CHAK is seeking to contract a qualified, reputable and experienced firm to develop and undertake Job Evaluation, rationalize functional structures and profile roles to enable the organization assign responsibilities to its human capital, thereby focusing effort on efficient and effective execution of the Strategic Plan for the period 2023-2027.
Click on this link to view the detailed Request for Proposals
With the change over from the National Hospital Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) less than one week away, CHAK member health facilities have raised concerns over lack of clarity on some operations of the new health financing scheme. The CHAK MHUs have also asked the Government to settle all their pending NHIF claims which run into millions of shillings.
In a meeting held last week with SHA, the CHAK member health facilities said they remained in the dark about fundamental operational issues of the fund including the contracting process, client registration, tariffs and claims system. The health service providers sought clarification on how the SHA referral system would operate as levels 4-6 health facilities were not allowed to receive walk-in patients under the new system.
The CHAK MHUs said they were unable to register patients in the SHA system and requested to be allowed to use portable devises to reach as many people as possible. Additionally, the health service providers sought clarification on the scope of emergency services to be offered by level 2 and 3 health facilities vis-à-vis those to be offered by levels 4-6 facilities under the new scheme, saying this was not clear.
Another question arose on when the health facilities would begin blocking patients on NHIF to SHA and exactly how the transition would happen. The SHA informed the health service providers that direction would be issued on the issue and transfer of patients from NHIF to SHIF would be seamless. It is worth noting that Kenyans are required to register afresh under SHIF although the deductions of 2.75 per cent of gross pay for salaried people are compulsory.
Source: SHA presentation to CHAK MHUs by Dr Joyce Wamicwe
During the meeting, the CHAK member health facilities were also briefed on expected digitization of the health sector. Although most Level 4-6 CHAK member health facilities have end-to-end health information systems and would most likely adapt well to a national system, few primary health care facilities (Level 2 and 3) are utilizing technology in health care. All health facilities in Kenya are required to have the web-based SHA portal by October 1, 2024, to facilitate claims processing after seeing patients. Digitization of Kenya’s health system has been provided for in the Digital Health Act 2023. Digitization would also ensure that health workers remained up to date with their licenses.
During several meetings with SHA, the CHAK member health service providers have consistently complained about long-standing NHIF payments, some of them several years old. The NHIF/SHA assured the health facilities that any NHIF payments not made by the roll over date of October 1, 2024, would be taken over by SHA. The CHAK member units asked SHA to issue them with a commitment letter, confirming the debts would be paid but were assured that all genuine pending NHIF claims would be honored by SHA.
The MHUs expressed concern at the time taken for claims to be moved from one stage to another in the NHIF system, saying some of the stages were taking an unnecessarily long time. Additionally, the CHAK MHUs said some claims were over seven years old and sought to know if these would be brought under SHA, urging their prioritization. Further, the CHAK MHUs pointed out that there were unable to view the status of their claims in the new SHA/NHIF system. The CHAK members demanded timelines for payment of the pending claims.
The MHUs added that pre-authorization for surgeries continued to take a long time, yet some patients required the service urgently. Some of the CHAK health facilities complained that they were unable to submit their claims to their local NHIF branches for processing as the system seemed to have a blockage.
In response, SHA told the meeting attendants that the blocked claims could be specific to certain NHIF branches and would be followed up once official complaints were received. Where the claims were already within the NHIF system, the CHAK MHUs were assured they had been captured as part of SHA debts and would be paid out.
Further, the CHAK MHUs were informed that it was impossible to view the stage at which their claims were in the new system. The CHAK members were asked to check for claims that had been returned but were yet to be acted on. It was noted that letters of claim rejection were yet to reach the health facilities in some instances and appeals could therefore not be lodged with SHA/NHIF.
SHA informed the CHAK health facilities that training on the use of its e-claim management system provider portal would be done beginning the third week of September 2024. The e-claims hardware would be provided by SHA.
SHA also informed the CHAK members that contracting would be done electronically and was anticipated to take a short time. Verification of data given during contracting would be done at a later date with consequences for fraud. The process of contracting would be continuous, giving service providers an opportunity to upgrade their services.
Under SHIF, empaneling of health service providers would being done by the Kenya Medical Practitioners and Dentists Council (KMPDC). A list of already empaneled health facilities was available on the SHA website. A total of 734 mission hospitals, both CHAK and KCCB, were already on the SHA list and empanelment was ongoing. The SHA pledged that SHIF tariffs wiould be gazzetted.
HIV testing is a crucial entry point to both HIV prevention and treatment efforts. Early detection through testing allows individuals to know their status, seek timely medical interventions, and adopt preventive measures to reduce the risk of transmission. Testing also plays a pivotal role in connecting people to life-saving antiretroviral therapy (ART) and support services.
