gender-based violence and abandonment.
(Left) A caregiver and Household Economic Strengthening (HES) beneficiary displays a sample of her work; (Centre) A trainee and beneficiary of the apprenticeship program with his trainer repairing a vehicle at a garage in Meru; (Right) A beneficiary showcases his skills in welding while making a window for a customer.
CHAK through its USAID Jamii Tekelezi program implements a Household Economic Strengthening (HES) and apprenticeship initiative in Meru County as part of its OVC program.
This initiative aims to improve the economic resilience and stability of caregivers and the children under their care to prevent and mitigate the impact of HIV/AIDS on PLHIV together with their families, and in particular, the financial hardships occasioned by caring for someone with HIV.
In Meru County, USAID Jamii Tekelezi program supports 3,456 OVC of who 1,388 are Children & Adolescents Living with HIV (CALHIV).
One of the strategies employed under the HES initiative is provision of business start-up kits for various income generating activities. Between January and June 2023, USAID Jamii Tekelezi Project supported 30 households with business start-up kits. A total of 26 out of the 30 households have shown improvement measured through increase in business stock and improved household income that has enabled them to cater for their basic needs.
Apart from the business start-up kits, USAID Jamii Tekelezi has rolled out an apprenticeship program to empower eligible OVC with vocational skills to better position them in the labour market as well as allow them to exploit business opportunities. By June 2023, 13 OVC had been placed in various apprenticeship training programs. These OVC are attached to local entrepreneurs and mentors willing to take them through basic training in vocations such as motor vehicle repair, driving, welding, electrical wiring, and hairdressing. Acquisition of these skills will improve their households’ economic prospects and enhance their resilience to thrive amid tough economic times. To achieve this, USAID Jamii Tekelezi collaborates with the County Departments of Health, Directorate of Children Services, the Registrar of Births, local administration, Department of Social Services among other partners.
CHAK implemented the ACHAP Afya project in five sub-counties in Kilifi County from July 2020 to July 2023. The project’s goal was to reduce maternal and child morbidity and mortality in Kenya and Uganda. To increase uptake of family planning (FP), the project engaged and empowered community-based distributors of FP methods to reach clients at household level.
A total of 19 Community Health Assistants (CHAs) were trained as Community Based Distributors to provide family planning commodities to underserved and hard to reach populations. To address the unmet need for family planning in the project area, ACHAP Afya expanded access to FP method mix at community level and engaged in commodity advocacy at the county level through Technical Working Groups. The Sub County Health Management Team supported the community-based distributors of FP with commodities, support supervision and mentorship.
For social behavior change leading to demand creation for FP services, the project worked with religious leaders, young people and community resource persons who encouraged women of reproductive age to take up family planning.
Esther Rua is a Community Health Assistant (CHA) who worked with the ACHAP Afya project as a family planning Community Based Distributor (CBD) in Ganze Sub-County.
To ensure the family planning needs of each household under her care were met, she worked closely with the Community Health Volunteers (CHVs) under her supervision.
The CHVs counselled family members eligible for family planning during their monthly household visits and then informed her when any of the people counselled chose a method. She would give the method to the client during the next support supervision visit with the CHVs. She says the CHVs have been effective mobilisers and the uptake of family planning in her community has been on an upward trend.
According to Jackline Ngala who also worked as a CHA and FP CBD in Ganze Sub-County, community forums such as chiefs’ barazas, outreaches, women’s group meetings and community dialogue days provide valuable opportunities to take the FP message to both men and women.
Teenage pregnancies are common in Kilifi County. According to KDHS 2014, the teenage pregnancy rate stood at 21.8 per cent against a national average of 18.1 per cent. Jackline adds that for teenagers 15-17 years old who cannot make decisions on family planning uptake, it is crucial to involve the parents.
Many parents with teenage girls allowed their children to take up a family planning method as counselling on abstinence had not been effective in preventing teenage sex. However, there are parents who felt that allowing teenagers to take up family planning allowed them to have careless sex.
Jackline, together with the CHVs under her supervision, held meetings with the teenagers monthly to advocate for abstinence, safe sex and family planning.
“We avoid giving hormonal FP methods to teenagers although many parents prefer Implano as it lasts the whole school term,” she adds.
Regina Muli, a CHA and FP CBD working in Kilifi South Sub-County, reached teenagers affected by early pregnancies through maternal child health clinics. When the teenagers visited the clinic with their babies, she would invite them for a chat on family planning.
“Many teenagers did not have the right information about family planning and after counseling, they were able to choose a method with the consent of their parents where applicable,” said Regina.
William Zoka, a community health assistant working in Kaloleni sub-county added that they integrated family planning services in mother-to-mother support groups and outreaches.
To reach more men, Zoka says he conducted community health dialogues targeting them. He also did health talks in the health facility during morning hours when clients came for services. Additionally, he was able to reach the men in entertainment joints and other places where they congregated.
ACHAP Afya supported the community-based family planning distributors with training, support supervision and data quality audits.
The government has pledged to work with religious institutions to deliver efficient and cost-effective health services as well as relevant education.
