The objective of the GIZ Health Sector Programme is to promote equitable access to quality and affordable healthcare, particularly for the poor; and mainly in the area of sexual and reproductive health. The program supports the Government of Kenya in its implementation of the National Health Sector Strategic Plan, health sector policy reforms, as well as planning processes derived from the Sector Wide Approach. As part of its support in improving access to quality and affordable health care, the German agency for Technical development Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), through the Health Sector Program (HSP) established a Public Private Partnership (PPP) with B. Braun Melsungen AG., one of the world´s leading healthcare suppliers in the year 2010.
The project sought to facilitate improvements in regulatory processes within the medical devices sub-sector, in order to improve on the quality of health services provided. The approach used in implementing the PPP was participatory; with overall support to Ministry of Health’s objectives, with inclusion of both public and private sectors, as well parastatals and semi-independent institutions under the State Department for Health. The PPPs activities centered on four target areas; Standards development for selected nursing commodities, training of Nurses on patient and clinician safety at a selected referral hospital, Quality Patient and Staff Safety trainings targeting health managers, and the Strengthening of health seeking and preventive behavior at community level in selected districts, through the Comprehensive School health programme. The PPP was concluded in May 2014, after three years of implementation.
Standards development for selected medical/Nursing commodities
In a collaborative initiative with the Nursing Council of Kenya and the Kenya Bureau of standards, GIZ recruited an independent standards development expert who guided implementation of this process. The development of standards for selected non-pharmaceutical products adopted a consultative approach, involving as many stakeholders as was practically possible. Generation of a priority list for selected non pharmaceutical commodities was conducted in February 2014 to allow for selection of commodities to be considered for standards development.
Subsequent workshops for generation of draft standards, and standards validation were undertaken in February and March consecutively. Both workshops were held at Elementaita Country Lodge in Naivasha. Since enforcement of the standards would require a defined administrative frame work, a draft policy document for management of nursing commodities at National, County and Facility levels, and National ports of entry, was developed between the 17th and 21st of March, 2014. A final validation workshop was then held btw the 9th to the 11th April at the KCB leadership centre. This workshop had broader stakeholder representation to allow for enhancement and acceptability of the developed standards. The formulated standards were handed over to KEBS for mainstreaming and adoption as national standards for regulation of these nursing commodities in the country, and thus contribute towards better health care delivery.
Implementation of training courses for nurses on patient and clinician safety
Moi Teaching and Referral Hospital in collaboration the GIZ – B. Braun public Private Partnership (PPP) implemented the Patient and Clinician Safety training (PCS) Program aimed at improving provision of quality health services at the hospital by targeting Nurses who were already working(In-service level).
Results from a baseline survey entitled ‘Practice and Knowledge of W.H.O nine intervention measures on Patient and Health Worker safety amongst Nurses and Nursing students at Moi Teaching and Referral Hospital’, in the year 2012, undertaken by independent consultants recruited under the B. Braun – GIZ partnership, was used to inform the model used to develop the comprehensive PCS curriculum and to deliver the PCS training programme.
In-service training; As an initial measure aimed at building the capacity of Nurse managers to continually roll out the PCS training programme, a TOT training involving 25 participants from various departments at MTRH was successfully implemented between the 19th to the 21st of March, 2014. A Comprehensive Patient and Clinician Safety curriculum for Diploma level (KRCHN) students was developed and is in use at the MTRH training centre. The PPP also enabled for the training of over 30 TOTs trained in March 2014. Trained TOTs then cascaded selected concepts from this curriculum, to over 626 Nurses in March and April, 2014. This is the largest single group of Nurses ever trained at MTRH. The pool of trained TOTs will form a critical mass of trained Managers able to continually train the rest of the Nurses at MTRH.
Pre-service training; The B. Braun PPP partnered with the Moi Univesity school of Nursing, in order to address gaps identified in a baseline survey entitled ‘Practice and Knowledge of W.H.O nine intervention measures on Patient and Health Worker safety amongst Nurses and Nursing students at Moi Teaching and Referral Hospital’ in 2012. Independent consultants developed a comprehensive Moi University School of Nursing PCS curriculum on the basis of recommendations arising from the baseline survey. This curriculum was used in the training of Student Nurses(and other groups of students) at Moi University using an intergrated model. This model allowed for integration of PCS specific content within topic areas identified for specific courses. Content covered within specific courses will thus be continually offered to other students undertaking these courses in the future, thus ensuring sustainability of the project, post funding period. A number of skills training materials and items for equipping the skills laboratory were also procured. This will greatly improve the quality of PCS training for students who will undergo subsequent training, under the various courses thus ensuring sustained quality of teaching and learning.
