MAXIMIZING POSITIVE SYNERGIES - World Health Organization

time periods. Informants believed that staff absorption by the government was a challenge
because the MOH had neither a system in place to manage more health workers nor the funds to
compensate those workers. Some respondents reported that a nationwide human resource
management system that will track all the health workers in Kenya is being developed and may
substantially aid this process.
Several respondents indicated that the health workforce represents an impediment to long-term,
sustainable progress in Kenya’s health system. Although the government has exceeded its
capacity to accommodate and compensate health care workers, the need for trained health
workers remains unmet in many rural areas.
Medical Products, Vaccines and Technologies
Many respondents agreed that both the Global Fund and PEPFAR have strengthened the health
system through the provision of medical products and technologies including vehicles, medicines,
food supplies and computers. GHIs have helped lower the cost of antimalarials, bed nets,
antiretrovirals (ARVs), HIV kits and other related commodities. In addition, they have provided
infrastructure, including facility renovations, new laboratories, information systems, and
procurement support. There were a variety of perceptions on the significance of these
contributions to infrastructure. Some informants felt that PEPFAR’s contributions to physical
infrastructure were minimal given the significant need. Others felt that PEPFAR has recently
increased its contribution to physical infrastructure, especially laboratory development. Regarding
the Global Fund, some respondents suggested that the Global Fund contributed to infrastructure
by providing funding for mobile voluntary counselling and testing (VCT) centres, vehicles, and lab
equipment. Others felt these contributions were insignificant.
PEPFAR’s objective in Kenya focused on rapidly increasing access to ARVs, which required effective
operations, management structures, and efficient supply chains. Although PEPFAR supported
strengthening logistics management within the national Kenya Medical Supplies Agency (KEMSA),
PEPFAR procurement of ARVs was primarily managed by the Mission for Essential Drugs and
Supplies (MEDS), a non-profit organization based in Nairobi. Informants reported, however, that
PEPFAR often supplied the government with ARVs when stock-outs in public facilities seemed
imminent, increasing the number of patients with reliable access to ARVs.
Informants reported that the Global Fund enabled greater access to drugs such as ARVs and
antimalarials as well as to health commodities, including long-lasting insecticidal bed-nets (LLINs)
and coverage with indoor residual spraying (IRS). However, informants’ opinions differed on
whether Global Fund processes and requirements helped stabilize and form better systems for
procurement, service delivery, and management. For example, the Global Fund imposed new drug
procurement and distribution processes for KEMSA, only some of which were viewed as
improvements. Although respondents believed that the Global Fund, along with other donors,
had helped support the planning process at the district level and introduced standard operating
procedures for KEMSA, it was noted that inefficiencies remain which need to be remedied.
Most respondents did believe that the increased availability of medications and improved stock
management systems improved health outcomes. Respondents also reported that support for
infrastructure and health technologies improved the health system beyond the target diseases, as
patients are able to benefit from the expanded diagnostic capacities provided by GHIs.
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