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Weekly Bulletin

Edition 31:4th - 10th August 2019 
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Will the Cancer Deaths of Prominent Kenyans Trigger Action by Government? 

Kenyans have been mourning lately. It is all because of Cancer. We lost Bob Collymore, the Safaricom Chief Executive Officer (CEO) and just after few days, we lost Ken Okoth, Kibra Constituency Member of Parliament (MP) and Bomet Governor, Dr. Joyce Laboso. Both Ken Okoth and Dr. Laboso were common figures in the Health Sector. Like we shared on the last week’s issue of the NEPHAK Bulletin: mailchi.mp/95f6cedfc7e5/e…, Ken Okoth combined two qualities that are very rare among Kenyan politicians. Ken was available and reliable. Availability and reliability are also the two characteristics that defined Bomet Governor, Dr. Laboso. She was also very supportive and responsive to health and HIV issues. This is how last year, Governor Laboso and her team hosted the World AIDS Day event at the Bomet Green Stadium. We are however aware that many more other Kenyans died from Cancer in the same period
       
Bob Collymore                                                 Ken Okoth, MP                                             Governor Laboso

Even as we mourn these prominent Kenyans, we have to deeply think and reflect on how to deal with cancer and other non-communicable diseases. With regard to cancer, we know that it is the name given to a collection of related diseases, in which body cells form and grow uncontrollably. Cancer has killed many people, it is a big challenge in our nation. It is a condition that can be managed and treated if detected early. The most important point to note is that Cancer is not a single disease but a group of related diseases. Many things in our genes, our lifestyle, and the environment around us may increase or decrease our risk of getting cancer. However, we should not surrender to this condition and disease called Cancer. 

The second most important point is that Cancer can be prevented. In the age of universal health coverage, let us prioritize Cancer prevention. Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer is lowered. This eventually reduces the burden of cancer and lower the number of deaths caused by cancer. There are a number of ways to prevent cancer. First is to avoid or control things known to cause cancer, second is changes in diet and lifestyle and third is finding precancerous conditions early. There is also the option of Chemoprevention (medicines to treat a precancerous condition or to keep cancer from starting) but one may also consider risk-reducing surgery. Let us also talk about Cancer. With national dialogue and public discussions around Cancer, people will be educated to ensure they adapt to routine screening and adopt lifestyles that enable prevention and management of Cancer. 

The point, however, is that defeating Cancer will require genuine leadership from the Kenya Government. Kenya needs genuine and focused leadership to transform the health and wellbeing of citizens. Investment is required and undue emphasis on curative health should be re-considered. Kenya needs to increase investment in the health sector so as to strengthen the health systems. Here, we are emphasizing primary health care. It is only through strong primary health care systems that the goals of universal health coverage systems will be achieved. The Kenya government and the Ministry of Health need to re-look at the current arrangements within the health sector and take necessary action to ensure that the sector works for Kenyans. 

In addition to the much-needed investment, the Kenya government and the Ministry of Health need a shift in mindset. Cancer will not be defeated by a government acting alone. We need a movement. We need non-state actors. We need civil society and we need the communities, including those managing cancer and other non-communicable diseases. In response to Cancer, communities are needed at the national policy level to health facility and service delivery levels. And the communities, including Cancer patients, will ask hard questions. For example, they will ask hard questions about the Kenya Health Equipment Scheme that came with a bias towards health equipment and supplies but with no support for human resources for health. 

Moved by the death of prominent personalities, the political leadership has started on a wrong note. Maybe they need to get out of the emotions of losing the loved ones before proper planning can be put in place. The President, Council of Governors and the high-level Ministry of Health, as well as the leading opposition leaders, have been moved to give some statements and commitments. However, their emphasis is on putting up and expanding health facilities and procuring equipment for cancer diagnosis and management. They are all wrong. Let the investment start with the education of the public and then move to increase the numbers and capacity of health care workers. Let the agencies responsible for regulating food safety also work. More importantly, let the political leaders realize that there are people with the knowledge and expertise who can advise them on how to respond to and manage Cancer. Surprisingly, some of these people with ideas on how to manage cancer are currently managing it and other non-communicable diseases.  

 

CSOs and Communities Renew Call for Meaningful Engagement in the UHC Planning and Roll-out


Civil Society Organizations, including networks of people living with, at risk of and affected with diseases last week renewed their call for increased and meaningful engagement in the planning an implementation of interventions aimed at improving the Health and wellbeing of Kenyans. The renewed call was made last week during a meeting of the CSOs leadership at the Nairobi’s KANCO offices. The CSOs leadership was meeting as part of their quarterly coordination and organizing meetings.

During the meeting, the CSOs leadership deliberated on the planned Health Summit and which a draft program has been accessed by the CSOs leadership and to which no non-government agency is included. The draft program for the Health Summit planned for later this month gives the impression that the Summit will be by and for the national and county government. Although it was reported that the Health NGOs Network (HENNET) leadership has been invited to join the Summit, the fact that no CSO is in the program was considered by their leadership that their role and engagement is not much valued. The CSOs leadership, therefore, mandated a small team to reach out to HENNET and the Ministry of Health to ensure that non-state actors are engaged in the Health Summit and other health-related events. 