Speaking during a meeting with faith leaders at State House Nairobi, President William Ruto noted that religious institutions provide 40 per cent healthcare in Kenya and must be core in the Government plan and roll out of the Universal Health Care programme.
CHAK coordinated the successful partnership engagement with President Ruto during with education and health matters were discussed. A Memorandum on Health which highlighted areas of partnership strengthening and challenges that required Government support was presented.
The President, supported by CS Health, DG Health and Chairman of NHIF Board, responded to requests presented by the faith leaders. Education issues were responded to with the support of CS-Education.
Delayed NHIF payments and inadequate service package rates were top on the health agenda during the meeting with President Ruto. NHIF was represented by Chairman Eng. Michael Kamau and two Board members while MOH was represented by CS Susan Nakhuminchia, DGH Dr Patrick Amoth and DMS Dr Andrew Mulwa.
The MoU between Government (National/MOH and CoG/Counties) and the Kenya Faith Based Health Services Consortium (KFBHSC) will be updated to align to Government policies.
President Ruto commended religious organisations for their role in the provision of social services. He said the government appreciated their contribution to the provision of health and education and committed to continued partnership with them.
Family Planning (FP) has been defined as getting children by choice not chance. It involves making a conscious decision on family size and spacing between children. Studies show that male involvement positively influences continued use of family planning methods.
In Kenya, family planning is frequently perceived as a woman’s concern, and family planning programs most often target women. Yet men have greater decision-making power over household matters including health care due to gender dynamics.
Religious leaders have been identified as influential advocates for health as they are well trusted in the communities they serve and are able to reach the smallest family units and individuals. Equipped with appropriate messages and skills, religious leaders will not only empower their communities and congregations, leading to increased uptake of health services, including family planning, but are also able to advocate with policy makers and influence key decisions.
Ustadh Rashid Osman, a religious leader from Kilifi County, was one of the 54 faith leaders from six counties in Kenya trained in family planning, gender-based violence and HIV/AIDS advocacy through the Christian Advocacy for Family Planning in Africa (CAFPA) project.
The project, funded by the Bill & Melinda Gates Foundation through Christian Connections for International Health, engaged religious leaders to advocate for community and policy maker support for family planning, gender-based violence and HIV/AIDS to drive positive policy change. CHAK implemented the project from 2013 to 2021.
Ustadh Rashid says he started off as an ordinary Imam, completely unaware of the effects of gender-based violence, unplanned families and HIV/AIDS on his community. He however got involved in advocacy when he was selected as a family planning champion by the National Council for Population and Development, a government body.
In 2017, due to demand for reliable health information in his community, he thought of forming a CBO for Imams to discuss issues around reproductive health with regard to Islam. Muslim Intervention for Health Education (MIHE) has been instrumental in bringing health messages to the community.
The faith leaders’ training by the CAFPA project, gave Ustadh Rashid additional motivation to continue addressing reproductive health issues in his community. A key challenge for him, however, was getting men involved in FP and reproductive health decisions in their families. Whenever he called meetings to discuss FP and reproductive health only women showed up.
Meanwhile, Ustadh Rashid continued receiving invitations to seminars and workshops to discuss reproductive health issues in the Muslim community. He also continued attending capacity building sessions and holding community meetings in mosques. During the meetings held weekly, the community talked openly about the issues they were facing at home. It became apparent that women were suffering gender-based violence. Early pregnancy was a challenge among the youth that affected families and about which men as the family heads were very concerned. The community therefore began to actively seek solutions to these challenges.
To address the problem of male involvement, Ustadh Rashid began by speaking to men in the mosque where he served as Imam during Friday sermons and prayers. He told them that they were responsible for their households, according to Quran teachings, and needed to get involved in decisions affecting their families. After prayers, he asked the men to stay and discuss HIV/AIDS and teenage pregnancies. The men responded positively because these issues were affecting their households. During these discussions, he introduced family planning and gender-based violence which were regarded as taboo topics in the community.
Ustadh Rashid worked closely with health workers from local health facilities and other religious leaders in the CAFPA project to give the right information to his community. To reach even more mosque congregations in his locality, Ustadh Rashid structured Rabai Sub-County Imams, over who he is in charge, into four wards. He has continued to reach out to Imams in each ward with FP, HIV/AIDS and gender-based violence messages and tasks them with getting the information out to the men in their congregations. Each ward has between nine and 13 Imams. Initially, the Imams were against FP and needed to be convinced that it was allowed in Islam. Utadh Rashid held meetings with the Imams and their congregations, so the community could participate freely in the discussions.
He has also used mainstream media, mainly radio, as well as social media to advocate for FP, HIV/AIDS and gender-based violence. Through radio stations that target the Muslim community in Kilifi County, including Radio Rahma, Msenangu FM and Boss Radio, Ustadh Rashid has been able to pass FP, HIV/AIDS and gender-based violence messages and encourage men’s participation.
He has formed three WhatsApp groups, two targeting Imams and one targeting football coaches to act as advocacy platforms for the health issues affecting his community. Through the WhatsApp platform, Ustadh Rashid is able to address the Imams’ concerns and answer any questions they may have.
