Healthy Markets CoP Session - Kenya - October 31, 2023

The Healthy Markets Community of Practice (HMCoP) is a group dedicated to generating awareness of market development and private sector engagement work happening in different countries and for participants to leave with a greater understanding and appreciation of the country’s health market. The speakers for October represented FHM Engage, Afya Research Africa, Kasha, ThinkWell, MYDAWA, Jhpiego, Bayer, and DKT.

The October meeting of the Healthy Markets Community of Practice (HMCoP) focused on Kenya. We would like to thank our FHM Engage Private Sector Development Advisor Judy Mboya for all her hard work in helping to organize this meeting. As co-host of the HMCoP, USAID Senior Private Sector Advisor Andrea Bare introduced the agenda and the speakers. This meeting will be the first of two sessions and will serve as the starting point for our discussion as the HMCoP plans to hold another session on Kenya early next year. In the next part of the meeting speakers gave brief presentations on their work. 

Judy Mboya, Private Sector Advisor for FHM Engage, provided context for the family planning (FP) market in Kenya through an overview of FHM Engage’s recent market description findings. In Kenya, there has been both an overall decline in total fertility and an increase in the modern contraceptive prevalence rate (mCPR) among rural women. Meanwhile the total fertility rate (TFR) has remained relatively stagnant for urban women and there has been a decrease in the mCPR among married and unmarried urban women between 2014 and 2022. Data from Kenya’s Demographic and Health Surveys (DHS) shows a significant increase in women using implants but a decline in injectable use as well as a high use of traditional methods among unmarried women in urban areas. The country has a robust health infrastructure with over half of health facilities owned and managed by the private sector with nearly 40 percent of modern FP products offered through a private service delivery point and almost all emergency contraceptives (EC) are provided by the private sector. Despite the high level of private sector facilities, nearly 400,000 women in urban areas and over 1 million women in rural areas, who are at risk for pregnancy, are not using contraceptives. Starting in June 2024, the Government of Kenya will be responsible for financing 100 percent of family planning commodities. Current challenges around demand generation, supply, commodity financing, information, and regulation in the current FP market will become more acute if the financing gap is not met. 

Maeve Rafferty, Project Manager for MYDAWA, gave an overview of MYDAWA and its work. MYDAWA is the first end-to-end telehealth and e–pharmacy licensed by the Kenya Medical Practitioners & Dentist Board and the Pharmacy & Poisons Board in Kenya. The company is focused on ensuring better health outcomes for people across Kenya and they work to achieve this through four main approaches: 1) incorporation of omnichannel access: leveraging technology to offer coordinated healthcare solutions to enable patients to identify health issues before they become too serious, 2) expansion of telehealth consultations: offering patient-centered care, 3) positioning themselves as a trusted brand partner: offering information and resources to help patients take an active role in their health journey, 4) focus on timely last mile delivery: providing convenient access to affordable and good quality health and personal care products by maintaining control of their own supply chain, and 5) low-cost pharma contractual manufacturing. Since October 2022, MYDAWA has been involved in the testing of an online approach to HIV screening through the “ePrEP Kenya” Pilot. MYDAWA delivers daily oral PrEP (HIV pre-exposure prophylaxis) and PEP (HIV post-exposure prophylaxis) to clients through their sexual wellness page and self-screen for HIV risk. In collaboration with multiple partners, MYDAWA has developed an online pathway for online PrEP/PEP delivery. The interim results have been positive and have demonstrated that online PrEP and PEP services can be provided at reasonable costs and customers are willing to pay for delivery of these services. 

Elizabeth Ombech, Director of Operations for Afya Research Africa (ARA), presented on their Ubuntu-Afya model, which establishes medical centers in partnership with communities. ARA works in three complementary areas of healthcare; providing care, health technology, and research. One challenge that ARA is working to address is that rural Kenyan communities are rarely considered for private healthcare enterprise and public health resource allocation. ARA’s Ubuntu-Afya model establishes private medical centers in partnership with communities. Normally, these  communities also operate a supplementary enterprise –  often centered around financial services – so that the revenue from the supplementary enterprise can subsidize the cost of running the medical center. ARA currently operates in counties where there are high rates of teenage pregnancy, so they target adolescents and young women on sexual and reproductive health (SRH) and FP related topics and work to address their barriers to access. ARA’s engagement creates awareness and generates demand for these SRH/FP products and services at an affordable price. ARA has been able to gather feedback from adolescents and young girls who have stated that the main barriers they face to accessing products and services are a lack of privacy, friendly staff, information, and choice.  Through this feedback, ARA is addressing these barriers with locally available solutions. Overall, across ARA’s Ubuntu-Afya kiosks there has been a 42 percent increase in FP uptake between 2022 and 2023. 

Edna Anab, Kenya Health Lead for Kasha, gave an overview of Kasha’s Access to Health Platform. Kasha is a last mile distribution platform that provides pharmaceutical, household goods, and consumer health products to low-income consumers in Africa. These products may be distributed directly and discreetly to consumers or may be distributed through pharmacies, retailers, facilities and then into communities.  Kasha operates an omnichannel distribution system and an agent network that optimizes ordering, generates sales, and provides health services and information. Kasha also builds awareness of and demand for health products and services through agent engagement and community events and through their online tools which have, thus far, been able to reach 5.2M people. Kasha conducts FP demand generation both online (via the social media platforms, Instagram and Facebook) and offline (through Ministry of Health approved materials) and operates an FP referral service so that patients may be referred to partners for short-term FP methods and also DMPA (depot medroxyprogesterone acetate). In addition, Kasha’s model provides private health providers with training so they can best assist customers/patients in their health journey. 

