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:

1. Leadership and governance
2. Financial perspective
3. Infrastructure improvement
4. Quality healthcare

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.     

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:

1. Use of labor-intensive technology
2. Accelerating investment in agriculture
3. Diversification of healthcare
4. Services and employment growth
   
   Suicide prevention

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:

• Tobacco – 6 years
• Alcohol – 7 years
• Cannabis – 8 years
• Khat – 9 years
• Prescription drugs – 8 years
• Heroin – 18 years
• Cocaine – 20 years

CHAK and MHUs mental health programmes  

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.

 Photos: 
(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.