Additionally, Utadh Rashid has used Facebook Live, Facebook, Instagram and Twitter to engage his audience. His social media posts are taken positively by the younger audiences who follow him while FP concerns raised on these platforms are appropriately addressed.
Following the training by the CAFPA, Ustadh Rashid felt more empowered to speak about FP, HIV/AIDS and gender-based violence in his community. Additionally, by working closely with health workers from local facilities, he has also been able to reach youth and women in addition to the men.
The Imams working under him in Rabai County have been empowered to speak out on FP and reproductive health issues in their communities, including encouraging men’s participation in discussing and finding solutions to the challenges facing their families.
During the men’s meetings held after Friday prayers, the men agreed that FP was getting the number of children one could comfortably bring up. Further, it was agreed that according to Quran teachings, a woman needed two years to breastfeed a child while couples were advised to take an additional year to attempt conception. This added up to child spacing of three years, removing the idea that FP was not accepted in Islam.
The big question then became which FP methods were allowed in Islam apart from breastfeeding. This opened the door for discussions and it was agreed that non-permanent methods were allowed and acceptable. This view is backed by Muslim scholars whose studies and writings Ustadh Rashid constantly refers to in his teachings, in addition to supporting Quran text.
Before Kenya recorded its first case of COVID -19 infection in March 2020, we had already witnessed how the global pandemic had seriously hit countries with even more robust healthcare systems.
If there was one thing that this pandemic taught us from the onset, it was that fighting this virus was not going to be a government and health workers–only affair. Globally, citizens were already acknowledging the difficult conditions in which frontline workers were battling to save lives.
We saw people lining up the streets in these cities every evening as the day’s shift came to a close. Clapping, hooting and waving as they showed appreciation to the brave healthcare workers who were at the frontlines of the fight against the pandemic. Other than reminding us about the values of humanity, these scenes served to hint to us that to win against this virus, we all had a role to play.
As we got to July 2020 and were approaching the peak of the first wave in Kenya, the country’s healthcare system started to feel the brunt of the pandemic. Limited isolation spaces in government facilities, high cost of care in private facilities, which made them inaccessible to their regular clientele, and a sharp shortage of PPE and other medical equipment threatened the country’s efforts to contain the spread of the virus.This pandemic brought to fore the need for government, private and faith-based healthcare providers to work together to manage the infection numbers.
Mission hospitals have over the years supplemented the country’s public healthcare system through the provision of quality and affordable health services.
During this unprecedented times, these faith-based facilities have proven to be an integral part of the National and County COVID-19 pandemic emergency response infrastructure. They have set aside isolation wards, ICU beds, oxygen treatment support facilities, trained staff and have established protocols for COVID-19 screening, treatment, infection prevention and control.
This has escalated the mission hospitals’ need for PPEs for frontline staff, and other medical equipment.
The current high cost of PPEs and other associated medical consumables not only makes it difficult for mission hospitals to care for COVID-19 patients, but also challenging for them to provide their other patients with the care they need in a safe environment. A majority of these facilities are located outside Nairobi and some of them, like Kijabe, Chogoria, Kikuyu and Tenwek Mission Hospitals, provide highly specialized care to patients who cannot afford to seek treatment in private health facilities because of prohibitive costs.
Unlike government health facilities which are funded by the exchequer and private hospitals, which operate on a business model, mission hospitals are essentially run as charitable institutions inspired by faith foundation and commitment to compassionate service relying on donations and the heavily subsidised fees that they charge their patients. On many occasions, these health facilities have to waive fees for the vulnerable, needy, and very poor patients.
It is for this reason that we are grateful for the donation of PPE kits worth KES 33 million made by Equity Group Foundation (EGF) and the Kenya COVID-19 Fund Board to support mission hospitals with active COVID-19 isolation units. Such donations allow us to continue offering compassionate care to all our patients at affordable costs.
While in the last few weeks we have noted a decline in COVID- 19 case positivity rates, we are not yet out of the woods. To date the country has recorded over 240,000 confirmed infections for those tested and unfortunately we have lost over 5,000 lives . Recently, while addressing the nation as the government reviewed containment measures, Health CS Mutahi Kagwe warned that Nairobi had run out of beds for COVID-19 patients. COVID-19 truly brought a strain on the health system.
With treatment and isolation spaces in public hospitals dwindling in the wake of this surge, and costs keeping many away from private facilities, mission hospitals are more likely to take on even higher numbers of new COVID-19 patients in need of hospital admission. Already, a majority of mission hospitals have designated isolation areas and units set aside to manage COVID -19.
While the donation from Equity and the Kenya COVID-19 Fund Board has gone a long way in plugging the shortfalls in the mission hospitals, we are still far off from being sufficiently equipped to handle the looming surge. This is an opportunity for more Kenyan corporates to come on board and provide the much-needed support to strengthen hospitals infrastructure and capacity for response at this critical time.
Authored by Dr. Samuel Mwenda, General Secretary, CHAK.
Page 1 of 2