The overall purpose of the project is to strengthen community participation in health sector governance in Coast, Eastern and Central regions of Kenya
Community participation is critical to the promotion of accessible, affordable, equitable and effective health care services at the grassroots level. The second National Health Sector Strategic Plan 2005 – 2010 (NHSSP II) embraces the principle of community involvement, as it aims to enhance access to health care in order to improve productivity and reduce poverty, hunger and child and maternal mortality. Indeed, the Kenya Health Sector Reforms (HSRs) and the primary health care (PHC) concept have both recognized the importance of implementing a rights-based approach to health in Kenya, ensuring that community members are actively involved in prioritizing and addressing local health issues.
As envisaged by the Ministries of Medical Services and Public Health and Sanitation, the implementation of the NHSSP II requires effective decentralisation of governance, management and service delivery in order to bring health sector decision-making and action as close as possible to the community and individual households. Therefore, the main purpose of the proposal is to strengthen identified community decision making processes in order to effectively identify community health needs and participate more actively in the improvement of community health care services.
Nyeri North DHMT Members
A major impediment to community participation in health sector governance and management is lack of awareness about Economic Social and Cultural Rights, including the right to health. Creating awareness of the right to health, including the rights-based approach, is the major priority of this project. It is hoped that with improved human rights awareness community members will be in a more informed position to demand for quality health services from the government. Similarly, they will be in a better position to select able representatives in Health Facility Committees, DHMB/Ts and hold them accountable in the execution of the duties and responsibilities as contained in their terms of reference.
As the achievement of community health needs is pegged on how well the community representatives on the various committees understand and undertake their respective roles and responsibilities, the project is enhancing their capacity to execute their mandates. This is been achieved by facilitating the committees to understand their mandates as community representatives, including training them on tasks such as planning and budget making, which forms part of their core business.
The quality of health services that communities in Kenya are receive from health facilities is wanting and only a few members of the community are aware that it is their right to be provided with quality health care services. The project is therefore creating awareness on the right to health by informing community members about the patient’s charter, which stipulates the services that a client is entitled to in a health facility. The project is going further to inform and educate the public about the complaints procedure in case there is an infringement of patients’ rights.
To ensure ownership and sustainability of patient’s charter, the project is facilitating selected health facilities in the target regions to adapt or develop their own charters with the participation of the community, government and other stakeholders in the district.
The project is also enabling community members to demand for transparency and accountability in the management and governance of the health sector at the district levels. To achieve this, members of the community are made aware about the health sector budget making processes, including the District Health Plans and Annul Operational Plans. Information is also been provided about the national budget making process – the Medium Term Expenditure Framework (MTEF) – including its linkage with the health sector Annual Operation Plans.
To ensure the community is informed about the devolved funds earmarked for the health sector such as the proposed – Health Sector Service Fund (HSSF) – the project is informing and educating the community about the fund, its purpose and how it should be spent. In addition, to boost the fund governance, the project is clarifying the roles and responsibilities of the proposed Facility Fund Committees, training them on project planning, budgeting, resource mobilisation, monitoring and reporting procedures.
Project targets
The project is targeting Health Facility Committees, DHMT, DHMB and MOH staff working at dispensaries, health centres and district hospitals, civil society and general public from Mbeere districts in Eastern, Nyeri North in Central and Kwale district in Coastal province.
Project period: 36 months (January 2009 to December 2011)
Expected project outputs.
1) Strengthened grassroots communities to progressively realize their right to access quality health care and to seek accountability from health facilities
2) Dissemination of human rights information on issues affecting health care services in Kenya with case studies drawn from intervention areas (Coast, Eastern and Central) through website, newsletters, MOH forums, conferences and workshops
3) Improved health status and reduced disease burden in the community due to quality health delivery systems at the community level.