For men, who are often part of high-risk populations due to factors such as lower testing rates and higher engagement in certain risky behavior, regular HIV testing, with linkage to prevention or treatment services as appropriate is especially critical.
According to the Kenya Demographic Health Survey 2022, men were less likely to test for HIV/AIDS despite being more likely to have multiple sex partners than women. The document reveals that 67 per cent of men aged 15 to 19 years have never tested while 27 per cent of those aged between 20-24 years do not know about their HIV status. Eleven per cent of men aged 25 to 29 have never been tested, 10 per cent of those between 30 to 34 have never tested, while 15 per cent of men aged 40 to 49, have never been tested. Of the men who have ever had sex, 31 per cent have never tested for HIV.
The Red Carpet Strategy innovation
To encourage men to test for HIV, CHAK, through its CHAP Stawisha project implemented an ambitious strategy dubbed the ‘Red Carpet Strategy’. This Differentiated Service Delivery (DSD) approach involves rolling out the red carpet to receive and welcome men seeking health services, simulating a VIP approach to HIV testing and prevention. The strategy seeks to provide a holistic service to improve access, mitigate stigma and ensure value addition by incorporating Non-Communicable Diseases (NCDs) and mental health screening, management and referral into the HIV testing and prevention package.
To implement the strategy, CHAP Stawisha works with high-volume health facilities with over 500-1000 clients current on HIV/AIDS care and treatment. The project also works closely with community leaders who avail spaces such as churches or public grounds for the VIP services, ensuring not only local ownership of the strategy but also cutting costs. Sometimes, the event is held within a health facility.
The process begins with mobilization of the men in the target community for the VIP health services, as they are known. Male champions do the mobilization, reaching out to their fellow men. CHAP Stawisha collaborates with health facilities in the target communities, Community Health Promoters, faith leaders, social and business groups to mobilize the men. The health facilities may print fliers or use other means for mobilization while the Community Health Promoters do door-to-door mobilization. The faith leaders involved also make announcements about the free services during the worship days closest to the Red Carpet Day. Additionally, leaders of social-economic groups, e.g. boda boda and women’s chamas are looped in and asked to sensitize their members on the event. The women play the critical role of relaying information to the men around them. Some women also escort their partners to receive the services.
As the men arrive, they walk on the red carpet to the entry point where they are received and directed to a screening point. At the screening point, those eligible for HIV testing are segregated after being screened for NCDs and mental health. A screening tool is used to determine who is eligible for HIV testing.
Those eligible proceed for HIV testing and blood sugar monitoring. If found to be HIV-negative, the men are initiated on either event-based prep or daily oral prep based on their HIV risk profile, while those identified as HIV-positive are escorted to the health facility to be initiated on ART.
HIV self-test (HIVST) complements existing testing approaches such as the rapid test. Directly Assisted HIV Self Test service delivery approach is utilized during red carpet; trained health service providers and peer educators demonstrate to the client how to perform and interpret the HIVST test. The client then does the self-test and interprets the results. Clients who are found to be HIV-positive are taken through counselling, a confirmation retest using rapid test and treatment started.
The Social Network Strategy (SNS) has been incorporated within the Red-Carpet Strategy to reach more men with HIV services. The SNS strategy is based on the principles that people in the same social network share the same behavior that increases the chances of getting or transmitting HIV, and, in addition, that people in the same social network know and trust each other; summarized as screen me, test me, know my background, identify more people. In the Red-Carpet Strategy, men initiated on PrEP and ART are oriented on SNS and become recruiters who reach out to others who are at substantial ongoing risk of exposure to HIV within their social circles. The recruiters either refer or escort the men for HIV testing during a planned Red Carpet community event or to the facility
The project liaises with the sub-counties to provide condoms during the event where possible.
Red Carpet outcomes
The red carpet strategy has proven to be an effective strategy in reaching men for HIV prevention and treatment services. Through the strategy, a total 4,515 men utilized the VIP services over a 12-month period. A total of 10 New HIV positive clients were identified and initiated on ART, while a further 1,663 men were started on PrEP, an 8-fold increase in PrEP uptake among men.
For diabetes management, hypertension and mental health, referrals are made to the nearest county health facilities. A total of 52 new Hypertension (HTN) clients, 25 new Diabetes Mellitus (DM) clients, and 18 mental health (depression and generalized anxiety disorder) cases have been referred for treatment.
Overall, men express satisfaction and demonstrate high acceptance of the community level VIP services.
