Health as a Human Right

1. Health as a Human Right The dilemma of Church Health Services Presentation by Dr Samuel Mwenda, GS – CHAK Christian Health Association of Kenya

2. Presentation outline • Introduction to CHAK & Church health services • Motivation & foundation of Church involvement in health services • Responsibility of the Church in Health service • PHC approach towards universal health coverage • Challenges & dilemma facing Church health services • Health as a right; obligations, reality & ethical dilemma • Conclusion Christian Health Association of Kenya

3. CHAK Background information • CHAK is a national network of Protestant Churches’ Health facilities & programs from all over Kenya • Was started in 1930’s as a Hospitals’ Committee of NCCK. • Changed to Protestant Churches Medical Association (PCMA) in 1946 – with the sole mandate of receiving & distributing Government grants to Protestant Churches Health facilities • Acquired the name CHAK in 1982 – and expanded mandate to that of facilitating the Churches role in health. The grants gradually declined and completely stopped in 1996. Christian Health Association of Kenya

4. Membership 455 • 25 Hospitals • 50 Health Centers • 322 Dispensaries • 58 Churches/church health programs • 10 Nursing Training Colleges www.chak.or.ke Christian Health Association of Kenya

5. Health facilities in Kenya Christian Health Association of Kenya

6. FBO HEALTH SERVICES NETWORK Christian Health Association of Kenya

7. Supports access to Essential Drugs & ARVs in Kenya through MEDS (CHAK-KEC partnership) Mission For Essential Drugs & Supplies www.meds.or.ke Christian Health Association of Kenya

8. Vision of CHAK • Vision- “All member units providing comprehensive, sustainable and affordable quality health services to all, and witnessing to the healing ministry of Christ” • Goal – “ Promote access to quality health care” Christian Health Association of Kenya

9. Health sector vision • “An efficient and high quality health care system that is accessible, equitable and affordable for every Kenyan” • From a rights perspective; it is the right of every Kenyan to have access to good quality health care Christian Health Association of Kenya

10. Mission health services – motivation & foundation • Mission health facilities are public service institutions owned & managed by the Church providing a public service • The MOH is legally charged with the responsibility of health policy development, setting of standards and regulation. MOH is also a service provider charged with the obligation of ensuring health for all citizens Christian Health Association of Kenya

11. Foundation/mandate • Traditionally the mission health facilities have been established with deeply rooted convictions of faith founded on a strong Biblical basis. Both the old and New Testaments have many passages on health and healing. Indeed, the Ministry of Jesus had 3 main pillars; teaching, preaching and healing – Matthew 9:35 “Jesus went though all the towns and villages, teaching in their synagogues, preaching the good news of the Kingdom and healing every disease and sickness”. Vs 37 …. The harvest is plentiful but the workers are few” • Christians are commissioned to go out and do the same. Mathew 28: 19. “Therefore go and make disciples of all Nations …”. Matthew 10:7 -8 “As you go preach the message … heal the sick ….Freely you have received, freely give” Christian Health Association of Kenya

12. Mandate..2.. • The Biblical teaching provides a sound sustainable foundation & motivation for church involvement in the health Ministry. Christians have a duty and obligation to contribute to the provision of health services. • However the resources available for this work are scarce and the operating environment is dynamic, complex and competitive. • Faith communities have a role in people empowerment, facilitation and service delivery Christian Health Association of Kenya

13. Dual responsibility • Advocacy for the masses and the voiceless for rights & access to basic services • Service delivery in social sectors and development ;including health, education, agriculture, water & environmental conservation • Performance standards; you are to be the light & salt of the world. Do unto others as you would wish them to do unto you Christian Health Association of Kenya

14. Strategic positioning of FBHS in promoting equity & health rights • Wide geographical spread including to areas least covered motivated by desire to reach out to the needy & underserved • Biblical teaching on reward for serving the needy & underserved; Mathew 25:34-40: “..Come you who are blessed by my Father, take your inheritance the kingdom prepared for you since the creation of the world. For I was hungry & you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes & you clothed me, I was sick and you looked after me, I was in prison & you came to visit me…..whatever you did for one of the least of these brothers of mine, you did for me” Christian Health Association of Kenya

15. Mission statements from selected CHAK Hospitals • PCEA Chogoria Hospital Mission Statement • To witness to the Lord Jesus Christ by participating in the ministry of healing, addressing the needs of the whole person to the glory of God. • PCEA Kikuyu Mission Hospital & Vision • “The love of Christ through healing" • "Mission Hospitals are Islands of hope in a sea of despair." Christian Health Association of Kenya

16. Mission statements - 2 Kijabe Hospital Mission Statement • With God's help and to His glory, AIC Kijabe Hospital seeks to provide excellence in compassionate health care, education and spiritual ministry in the name of Jesus Christ • Motto: Health care to God's glory Tenwek Mission Hospital • Mission Statement • Tenwek Hospital is a Christian community committed to excellence in compassionate health care, spiritual ministry and training for service. • Motto: We treat Jesus heals! Christian Health Association of Kenya

17. PHC model that guarantees universal access to health • “Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the communitythrough their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination” (Alma Ata Declaration 1978, para.VI) Christian Health Association of Kenya

18. Universal access to health : quotes from WHO • “The main target of PHC should be the attainment by all people of the world of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the means of achieving this goal” (Declaration of Alma Ata: Principle 5 WHO/UNICEF 1978 • “Decades of experience tell us that primary health care is the best route to universal access, the best way to ensure sustainable improvements in health outcomes, and the best guarantee that access to care will be fair” (Dr Margaret Chan, Director General WHO, August 2007) Christian Health Association of Kenya