4) MOH staff working at level 2, 3 and 4 (dispensaries, health centres and district hospitals respectively) trained on human rights and right based approaches
5) Roles and responsibilities of the DHMT, DHMB and Facility Committees explained to target communities
6) Strengthened grassroots communities participation in health sector budget process at district levels
7) Circulation and Dissemination of patient’s charter to communities in target regions to strengthen access to quality health care and seek accountability from health facilities
8) Participatory development and implementation of Facility Plans and District Health Plans
9) Health Facility Committees, District Health Management Boards/Teams capacity to represent community interests in the planning and implementation of health projects at district level improved
10) Demand for transparency and accountability in allocation and utilisation of Health Sector Service Fund channelled to health facilities
The community is empowered and respect for human rights enhanced.
Background
HERAF in conjunction with the Kenya Human Rights Commission (KHRC) with support from the European Union (E.U) has implementend a project named,"Strengthening Community Participation in Health Sector Governance in Kenya." which is aiming to strengthen communities participation in health sector governance and management in Coast, Eastern and Central regions of Kenya.
The project started on January 2009 and is intending to run for a duration of 36 months.
Mbeere District Photo
HERAF is the overall implementing agency for this project. HERAF has implemented the proposed project with assistance from associate partners including Health NGO's Network (HENNET) and Institute of Economic Affairs (IEA).
KHRC is responsible for:
Providing financial management and administration for the project
Advising on financial planning and budgeting, oversee the financial distribution
Ensuring financial procedures are followed as per requirements and standards spelt out by the donor, including the internal and external audit of the funds.
OBJECTIVES OF PROJECT
The specific objectives of the project are:
To strengthen the capacity of grassroots communities to hold the government structures accountable in implementing the rights based approach to health care programmes at the district and community level
To empower the DHMB/T to represent community interest in the implementation of health sector programmes at the district level
To improve health service delivery by empowering communities to monitor the quality of health services provided and to demand quality services
To advocate for transparency and accountability in planning, budgetary allocation and management of resources allocated to the community-based health facilities in order to address prevailing disease conditions.
The three project locations have different geographical and socio-economic conditions which exposes them to different disease conditions. Plans within the health sector should be able to address different health issues specific to different geographical locations. Through this project, the community will be empowered to participate in health sector governance through contribution in making of plans that address their specific issues which are unique to them while the health management teams/Boards will be empowered to make decisions that address the community needs.
Project activities
With EU Project having the main objective to strengthen community participation in health sector governance and management in Coast, Eastern and Central regions of Kenya it has the following activities to undergo within the stipulated time margin of 36 months as from January 2009.
Inform and educate target groups on the right to health.
Clarify to community the roles of Village Health Committees, Health Facility Committees, DHMB/T, and Provincial Health Management Teams
Conduct capacity building trainings for DHMT, DHMB and Health Facility Committees to develop and implement district health plans, supervise and to mobilize more resources for the respective facility
Inform and educate the public on the contents of the ministerial service charter for health service delivery
Create awareness and educate the community on the link between the health sector budget making process and the national budget making process - Medium Term Expenditure Framework (MTEF)
Demand for transparency and accountability in allocation and utilisation of Health Sector Service Fund channelled to health facilities
There are two major sets of activities and results which have been envisioned in the implementation of the project:
One, activities geared towards creating demand for health rights and quality of health services - demand is built upon the community
Two, activities creating a supply of human rights awareness and good governance and management of health systems. Supply is generated through capacity building of health management teams and creating effective and efficient structures .
Both demand and supply inputs yields overall objective of the intervention: Strengthened community participation in governance and management of health care systems in Kenya.
Targeted groups
For implementation of all the activities the following are the groups we are targeting for the project to be counted successful.
Health Facility Committees
District Health Management Teams (DHMT)
District Health Management Boards (DHMB)
MOH staff working at health facilities
Civil society and the general public
Women, children, and youth will be deliberately targeted for benefits accrued from this intervention
Final beneficiaries - General public from Eastern, Central and Coastal regions, especially women, children, PLWHA, the physically challenged, senior citizens and youth
