Public-Private Partnerships: An experience from Kenya

Presented by Dr. Sam Thenya, Group CEO, the Nairobi Women’s Hospital at the Cambodian National Forum on Public-Private Partnership in Health on November 7, 2012

2

Objective/purpose :

• To give insights on how the Nairobi Women’s Hospital/GVRC has been able to harness the power of PPPs, and in addition to highlight the PPP process• To inspire Cambodians to embrace PPPs for healthcare to reap the benefits from PPPs

Scope:

This presentation gives an overview of PPPs at the Nairobi Women’s Hospital/GVRC

Expected results/outcome:

Improved understanding of the potential that healthcare PPPs have in any developing country

3

NWH Hurlingham , the mother branch - 2001

NWH Adams - 2009 NWH Ongata Rongai - 2011

Other branches:Kitengela – 2012Eastleigh – 2012Nakuru - 2012

4

The Nairobi Women’s Hospital/GVRC

• Founded in 2001, the NWH/GVRC has for the past eleven years provided quality and affordable healthcare to Kenyans as well as medical and psychosocial support to survivors of gender-based violence

• Since our inception in 2001, we have seen over 600,000 patients while our Gender Violence Recovery Centres housed in all our branches have attended to over 22,000 survivors

• Our mission, “We are trusted with the healthcare of our women in Africa” is embodied in a unique model which incorporates the Gender Violence Recovery Centre (GVRC) in whichever region we expand to

• NWH has a Medical Training School with a School of Nursing and Healthcare, and a Waste Management arm with a commercial incinerator

5

General advantages of healthcare PPPs:• Improved health care facilities with better services, better equipment, increased bed occupancy and access• Reduction of child mortality rates through concerted efforts and eventual achievement of MDGs • Increased participation of the private sector in healthcare• More willingness by the public to contribute to the national health fund• Increase in number of health facilities, especially in rural areas• Improved monitoring and evaluation of state- and privately- funded projects through better project preparation, better risk allocation, increased transparency, wider quality control, and greater efficiency• PPP encourages the private sector to be more involved in Corporate Social Responsibility activities, for example free medical camps etc

Step 1. Assess private health

sector and policy

environment

Step 2. Dialogue to

create shared vision and

identify potential areas of

collaboration

Step 3. Agree on PPPs to

carry out together

Step 4. Take actions to

implement PPPs together

Steps to PPP engagement

6

1. Policy dialogue to engage the

private sector

3. Partnerships to improve

availability & accessibility of

healthcare

2. Policy reform to create

supportive environment for

PPPs

PPP framework

7

8S t a ff a t a s t r a t e g y w o r l d c a f é s e s s i o n

9

PPPs examples at the NWH/GVRC:• Project title and timeframe: Change management and strategy alignment advisory

support (2011 – 2012)• Implementer: The Nairobi Women’s Hospital/GVRC• Key stakeholders: Customers, staff, doctors, suppliers, government regulators and the

general public • Financial support from: The GIZ health sector• Geographic areas and target group: Kenya – key stakeholders• Objective: Strategic, managerial and organisational re-orientation of NWH/GVRC to

improve its sustainability• It was designed by Frank Kretchmar, Stepwise Management, Germany using findings

from study of hospital and centre• Through the PPP NWH/GVRC was able to formulate and implement a new robust

strategy in form of a structure tree; and a business model (the caring and protecting cycle); train managers on critical professional skills such as leadership styles, problem solving and total quality advantage as well as coaching and mentorship

• There were no difficulties faced in the PPP approach; but as is expected the change process always has people and process challenges

10P a r ti c i p a n t s a t a G B V t r a i n i n g i n I s i o l o , K e n y a

11

PPPs examples at the NWH/GVRC:• Project title and timeframe: E m e r g e n c y R e s p o n s e G B V/ S R H a n d

M C H P r o j e c t ( November 2011-March 2012)• Implementer: GVRC/NWH• Key stakeholders: Ministry of Health, District Security Group Members, Teachers,

Community leaders and community Members • Financial support from: The GIZ health sector• Geographic areas and target group: Select Counties of Turkana, Kitui, Garissa,

Isiolo, Wajir, Mandera, West Pokot, Makueni , Machakos, Samburu and Marsabit• Objective: To develop the capacity of service providers and the community in the

areas of Gender-Based Violence (GBV), Sexual and Reproductive Health (SRH) and Maternal and Child Health (MCH) in regard to emergency response