Challenges and mitigation measures
A key challenge faced by the strategy is the men not returning to the health facility for retest and PrEP refills. HIV retest is recommended as a follow up to ensure those continuing PrEP are still HIV negative. The program has developed a patient survey questionnaire to elicit patient perceptions of barriers and enablers to male prevention programming, and to complement the client centered red carpet approach, client education and to inform differentiated service delivery that responds to the client unique needs. This survey is administered by the healthcare workers to better understand client's response to the services being offered, understand where, what, and how to improve service provision, understand challenges faced by the clients in accessing services, as well as client's preference on service model to scale up uptake and strengthen retention.
Additionally, there is still low knowledge and awareness about HIV prevention, treatment and care services in communities. For example, most men are unaware of interventions such as event driven Prep (ED Prep) to prevent HIV infection as well as additional bio medical ARV based prevention such as injectable PrEP. Interventions such as the Red Carpet Strategy serve to cascade such knowledge from the facility to the community level.
Next steps
The red carpet strategy has shown demonstrable success, posing a best practice that needs to be scaled up beyond the high volume facilities initially targeted by this initiative, for a men-responsive HIV prevention programming at all levels of the healthcare system. To scale up and replicate this community-based HIV testing and PrEP provision service targeting men, several key steps are essential. First, partnerships with the government, local hospitals, community leaders, and men's groups should be strengthened to ensure culturally sensitive outreach and trust-building. Expanding access points in male-dominated settings such as workplaces, sports clubs, and social venues can increase testing uptake and PrEP access. Providing integrated community HIV services will enhance convenience, appeal and acceptance. Training healthcare providers to deliver gender-sensitive care and addressing stigma around HIV in these communities is vital. Regular monitoring and evaluation of these programs will help adapt strategies, ensuring scalability and sustainability for broader impact.
The Government has assured CHAK health facilities of a smooth transition to the Social Health Authority (SHA/SHIF) whose implementation will kick off in July 2024. The assurance comes in the wake of heightened engagement between CHAK facilities and NHIF to address delayed claims payments.
Delegates at the CHAK Annual Health Conference 2024 were informed that every Kenyan would be required to register afresh for SHA/SHIF. Bio metric registration would be done for all beneficiaries while every child would be registered within 14 days of birth.
The SHA/SHIF is mandated by the law to:
According to Julia Ouko who delivered a presentation on behalf of Dr Samson Kuhora, a law on empanelment and contracting would be formulated and a body put in place to run this function. A benefits panel would review benefits after every two years in consultation with CS-Health.
The delegates were further informed that although empanelment was not guaranteed, licensed health facilities in the country would be central to the implementation of the new policy direction.
Claims management would be done through claim settling agents and medical insurance providers. A tribunal would be set up to settle disputes although any decision could be appealed in law.
Speaking at the Annual Health Conference, Mr Chrisostim Wafula, Manager, Claims Management, NHIF/SHA told representatives of CHAK health facilities and other delegates that a multi-disciplinary team has been formed to support high volume hospitals in the claims reconciliation process as the transition process continued. The reconciliations were expected to be completed by June 30 with the process coordinated from NHIF/SHA head office.
Surgical claims flagged in 2023, some of which were way above the contract rates, had already been released to NHIF branches for processing and would follow the normal payment routes while old e-claims would be released at the end of April 2024 for processing.
Further, NHIF had received money from Government and would be processing Linda Mama claims. Capitation would be paid to the health facilities in the month of May.
Some CHAK member health units confirmed that they had received NHIF payments during the third week of April. However, the facilities continued to express reservations at the slow pace of claims payments, especially given the short time period left before the start of SHA implementation.
According to the delegates, some claims had been pending for over seven years and there were cases of capitation being paid using a wrong formula. The health facility representatives termed this unfair given that the capitation was already too low for the services offered.
The challenges had further been compounded by the on-going doctors’ strike that had pushed huge numbers of patients, especially those critically ill, to the CHAK facilities, given that county health services had ground to a halt.
Further, lower level health facilities were struggling with claims and there was no guarantee they would be empaneled for SHIF due to challenges with internet connectivity. Although the Government had embarked on installation of fibre optic cables, this was mainly serving county and sub county offices and adjacent areas. Lack of internet connectivity would greatly impact Level 3 health facilities which served a large number of clients.
The CHAK member health units also expressed concern that many clients were unaware of the NHIF benefits package and called on the Government to address this shortcoming during the SHA/SHIF implementation. The delegates were informed that there was a plan to communicate the SHA/SHIF package through the division of benefits.
Further, the delegates were briefed on the referral system in the new system. Patients would be referred to Level 4 and 5 health facilities from Level 2 and 3.