The CSOs leadership also revisited the earlier call for meaningful engagement in the planning and delivery of interventions aimed at achieving universal health coverage. The call was to add onto the voice of the wider CSOs team that met and crafted a position and ask on the planned high-level meeting on UHC. In the earlier call, CSOs asked for the need to invest in social accountability/empowering CSOs and the communities to ensure that citizens can demand for UHC and hold their respective government to account on the implementation and achievement of UHC. CSOs also wanted partners, including those at the global level to put in place an all-inclusive governance structure (representatives from CSOs and affected communities) that would oversee the implementation of UHC at all levels and to engage CSOs as equal partners; ensure that the various groups (Young people, PWDs, Elderly, populations in transit/migrants, those affected by emergencies, prisoners, key populations and ethnic minorities, persons living with chronic conditions) are meaningfully involved and to ensure that their needs are met. 

Spherically for Kenya, the CSOs leadership want the essential Benefits Package for UHC to be inclusive to enable citizens to live a healthy life expanding it to include preventive and promotive health. According to CSOs and communities, this can only be guaranteed through investing on a holistic health systems approach and leveraging on existing technological advancement/innovations/existing programs and initiatives in the health sector to support the implementation of UHC. More importantly and as stated above, CSOs consider UHC to be beyond the health sector and the Ministry of Health and want legislators at the county assemblies to be sensitized on the need to implement the budget to ensure there are resources for health. There is also a need for policy guideline or framework to anchor the implementation of UHC in the country’s legal framework. 

However, according to the CSOs leadership, the above ideas and contributions remain only on paper if their leadership are not invited by the government to join the structures and platforms where UHC issues are being debated. It is against this background that the CSOs also proposed a national forum on UHC spearheaded by non-state actors and which the state representatives are invited to engage. 

 

A Voice from the Frontlines: Joining the MPPF and Partners


This year marks the fifth anniversary of the signing of two licensing agreements between ViiV Healthcare and the Medicines Patent Pool (MPP) that have allowed generic manufacturers to produce and sell single and combination versions of Dolutegravir (DTG) for adults and children in countries with the highest burden of HIV. We at NEPHAK join the Medicines Patent Pool Foundation and their financier, the UNITAID, in celebrating the science that enables people living with HIV to access better, safer, well-tolerated HIV medicine. Below, we share the story of Jackie Wambui who, is affiliated to NEPHAK and has been in the frontline advocating for and using Dolutegravir based HIV medicine. 

Jackie is an HIV positive activist with a special interest in sexual and reproductive health for young HIV positive women and girls and advocating for their rights. Jacque was put on several different antiretroviral regimens, including d4T (Stavudine), Nevirapine and Efavirenz before being switched to TLD (tenofovir/lamivudine/dolutegravir). According to Jackie, “
The main difference dolutegravir (DTG) has made is that it has fewer side effects than the other drugs and it comes in such a low dose, only 50 milligrams! I’m in my fourth month of treatment and I would say of course I am more hyper, I’m no longer lethargic, I no longer dread taking my pill at 10:00 PM at night.

Jackie has also spoken to other NEPHAK members who have switched to Dolutegravir and says: “
Many of those who have switched are saying that their life is much better. They are able to function well. Especially for women who were not able to take care of their children and to run a family and do the daily hustle, it’s much better.”  Knowing that people react differently to a different regimen, Jackie states that in her case: “With dolutegravir there’s no more dizzy spells. For a long time, I couldn’t just stand up and walk out of a seat because I had to wake up slowly. It was quite painful. But now with dolutegravir, my body is getting used to it, and my bones are getting less stiff.

Talking about the remaining challenges in her country, Jacque says: “
women living with HIV should be given the choice. Inform them about the risks and benefits of the different ARV regimens, and let women decide what is best for them […]. Also, sexual and reproductive care and counseling should be integrated into HIV settings.” This has been the main challenge with the roll-out of DTG in Kenya in as much as many women living with HIV are now enrolled in the DTG based medicine. In the last one year, there was no balanced information on DTG. Health care workers emphasized the risks while communities and PLHIV emphasized on its benefits. What is required as Jackie explains here is a proper treatment education that covers both the benefits and the risks of Dolutegravir. We should also add that the superiority of any HIV drug is in adherence to it. So, let all people living with HIV enrolled on Dolutegravir adhere to it as advised by the clinician. 

 

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NEPHAK Weekly Bulletin is published by the Advocacy and Communications Office at the NEPHAK National Secretariat. Articles can be reproduced freely as long as NEPHAK is acknowledged. Further details can be obtained from The Editor Tel: 0720209694, Email:info@nephak.or.ke, Website: www.nephak.or.ke, Tweet us: @NEPHAKKENYA

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