The healthcare partnership between the Netherlands and Kenya has made remarkable progress, with increased Dutch support for pediatric oncology care extending from the Princess Máxima Center for Pediatric Oncology in the Netherlands to the Moi Teaching and Referral Hospital/Moi University in Kenya (MTRH), and now expanding to additional regions, including the ongoing expansion at the Kenyatta National Hospital (KNH).
This collaboration aims to revolutionize pediatric cancer care and research in Kenya, addressing various challenges and fostering innovative solutions.
In Kenya, the survival rate for child cancer patients are very low, this is primarily attributed to delayed diagnosis, limited access to facilities equipped for early detection, and the high cost of treatment for diagnosed cases.
Netherlands’ Ambassador to Kenya, Maarten Brouwer views the collaboration between with Princess Máxima Center for Pediatric Oncology and the Moi Teaching and Referral Hospital as well Kenyatta National Hospital as a continuation of the strong working relations between the two countries to address the health gaps.
“The gap in cancer survival rates is huge between the Netherlands and Kenya; survival rates are at 80 percent in countries such as the Netherlands, and 20 percent at best in countries such as Kenya. Princess Máxima Centre hopes to contribute to the realization of the WHO goal of 60 percent cure of the 6 curable types of cancer by 2030.”
Princess Máxima Center for Pediatric Oncology is based centrally in the Netherlands and was built in a capacity effort to provide better-specialized healthcare and much-needed research on childhood cancer In the Netherlands,
“Before the center was built, we had small hospital departments dealing with child cancer. Those small departments were not able to develop and deepen their knowledge on how to treat child cancer, and yet child cancer was a growing problem in the Netherlands. So a decision was made to bring all these different departments together and now there’s one specialized center- the Princess Máxima,”the Ambassador explained.
The objective of the MTRH/KNH-Princess Máxima Centre collaboration is to enhance the quality of care for pediatric cancer patients in Kenya.
It involves capacity building through training, providing advice on the care for individual patients, conducting educational activities for professionals and parents/patients, and engaging in clinical research.
While the program will benefit Kenyan patients, it is a symbiotic relationship with the Centre benefiting as well. It is a two-way street since Princess Máxima requires a larger population to deepen their research and strengthen the outcomes of their approach to dealing with the cure and management of child cancer.
“The Centre has become the biggest child oncology Centre in Europe and that’s not for nothing. Because if you want to develop a curative basis for child oncology, you need a sufficiently large population of patients to understand the different kinds of cancer and what works,”his Execellency explained.
Despite its noble objectives, the collaboration has encountered challenges during implementation. Delays in formalizing operational structures and some regulatory approvals have hindered their outreach to other health facilities in Kenya.
“The World Child Cancer Foundation Netherlands supports Princess Máxima Center financially, facilitating their work in Kenya, Malawi, Tanzania, Kosovo, and Indonesia. The foundation also has a connection to similar foundations in the US. They are trying to set up local offices of the foundation one of the things we are discussing with the Government of Kenya, to have an office locally registered in Kenya but are facing delays in formalizing the branch set up. They also would like to have a formalized agreement to facilitate their expanded outreach but this is yet to happen. We have however escalated this to the ministry of health leadership and the issue is being addressed.”
Beyond Pediatric Cancer, the government of the Netherlands is keen on working with Kenya in realizing its universal healthcare goals, this aligns with The Dutch Global Health Strategy 2023-2030: ‘Working together for health worldwide’, which aims to contribute to a coordinated and targeted way to improving public health around the world.
Ambassador Brouwer reiterated, “Health challenges don’t stop at borders. This was made painfully clear by the COVID-19 pandemic. At the same time, there is great inequality; around a third of the world’s population has no access to essential health services. This also affects public health in the Netherlands. It is vital, therefore, that the Netherlands works to improve the health system in other countries.”
In line with the Global Health Strategy, the Dutch government is directly collaborating with the Ministry of Health on climate change and Health.
“Kenya is a global champion for greening the environment, including in energy. Shortly, the Ministry of Health Netherlands will enter into a government-to-government cooperation with Kenya on various forms of collaboration that involves,Peer-to-peer knowledge exchange, collaboration on developing and mobilizing for a strengthened resolution on climate change and health at the World Health Assembly, collaboration on supporting the functioning of the newly established National Public Health Institute and strengthening coordination framework on Climate and Health by the Ministry of Health; and Developing guidelines for greening the health sector in Kenya.”
Expanding on the healthcare sector, the Ambassador emphasized the critical need for a multi-sectoral approach to improve health outcomes within the country.
Additionally, he underscored the significance of investing in primary healthcare to promote prevention and early diagnosis using the existing systems to reduce the financial burden on the government and patients.