Geredine Kandie, Technical Advisor for ThinkWell, spoke on FP financing in the private sector. ThinkWell is a health systems organization that uses tailor made health financing approaches to help low- and middle-income countries achieve universal health coverage (UHC). Kenya’s health purchasing landscape is complex and evolving with financing for the private sector coming from four main sources: 1) the Social Health Insurance Authority, 2) private insurance, 3) out of pocket payments, and 4) some donor funding. In Kenya, 40 percent of facilities are privately owned and provide about 49 percent of all health services. Private providers contribute to around 40 percent of the FP services offered in the private sector; however, these are mainly short-term methods. To improve consumer choice, the private sector must be incentivized to take up long acting and reversible methods. The current lack of choice means that even wealthy women must use the public sector, and this further disenfranchises poor women. Kenya’s new health financing reforms present an opportunity to engage the private sector in achieving UHC. From the financing lens, more needs to be done to change the provider payment method so that providers are incentivized to invest in offering a wider array of family planning products. 

Levis Otundi, Country Manager for Jhpiego, focused on Kenya's roadmap for private sector provision of contraceptive implants which are currently underutilized. Today, free, publicly procured contraceptive implants dominate the market and are provided to public and private facilities. However, the private sector is expected to lose access to free commodities as Kenya’s health financing landscape is changing. By 2025, the Ministry of Health will need to fully fund FP commodities. It’s estimated that if the private sector had a similar share of the implant market as other methods, users could double in size to over 500,000 annually. Building on previously identified global barriers and recommendations, Jhpiego is working to identify specific constraints and opportunities that the private sector is facing for the provision of implants. In September 2023, Jhpiego conducted a workshop with stakeholders who identified four main barriers, namely: 1) lack of a private sector supply chain for contraceptive implants, 2) lack of measures to offset the anticipated cost increase once public sector commodities are withdrawn, 3) insufficient labor capacity and motivation and 4) the need for government stewardship. With these constraints in mind, Jhpiego has identified strategic priorities to sustainably increase the delivery of implants in the private sector and expand its coverage of affordable implants as part of the method mix to address consumer needs in support of FP2030 goals. 

Willis Ogutu, Institutional Health Supplies Partnership Manager for Bayer,  gave an overview of Bayer and their partnership with Zuri Health. Bayer works to help provide 100M women in low and middle income countries (LMIC) with access to modern contraception by increasing availability, adding further options in long-acting reversible contraceptives to the method mix to meet unsatisfied demand, increasing self-reliance, helping build donor-independent markets, leveraging partnership programs to increase awareness, and applying best-practice knowledge. Bayer has partnered with Zuri Health to grow the private sector and develop Zuri’s reach and impact. Together, they are aiming to reach 1.3M people through mobile, internet, and social media. In the coming six months, the project aims to support 48,750 women of reproductive age in Kenya to access modern contraception methods through a mix of online and offline interventions including tech-Hub, healthcare service providers, pharmacies, clinics. It should be noted that Zuri is not restricted in its partnership with Bayer and encourages other organizations to join with Zuri to contribute to this work to continue developing the private sector. 

Dr. Stephen Githinji, National Sales Manager for DKT, gave an overview of their operations in Kenya. DKT is a global organization with over 30 years of experience in social marketing of FP, HIV/AIDS prevention, and reproductive health products and is also the world’s largest private provider of FP, HIV/AIDS prevention and safe abortion products and services. DKT established operations in Kenya in 2017 and is working to increase availability of SRH products through expanded distribution networks and improved method mix availability. This is accomplished by increasing demand and inspiring new contraceptive users through advertising and educational campaigns. DKT is working to strengthen the supply chain to increase the availability of contraception and improve method mix variety while also ensuring the quality of products and services at every point on the supply chain. DKT utilizes their warehousing, order processing, and delivery services to provide products to pharmaceutical distributors, general trade distributors, and NGOs. These products then go on to a variety of outlets that include pharmacies, clinics, hotels, and petrol stations. The organization has continued to grow since 2017 which they hope to continue not only in Kenya but throughout the rest of the region.

To end, we extend a great thanks to all who participated in this session on Kenya, particularly to those that took the time to speak and prepare slides. We are excited that there was such a positive response to this meeting and we are pleased with the continued thoughtful dialogue and connections being made throughout these sessions. We hope that participant engagement remains high and that organizations continue to share the progress of their work so that we may continue to facilitate this collective learning and look forward to continued participation in future sessions. 

Resources

We have a web page! On the new USAID Health Market Links website, managed by FHM Engage, you can find our past session recordings, slide decks, or revisit past newsletters. See the HMCoP page here:

Healthy Markets CoP | FHM Engage (healthmarketlinks.org)

Also, we are interested in hearing from those of you that have been engaged in the HMCoP.  Please use this survey as an opportunity to let us know your thoughts and if there are any changes you would like to see or feedback you would like to share.

Future Meetings

The next HMCoP convening will focus on Ghana and is tentatively scheduled for December 14, 2023; a calendar invite is forthcoming. Upcoming sessions will include Sierra Leone, India, and a return to Kenya. If you would like to take part in or contribute to any of these sessions, or you would like to make us aware of an organization or project, please email Elizabeth Peña (epena@FHM-Engage.org) or Judy Mboya (jmboya@fhm-engage.org).

Questions?

Please email Judy Mboya (jmboya@fhm-engage.org or Elizabeth Peña (epena@FHM-Engage.org).