19. Scenario facing Church health services in Kenya; a ministry under threat of identity, mission & financial viability! “Declined external support, dependence on user fees, HR crisis…declining utilization, leading to …uncertain future survival or role” Christian Health Association of Kenya

20. Historical sources of support for church health services in Kenya • Donations from local & sister churches abroad • Missionary expatriates eg doctors,nurses,administrators & paramedical staff • Government grants • Government seconded staff • Donated drugs, medical supplies & medical equipment • User fees/patient fees – was the least significant source of funding Christian Health Association of Kenya

21. Current sources of support • User fees/patient fees – (contributes over 70% of recurrent expenditure) • Donations – but now targeted to capital development or designated programs • Missionary expatriate workers & Government seconded staff • Government supported Medical supplies eg vaccines, TB drugs, STI drugs, RH commodities, ACT/AL anti-malarial drugs and HIV test kits & ARV drugs and occasional equipment • Donations of drugs, medical supplies & equipment (very irregular) • Financial sustainability is a major challenge (huge accumulated debt burden and declined utilization of IP services) Christian Health Association of Kenya

22. Summary of Key challenges facing Church health facilities • Financial sustainability • Human Resource retention, development & motivation • Declining utilization • Competition from MOH & Private sector – MOH has produced a Service Charter which defines their commitment to patients • Changes inhealth sector policies • Health sector reforms / Result Based Management • Health financing policies • Free commodities without support for other inputs • Quality standards set by regulatory authorities • Demands & expectations from clients • Governance & management • Political and social-economic situation Christian Health Association of Kenya

23. Challenges Faced in Achieving Annual Goals by both MOH & FBO health facilities Christian Health Association of Kenya

24. Situational Analysis of FBHS vis-à-vis MOH – 2006/7 • Identified trends and areas of critical capacity weakness in FBHS which require intervention • Declining service utilization while MOH is increasing (current level about 30%) • Comparable capacity and quality with MOH • Weak in annual planning & collaboration with MOH • HR instability - low motivation & retention • Financial non sustainability due to reliance on user fees amidst poverty, HIV/AIDS & underutilization • Weak financial management systems • Weak governance & management systems • Infrastructure & equipment in need of rehabilitation, repair and maintenance or replacement Christian Health Association of Kenya

25. Health Centre service utilization Christian Health Association of Kenya

26. Hospital admissions Christian Health Association of Kenya

27. Surgical admissions Christian Health Association of Kenya

28. CHAK facilities collaboration with MOH Christian Health Association of Kenya

29. Resource Mobilization Christian Health Association of Kenya

30. Trends in Resource Mobilization -FBHS • . Christian Health Association of Kenya

31. Utilization of Resources –2004 Christian Health Association of Kenya

32. CHAK Costing study results Christian Health Association of Kenya

33. Human resource crisis • The most acute challenge facing health service delivery in FBHS today • High turn-over - HR migration – to MOH,NGOs, other countries (Africa & Western countries) • Imbalance in the terms & conditions of service between FBOs & MOH • Perceived lack of job security • Inequitable distribution between rural & urban areas • Heavy work load due to serious shortage & demand for multi-tasking • Lack of or inadequate HR policies • Lack of development opportunities • Lack of amenities in rural areas Christian Health Association of Kenya

34. Preferred employers by staff/employees in MOH & FBHS Christian Health Association of Kenya

35. Reasons for preferring MOH as an employer Christian Health Association of Kenya

36. Rights approach to health • From a rights perspective; “it is the right of every Kenyan to have access to good quality health care” • Increasing awareness of this right is increasing demand and pressure on the health provider • But whose obligation is it to provide that desired care? • What is the place and obligation of the provider? • What is the implication in terms of resources needed? • How do we mitigate the risks to the provider Christian Health Association of Kenya

37. Government may have the lead obligation but we all have a responsibility, including the consumer WHO PAYS FOR HEALTH SERVICES (National Health Accounts 2003) Christian Health Association of Kenya

38. Rights & ethical dilemma • All in need deserve attention! • Yet some health needs are too expensive and with doubtful outcome • Allocation of resources are imbalanced • Should we allocate the resources where there is assurance of the greatest returns/benefits? eg ICU care versus PHC • Should we discontinue care to those who are consuming too much at the expense of a greater majority? Christian Health Association of Kenya

39. Conclusion • Health is a basic human right for all • It is the primary responsibility of the state to provide this right • It is the obligation of all stakeholders to contribute responsibly towards attainment of the highest standard of health • Health is a public good which must always be subsidized, for it to be accessible, affordable & sustainable Christian Health Association of Kenya

40. Conclusion..2.. • The PHC model is the most realistic approach towards attaining universal health coverage • The FBO health services have a sustainable faith foundation, which promotes equity hence should be facilitated, encouraged, financed & capacitated • A functional referral system should be established across the various levels of care operated by different stakeholders to ensure access to quality health care to all • People should be educated & empowered to participate in their own health promotion through healthy lifestyles and contribution towards health • All stakeholders should go beyond advocacy for increasing demand to facilitation of access Christian Health Association of Kenya

41. We should draw inspiration & encouragement from scripture and our faith in God 1 Cor. 15:58 ‘Therefore, my dear brothers, stand firm, let nothing move you. Always give yourselves fully for the work of the Lord, because you know that your labour in the Lord is not in vain’ Christian Health Association of Kenya

42. Thank you! The clamour for health rights must be accompanied by responsibility to act towards better & more accessible services and healthier lifestyles Christian Health Association of Kenya