• It was designed by NWH/GVRC in-conjunction with GIZ• The team was able to build capacity of service providers on GBV/SRH and MCH,

perform job mentoring on GBV/SRH and MCH and attend to health needs of communities through medical camps

12

Sometimes, implementation of activities is delayed, especially at the beginning of the partnership, due to lengthy negotiations and discussions. However, upon signing the contracts, most of the time the projects’ implementation has been smooth, with few operational interruptions, mostly caused by local situations on the ground. For example this year, some GVRC activities were delayed due to national teachers’ and doctors’ strikes held countrywide, and as such, since both the teachers and doctors are key partners, most activities had to be postponed. More interaction with partner staff is encouraged for better understanding of issues on the ground, so as to enhance programming.

Main challenges

13S t u d e n t s a t t h e 2 0 1 1 G r a d u a ti o n C e r e m o n y

14

PPPs examples at the NWH/GVRC:• Healthcare education is relatively expensive with a Diploma in Community

Nursing costing between Kshs. 135,000 (USD 1,580) to Kshs. 250,000 (USD 2,925). This means a majority of students from poor backgrounds are unable to access this education. The NWH Medical training College is working with a scholarship program for health workers in Kenya designed by the Higher Education Loans Board (HELB) in collaboration with the Ministry of Medical Services and the Ministry of Public Health and Sanitation, and supported by USAID-funded FUNZOKenya to link would-be students with the fund. The project targets bright and needy students who are committed to becoming health workers and in-service health workers who would like to further their studies. This year one of our students was awarded a Kshs. 135,000 scholarship. It being our first year engaging with FunzoKenya, we hope to have more students from our Nursing School and Community health courses receive scholarships.

15

Incinerator

16

PPPs examples at the NWH/GVRC:• Project title and timeframe: Establishing of hospital waste management

according to NEMA (2009/2011)• Implementer: The Nairobi Women’s Hospital • Key stakeholders: The government, hospitals and clinic (public and private),

waste collectors, general public• Technical support from: The GIZ health sector• Geographic areas and target group: Nairobi and its environs - key stakeholders• Objective: Implementation of best practice in biomedical waste management

and proper institutionalisation of waste management in Kenya • It was designed by the GIZ and NWH team using local government body, NEMA

and available international guidelines on healthcare waste management• Through a social marketing campaign the project is able to inform, educate and

empower the community on proper healthcare waste management

17

Surefire Manual load medical/general waste incinerator-TS200/4

Waste Density: 125-350kg/MWaste CV: 3,000KCAL/kgMoisture Content: 10-25%Estimated Ash Residue: 5-10%Nominal Capacity: 200Kg/hour batch loadSecondary Chamber: 0.5 second at 850◦C

Environmental: World Bank & World Health Organization Emission Standards, UK Clean Air Act 1999, BS3316 1987

Incinerator specifications:

18

Initial outlay Amount in Kshs. Enviromental Impact Assesment EIA) 175,000.00 Submission of report to NEMA 10,000.00 purchase of incinerator 14,544,032.80 Installation site 1,391,203.10 Incinerator Operating license-Application form 3,000.00 Incinerator Operating license (Annual Fee) 75,000.00 Truck 2,500,000.00 Weighing Scale(500kg) 50,000.00 Safety Attire (2) 80,000.00 Metallic ash bins(200L)(3) 6,000.00 Storage cage(2) 80,000.00 Signage 5,000.00 Additional Equipment-Fire extinguisher & First aid kit 10,000.00 Total 18,929,235.90

Recurrent Costs Garbage collection 80,000.00 Fuel(NWH waste only) 2,064,000.00 Maintenance/service) 12,000.00 Total 2,156,000.00

Grand total 21,085,235.90

Cost:

19The tower

Challenges:• Before GIZ support the NWH had no

technical knowledge/experience on health waste management

• The GIZ technical consultant found technical differences in what had been ordered and what had been delivered

• The project had a huge initial outlay (>Kshs. 20 million)

• Being located in a residential area the incinerator had to be of unique specifications (for example, the chimney had to be 3 metres taller than the tallest building)

20

Conclusion: We at the NWH/GVRC believe that PPPs do work and we are

grateful to GIZ for the help it has given throughout these projects. We plan to implement the waste management project in all our branches and future branches outside Nairobi - in Nakuru, Kisumu, Mombasa. To conclude, I would like to urge the private sector and the government to come together and find suitable PPP models for health care, as this is a win-win partnership for all parties involved.

21The incinerator launch, 2011