CONCEPT NOTE

OVERALL UNGA THEME: Rebuilding Trust and Reigniting Global Solidarity: Accelerating Action on the 2030 Agenda and its Sustainable Development Goals towards Peace, Prosperity, Progress and Sustainability for All

COG UNGA SIDE EVENT TITLE: Repositioning Primary Health Care through Good Health Governance and Strategic Financing for Primary Care Facilities at the Sub-National Level

1.0 EVENT SUMMARY INFORMATION:

Event ID: HQ21
UNGA Dates: 5th to 19th September 2023
Date of side-event: Sunday, 17th
Venue: Conference Room 7 (CR7)
Organizing partners: Council of Governors - Kenya; Ministry of Health (MOH) Kenya; MOH Rwanda, WHO Kenya, UCLGA, United Regions Organization, National Treasury State Department for Economic Planning; Amref Health Africa and UNICEF Kenya.
Short one-line description: Repositioning Primary Health Care through Good Governance and Strategic Financing for Primary Care Facilities at the Sub-national level High-level participation: Cabinet Secretary for Health - Kenya; Minister for Health - Rwanda; Minister for Health - Denmark; Governors - Kenya; Secretary General UCLG; Secretary General URU-FOGAR; Cabinet Secretary - National Treasury and Planning, Kenya; CEO, Amref Health Africa, UNICEF Kenya.

2.0 WHY REPOSITION PHC?
First conceptualized in 1978 in Alma Ata , Primary Health Care (PHC) focuses on the principles of equity, community participation, intersectoral action appropriate technology, and a decentralized role played by the health system. Studies estimate that for every shilling invested in PHC, an economic return equivalent to KES 10 is being realized. In addition to this, there are other non-quantitative benefits of investment, including empowerment of youth and women, increased knowledge and capacity at the community level as well as increased data pool on indicators not directly linked with health such as school enrolment.

According to UNICEF , diarrhea, pneumonia, and neonatal complications are the main causes of death in Children under 5. These are both preventable and treatable with timely primary healthcare interventions at the community level. Thus, a need for continued advocacy for sustainable investment in health promotion as a means of eliminating communicable illnesses in children, who constitute more than 45% of Kenya’s population.

A healthy population is an impetus for greater economic development. Today, attaining Universal health coverage (UHC) remains a central priority of both the National and County Governments. UHC is an important pillar in transforming Kenya’s health sector for enhanced service delivery. UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. The delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality-assured products, and enjoy decent work.

WHO estimates that about 100 million people globally are pushed into poverty annually because of catastrophic health expenditures. As such, improving the financing of primary health care and reducing out-of-pocket expenditure is fundamental for the reduction of multidimensional poverty. In this regard, advocacy for the uptake of PHC services remains critical. Further, and in line with this year’s theme “Rebuilding trust and reigniting global solidarity: Accelerating action on the 2030 Agenda and its Sustainable Development Goals towards peace, prosperity, progress and sustainability for all,” we must also recognize the complex relationships that exist between conflict, health, and peace. Violence and armed conflict have obvious negative effects on health. For certain populations (e.g., ethnic, regional, or religious), a lack of access to fundamental social services like health care can cause sentiments of exclusion and unfair or unequal treatment. These injustices frequently give rise to complaints, which then escalate into acts of violence. For this reason, PHC initiatives play a critical role in reigniting solidarity by allowing for the full participation of community members in implementation and decision-making.

Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015. At the United Nations General Assembly High-Level Meeting on UHC in 2019, countries reaffirmed that health is a precondition for and an outcome and indicator of the social, economic, and environmental dimensions of sustainable development.

The event also builds on the African Union’s African Leadership Meeting on Investing in Health (ALM) Declaration commitments (2019) provides a backbone for health financing reforms and provides Partner States with the mandate and high-level guidance on the areas upon which to focus reforms, provide a roadmap and tools for addressing the various pillars of health finance including Increasing domestic investment in health; Improving effectiveness through the strategic use of resources; Increasing the coherence of investment in health; Improving public financial management (PFM) capacity; Enhancing national health financing systems; Better engage the private sector; Convene African Ministers of Finance and Health; Establish regional health financing Hubs; Complement the Africa Scorecard with a domestic health financing ‘Tracker’; and Digitize the Africa Scorecard on Domestic Financing for Health. This side event provides a platform for dialogue as an enabler to attain these commitments and make gains to related SDGs.

The Kenyan Government – both at the National and County levels notes that PHC is a critical component of achieving UHC and has largely partnered with UNICEF and Amref Health Africa who play a central role in support of Primary Health Care interventions within the Counties.
This session will discuss how PHC can be maximized in Kenya as a tool for achieving UHC.
The side event will also be a platform to reinforce the Devolution Conference's commitment to health indicates that County governments shall increase investment in primary health care, including community health services in order to step up preventive and promotive health services.

Public participation in Kenya is considered a crucial pillar of democracy. The Constitution of Kenya, 2010 (the Constitution) makes it a fundamental fragment of Kenya’s governance system as it not only makes it a right but also an integral national value and principle of governance under Article 10 of the Constitution.
Article 174(c) of the Constitution states that the object of devolution is to “enhance the participation of people in the exercise of the powers of the State and in making decisions affecting them.”
The Council of Governors (COG) as established under Section 19 of the Intergovernmental Relations Act, 2012 has the statutory mandate to facilitate capacity building for the 47 counties and has a lead role to play in initiating preventive or corrective action as the counties execute their functions to give effect to the Part 2 of the Forth Schedule to the constitution.
It is against this background that CoG held a three day workshop with the directorates of public participation and communication in Nyamira County whose objective was first to Sensitize the County on the draft policy on public participation and the model law on public participation and then help them improve their policy and draft Bill in order to enable them to introduce both to the legislative process in line with the Draft Kenya Public Participation Policy, 2018.
The two teams from the Council of Governors and the County reviewed the draft policy and came up with recommendations that would be incorporated in the policy. The Council also shared a schedule of events with the County Government to ensure that the policy and the draft Bill are passed by both the Executive and Assembly within this quarter. This will give room for proper citizen engagement in all development that is carried out in the County.
Finally, County Officers established that in order for the Public Participation Policy to be implemented successfully, and because of the good relationship between the departments of public participation and communication, there is also need for the communication policy to be finalized.