Quality Patient and Staff Safety (QPSS) Managers trainings
In collaboration with Strathmore University, a number of Health Managers from both the private and public sectors were taken through the Quality Patient & Staff Safety (QPSS) programme. The course targeted health managers from various regulatory institutions within the medical devices sub-sector, the state department for health, and various public and private hospitals. Its formulation was informed by training needs analysis (TNA) conducted on prospective target groups within the Ministry of Health, private and public hospitals, and the various medical devices associated regulatory agencies. The first management training that targeted thirty three (33) senior managers was implemented between the 28th Nov and 2nd Dec 2011, while the 2nd management training targeting 27 operational level managers was implemented in two modules, the first being implemented between the 12th to 16th of March 2012, while the second module was offered between 7th -11th of May.
Strengthening health seeking and preventive behavior at community level at Gucha & Butere Districts
In a mini-partnership with the Scaling up of the comprehensive School health and hygiene programme (CSHP), undertaken by the African Medical and Training Foundation (AMREF) in Vihiga, Butere, Bondo, and Gucha Districts, B. Braun ingrained some of its specific objectives within this bigger programme. The aim of the programme was to enhance the quality of health in schools and communities by creating a healthy and child friendly environment for teaching, learning and development by building the capacity of school community to improve health, quality of life and developmental capacity of school going children and their communities through the implementation of comprehensive school health initiatives.
The B. Braun PPP sought to; Train teachers on the school health package and implementation of this package in Butere and Vihiga districts, to establish linkages between pilot primary schools in the two districts and relevant level two and three health facilities and to finally ensure access by school pupils and staff to personal disinfectant products. At the conclusion of the CSHP, a total of 240 teachers had been trained in both Gucha & Butere districts, and CSHP been taught in each of the 80 schools. Linkages between schools and health facilities were established, with each of the 80 schools linked to level 2 or 3 health facilities within their geographical reach and health workers trained on Youth friendly services offering health education sessions to students.Further, three hundred and sixteen teachers were trained on referral systems. Twenty six schools with running water, in districts, were supplied with Lifosan & Softaman hand disinfectants. Seventeen (17) health facilities were also supplied with wall dispensers & the disinfectant solutions in May 2013.
Challenges during PPP Implementation
The Kenyan General elections, held in March 2013, caused major delays in the implementation of training courses for nurses and the medical devices standards development process. Moi University school of Nursing was closed for the period of the elections, thus negatively impacting on the Nurses Training programme. The process of standards & specifications development has been a slow, complex process, given that it wasn’t initially clear who was to lead this process within the former Ministry of Medical Services. However, after the law allowed the Nursing Council to regulate a group of medical devices referred to us Nursing Commodities during the third quarter of year 2013, it became easier working with the NCK and the process got concluded. Further, ingrained interests arising from various players, minimal budgetary allocation (for the Government ministries) and internal politics have also served to delay timely conclusion of this process. Finally, delays related to the many partnerships with Public Institutions led to many delays as well. Public Institutions normally have longer procedures, especially for major partnership decisions to be made, and in regards to procurement of goods.
There is huge need to allocate sufficient time for project implementation, not only informed by Private sector internal work plans, but also the by the public Partners. Partnering with Public Institutions requires extensive negotiations at concept/proposal development stage. Input from the Public domain has to be precisely included into the proposal, with the Public Partner also agreeing to the project as part of their work plans. Failure to consider can result in projects that are not owned by the public institutions, but only owned because of the financial contribution. There is also need to allocate sufficient personnel during budget creation (in case the complexity of the project demands for this). The need to critically evaluate intended partnership benefits, for both the Public and Private partners, during project conceptualisation is critically important, and affects the manner in which a PPP gets implemented. Finally, ownership and a clear understanding of a project by top management are critical to successful and timely implementation of any PPP. In conclusion, there has been growing interest by various Health Sector players on issues dealing with Patient and Clinician safety in Kenya. Despite this growing interest, there is still widespread lack of awareness of the problem of adverse events.
Conclusively, the capacity for reporting, analysing and learning from experience is still seriously hampered by lack of methodological uniformity in identification and measurement, inadequate adverse event reporting schemes, and weak information systems (World Alliance for patient safety, forward programme, 2005). This PPP largely addressed all or some of these issues, at institutional, as well as at the policy level. Findings from the MTRH baseline survey will go to great lengths in addressing patient and clinician safety issues at institutional level. The need to facilitate replication of similar studies in other Public health facilities so as to have the basis to introduce training in national nurse’s curriculum is ever apparent. The Quality Patient and Staff Safety (QPSS) programme at the Strathmore Business School (SBS), managed to increase health managers’ knowledge on the broad areas of patient safety, cost benefit analysis, procurement and Leadership issues.
April 24, 2015
July 5, 2013
July 19, 2012
October 13, 2011