“The provision of healthcare itself is very expensive. People are paying a large part of their salary for the health services provided by a private clinic or a public hospital. Good healthcare is expensive, but prevention is always cheaper than cure, so I think that should be the starting point. It is cheaper and better for the patient and the budget. The more you can do at a lower level of health service provision, the cheaper it is.”
Around 15 years ago, the health system in the Netherlands underwent some changes and now according to the latest Euro Health Consumer Index report of 2023, the Netherlands ranks second in Europe on wait times, results, and the generosity of health systems.
The healthcare system in the Netherlands places a strong emphasis on primary and preventative healthcare, a model that Kenya is also transitioning towards.
“In the Netherlands, when we don’t feel well we go to a general practitioner, that’s the first line of health service. We don’t go to the hospital, and usually, the problem would be resolved there.”
He added, “When it is a serious matter that cannot be resolved there then you are referred to a more specialized hospital, clinic, or specialist. If we apply this to Kenya, your levels one, two, and three, which are about outreach with small health centers in the villages, will deliver primary healthcare, and therefore a lot can be done, and that’s the cheapest way of delivering health services.”
A robust healthcare system hinges on an efficient referral system to alleviate congestion and overpopulation at tertiary hospitals.
By streamlining the patient flow and directing cases to appropriate levels of care, the burden on specialized facilities is reduced. In Kenya, the referral hospitals that offer specialized and extensive treatment are level 5 and 6 however they are usually overpopulated by cases that should have been handled at level 1-4.
A well-functioning referral system promotes equitable access to services and optimizes resource allocation, ultimately improving health outcomes for all.
Echoing this point, Ambassador Brouwer said, “I travel a lot around the country and have visited many hospitals, most level 4 hospitals are in bad shape; some of them have been rehabilitated, but most people because they feel they cannot access good healthcare at levels one to four, immediately try to go to level five. This causes congestion where the services are expensive.”
“The overpopulation in levels 5 and 6 hospitals is a sign that levels one to level four are not up to standard, If the services provided at the lower level were of good quality and reliable, , it would take away a lot of people from the higher levels. Now that experience is the same as the one we have in the Netherlands with our system of a general practitioner, then a more specialized clinic, and then lastly, you go to a hospital bed. So, sharing the philosophy on prevention brings with it, if you want to deliver where it is cheapest, have a very good referral system, and provide good quality healthcare at level one.”
The Netherlands aims to deepen its involvement in the Kenyan health sector by utilizing the Combi Approach, which combines Aid and Trade, and the Dutch Diamond model, involving joint efforts from the Government, companies/NGOs, and academia to address local health challenges effectively.
“Through the Combi Approach, we hope to partner with Kisumu and Homa Bay Counties during the pilot phase to exchange experiences and expertise that match with the local challenges within the sector that have been identified as priorities by the said counties themselves.”
“These partnerships will result in various forms of public-private partnerships involving players from both sides co-creating solutions. This will mainly be on primary care, taking advantage of the benefits of digitalization approaches to address the challenges such as data collection, sharing of resources, decision making, monitoring, diagnosis, and the referral system.”
Some years ago, the Netherlands shifted its approach in Kenya, moving away from direct budgetary support and towards collaboration with private partners. This collaborative effort involves investment through public-private partnerships or directly between private entities.
The investments extend to hospitals, encompassing both urban and rural areas, utilizing both public and private channels. Furthermore, priority was given to technological investments and health innovations through partners like Philips.
Several Dutch companies and non-governmental organizations are established in Kenya, engaging actively across diverse sectors of healthcare, including training and education, e-health, health systems strengthening, research, medical devices, health financing, and advocacy for sexual and reproductive rights, among other areas.
For instance, in 2014, the Netherlands supported Kenya by rehabilitating and extending 23 hospitals across the country.
Additionally, AMREF, with funding from the Dutch Ministry of Foreign Affairs, implemented healthcare initiatives in Kenya in 2022, focusing on HIV/AIDS, TB, Malaria, RMNCH, and WASH, with a total worth of 37 million USD.
Moreover, the Dutch Government, through the Ministry of Foreign Affairs, has been a key partner of PharmAccess and the Medical Credit Fund (MCF), allocating EUR 12.5 million to MCF Phase II currently in implementation phase.
This funding will enable MCF to attract additional investments from both private and public sectors, totaling over EUR 80 million for healthcare investments in Africa in the coming years MCF targets (M)SME health facilities who are considered unbankable by mainstream financial institutions, hence addressing a gap.
The Netherlands is a strong supporter to the multilateral approach towards health. The Netherlands is among the top contributors globally to the following multilateral institutions which have significant presence in Kenya: WHO, UNAIDS, UNFPA, GAVI and GFF. The Netherlands is also part of the Product Development Partnerships (PDP) Funders Group which aims to ensure investments in research and development for new medical products and health technologies.