The Social Health Insurance Act 2023 establishes three new funds, namely, the Primary Healthcare Fund (PHF) which will be accessed in Level 2 and 3 health facilities upon registration to SHIF, the Social Health Insurance Fund (SHIF) which will be accessed in Level 4, 5 and 6 health facilities upon registration and up to date premiums, and the Emergency, Chronic and Critical Illness Fund (ECCIF) to be accessed upon depletion of SHIF cover.
As Kenya moves rapidly towards actualization of radical policy changes in health, including a shift to the Social Health Insurance Fund (SHIF) by July 2024, CHAK Member Health Units have expressed profound disappointment over poor handling of medical claims by Medical Administration Kenya Limited (MAKL).
The health facilities have accused MAKL, which handles medical claims for the police, prison officers and teachers, of unfairly rejecting medical claims reimbursements, disinterest in stakeholder engagement and wanting public relations practices.
The CHAK network members expressed their deep frustration during a plenary session at the Annual Health Conference 2024. Delegates at the conference representing hospitals, health centres, dispensaries, churches, church health programmes, Medical Training Colleges and universities from 45 counties condemned MAKL for what they see as blatantly unfair practices in handling medical claims for patients treated in CHAK facilities.
Delegates shared deeply troubling experiences which they said had disadvantaged the firm’s clients as it had become difficult to continue providing services with no guarantee of claims reimbursement.
Key grievances expressed by the CHAK Member Health Units against MAKL included:
The CHAK members, while citing limited revenue streams, added that they were inclined to guard the little income they got jealously and called upon MAKL to improve service delivery and respect the agreements signed with the health facilities.
Pointing out that they were at the front line in health service delivery and often had to deal with disappointed and disillusioned MAKL clients, the health facilities said they were faced with the dilemma of saving a life and accepting inadequate reimbursements, which was akin to being stuck between a rock and a hard place. Out of desperation, many clients were opting to pay out of pocket despite having an insurance cover paid for by the Government.
The CHAK MHUs resolved to remain resilient and fight the unfair practices by MAKL. They were adamant that despite the challenges, being people of faith, they would embark on prayers and aggressive lobbying and advocacy to ensure their grievances were heard and addressed. They proposed a multi-tiered approach with incrementally bold steps to ensure the situation was reversed.
CHAK has launched the Africa Clear Sight Partnership Project whose goal is to tackle presbyopia. According to MOH, 7.5 million Kenyans need eye care services, a number that is rapidly rising as a result of lifestyle choices and occupational hazards, among other reasons.
CHAK continues to work with other health sector players to address the vision crisis, recently launching the project at the Annual Health Conference held on April 23-25, 2024.
The project aims to increase awareness and education on presbyopia, its risk factors, associated impairment and its effects on quality of life. Together with partners, ACHAP, Restoring Vision and Africa Clear Sight Partnership, CHAK will work towards eliminating the near vision impairment.
Already, health workers from 25 Level 4 facilities, have been trained to screen for presbyopia and are expected to cascade the training to other project sites in their areas. CHAK received 100,000 reading glasses in February which continue to be distributed free-of-charge to people identified through screening to have presbyopia. CHAK expects to receive a further 100,000 pairs of reading glasses by August 2024.
What is presbyopia?
Presbyopia is when a person has difficulty focusing on near objects because of loss of flexibility in the lens of the eye. This causes up-close blurry vision and tends to occur as we get older, typically beginning at age 40.
Barriers to addressing prebyopia and other eye conditions
A low percentage of persons with presbyopia have spectacles and an even smaller percentage have spectacles that can correct presbyopia. Cost is the principal barrier to reading glasses use and this has featured in 62 per cent of respondents in different studies across sub-Saharan Africa.
Dr Michael Gichangi from MOH Ophthalmology Services Unit in his presentation at the CHAK Annual Health Conference 2024 identified the following barriers to eye care services in Kenya:
Project implementation model
In implementing the Africa Clear Sight Partnership Project, CHAK will conduct community based and health facility based activities. At the community level, CHAK will implement an awareness, education, and screening program for presbyopia in community forums and in outreach camps. At the facility level, the program proposes to integrate screening for presbyopia at all service delivery points.
The project’s implementation approach can be summarised as follows:
The project which is expected to reach catchment communities around 100 CHAK member health units is being implemented in a hub and spoke model in seven regions as follows:
PCEA Kikuyu Hospital is warehousing the reading glasses and is in the process of distributing 14,000 pairs to identified presbyopia patients. Partners in Sudan and the Kenya Society for the Blind have also received reading glasses for distribution.
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.
Vision 2050
A world-class mission hospital
Vision
The preferred mission hospital in Kenya and beyond.
Mission
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.
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