By Glennah Nyamwaya
The Global Fund to fight AIDS, TB and Malaria (GFATM) has noted its disapproval of the proposal by government for the engagement with counties through conditional grants.
Through a communique to the Kenya Coordinating Mechanism (KCM), the GFATM’s decision is based on findings of a detailed analysis and in-depth deliberations conducted by the senior management team of the Fund.
Experts say this can prove to be a dilemma judging by the fact that the 2010 Constitution stipulates that health is a devolved function and as such, health resources ought to be devolved.
The Fund’s decision also raises questions over its promise to adhere to the principle of country ownership.
According to reasons cited in the communique, the proposed modality of implementation of GF grants with oversight of the National Treasury’s Global Fund Management Unit prevents risks associated with the accountability of programmatic and financial reporting for the counties.
Another proposed modality to have the counties report to the National Treasury PMU conflicts with the responsibility and mandate of the Ministry of Health for health indicator which is a direct result of how programmatic activities are funded and results reported.
“The Global Fund grants in Kenya are performing well under the current architecture and have demonstrated tremendous results in the quality of health outcomes and the strengthening of health systems in the fights against the three diseases,” further states the GF communique.
However, Global Fund went ahead to indicate a commitment to work with counties and the KCM, encouraging counties to engage in future GF dialogue and grants negotiations.
During a visit to the country, GF Executive Director Peter Sands toured Mbagathi Hospital, a facility that has benefited from the implementation of the Program Quality and Efficiency (PQE) project in partnership with the Global Fund.
Speaking during the visit, Nairobi County Health Executive Mohamed Dagane noted that HIV prevalence in Nairobi has reduced from 6.1 per cent to 5.9 per cent within the last three years, attributing this to the PQE.
PQE is a two-year project funded by the Global Fund and implemented by the National AIDS STI Control Program (NASCOP) together with the Ministry of Health to demonstrate quality and efficiency in the implementation of Differentiated Care.
It targets 70 facilities across seven pilot counties of Nairobi, Kisumu, Vihiga, Nakuru, Homabay, Mombasa and Kwale, including Mbagathi Hospital which is the second largest HIV care facility in the country after Kenyatta National Hospital.
The project aims to achieve great results with minimal resources while at the same time reducing the burden on health systems through implementation of differentiated care through a quality improvement approach.
Nairobi Governor Mike Sonko who was also present said the Global Fund has been an invaluable partner to both the national and the Nairobi City County Government in helping to reduce the impact of HIV, TB and Malaria.
“Mbagathi Level Four Hospital serves a catchment population of more than three million people. In the outpatient department alone, the HIV clinic serves about 5,000 active patients, with an average workload of approximately 80-120 clients per day. Health services in Kenya have improved significantly over the last few years, but a lot still needs to be done,” Sonko said.
He noted that through the PQE, child mortality rates have declined and they have witnessed an improvement in the prevention of mother-to-child HIV transmission.
The Global Fund is a Geneva based international financing organization that aims to mobilize resources including finances to end the epidemics of HIV/AIDS, Malaria and TB, and ensure these diseases will no longer be a public health threat by 2030.
Substantial economic gains across much of the African continent, has seen the political recognition of the societal benefits of health investments by the African Union and governments, with 29 African countries including Kenya increasing their investments in health since 2000.
This commitment was further advanced to the top of the regional agenda at the African Leadership Meeting, “Investing in Health,” hosted by the African Union as part of its 32nd Summit in February 2019.
The African Leadership Meeting led to new commitments that will not only report progress, but will provide countries with important tools to put in place policies and practices to drive further increases in an accountable and transparent way.
Kenya is supposed to get more than Sh34 billion from the Global Fund and in September 2016 announced that it will donate Sh500 million to the Fund.
Since 2002, the Global Fund has signed grants with Kenya worth more than Sh1.4 trillion.
Kenya is among the 30 countries with a triple burden of TB, TB/HIV and multi-drug resistant TB and also ranks 14th among TB high-burden countries that contribute to 80 per cent of the global TB burden.
Currently, there are 1,493,400 people living with HIV in Kenya, while TB is the fifth leading cause of death among the population.