Public-Private Partnerships:
An experience from Kenya
Presented by Dr. Sam Thenya, Group CEO, the Nairobi
Women’s Hospital at the Cambodian National Forum on
Public-Private Partnership in Health on November 7, 2012
Objective/purpose :
• To give insights on how the Nairobi Women’s Hospital/GVRC has been able to
harness the power of PPPs, and in addition to highlight the PPP process
• To inspire Cambodians to embrace PPPs for healthcare to reap the benefits from PPPs
Scope:
This presentation gives an overview of PPPs at the Nairobi Women’s Hospital/GVRC
Expected results/outcome:
Improved understanding of the potential that healthcare PPPs have in any developing
country
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NWH Hurlingham , the mother branch - 2001
Other branches:
Kitengela – 2012
Eastleigh – 2012
Nakuru - 2012
NWH Adams - 2009
NWH Ongata Rongai - 2011
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The Nairobi Women’s Hospital/GVRC
• Founded in 2001, the NWH/GVRC has for the past eleven years
provided quality and affordable healthcare to Kenyans as well as
medical and psychosocial support to survivors of gender-based
violence
• Since our inception in 2001, we have seen over 600,000 patients
while our Gender Violence Recovery Centres housed in all our
branches have attended to over 22,000 survivors
• Our mission, “We are trusted with the healthcare of our women in
Africa” is embodied in a unique model which incorporates the Gender
Violence Recovery Centre (GVRC) in whichever region we expand to
• NWH has a Medical Training School with a School of Nursing and Healthcare, and
a Waste Management arm with a commercial incinerator
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General advantages of healthcare PPPs:
• Improved health care facilities with better services, better
equipment, increased bed occupancy and access
• Reduction of child mortality rates through concerted efforts and
eventual achievement of MDGs
• Increased participation of the private sector in healthcare
• More willingness by the public to contribute to the national
health fund
• Increase in number of health facilities, especially in rural areas
• Improved monitoring and evaluation of state- and privatelyfunded projects through better project preparation, better
risk allocation, increased transparency, wider quality
control, and greater efficiency
• PPP encourages the private sector to be more involved in Corporate
Social Responsibility activities, for example free medical camps etc 5
Step 1. Assess
private health
sector and
policy
environment
Steps to PPP
engagement
Step 2.
Dialogue to
create shared
vision and
identify potential
areas of
collaboration
Step 4. Take
actions to
implement
PPPs together
Step 3. Agree
on PPPs to
carry out
together
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PPP framework
1. Policy dialogue
to engage the
private sector
2. Policy reform
to create
supportive
environment for
PPPs
3. Partnerships
to improve
availability &
accessibility of
healthcare
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Staff at a strategy world café session
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PPPs examples at the NWH/GVRC:
•
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Project title and timeframe: Change management and strategy alignment advisory
support (2011 – 2012)
Implementer: The Nairobi Women’s Hospital/GVRC
Key stakeholders: Customers, staff, doctors, suppliers, government regulators and the
general public
Financial support from: The GIZ health sector
Geographic areas and target group: Kenya – key stakeholders
Objective: Strategic, managerial and organisational re-orientation of NWH/GVRC to
improve its sustainability
It was designed by Frank Kretchmar, Stepwise Management, Germany using findings
from study of hospital and centre
Through the PPP NWH/GVRC was able to formulate and implement a new robust
strategy in form of a structure tree; and a business model (the caring and protecting
cycle); train managers on critical professional skills such as leadership styles, problem
solving and total quality advantage as well as coaching and mentorship
There were no difficulties faced in the PPP approach; but as is expected the change
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process always has people and process challenges
Participants at a GBV training in Isiolo, Kenya
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PPPs examples at the NWH/GVRC:
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Project title and timeframe: E m e r g e n c y R e s p o n s e G B V / S R H a n d
M C H P r o j e c t ( November 2011-March 2012)
Implementer: GVRC/NWH
Key stakeholders: Ministry of Health, District Security Group Members, Teachers,
Community leaders and community Members
Financial support from: The GIZ health sector
Geographic areas and target group: Select Counties of Turkana, Kitui, Garissa,
Isiolo, Wajir, Mandera, West Pokot, Makueni , Machakos, Samburu and Marsabit
Objective: To develop the capacity of service providers and the community in the
areas of Gender-Based Violence (GBV), Sexual and Reproductive Health (SRH)
and Maternal and Child Health (MCH) in regard to emergency response
It was designed by NWH/GVRC in-conjunction with GIZ
The team was able to build capacity of service providers on GBV/SRH and MCH,
perform job mentoring on GBV/SRH and MCH and attend to health needs of
communities through medical camps
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Main challenges
Sometimes, implementation of activities is delayed, especially at the
beginning of the partnership, due to lengthy negotiations and discussions.
However, upon signing the contracts, most of the time the projects’
implementation has been smooth, with few operational interruptions, mostly
caused by local situations on the ground. For example this year, some GVRC
activities were delayed due to national teachers’ and doctors’ strikes held
countrywide, and as such, since both the teachers and doctors are key
partners, most activities had to be postponed. More interaction with partner
staff is encouraged for better understanding of issues on the ground, so as to
enhance programming.
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Students at the2011 Graduation Ceremony
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PPPs examples at the NWH/GVRC:
•
Healthcare education is relatively expensive with a Diploma in Community
Nursing costing between Kshs. 135,000 (USD 1,580) to Kshs. 250,000 (USD
2,925). This means a majority of students from poor backgrounds are
unable to access this education. The NWH Medical training College is
working with a scholarship program for health workers in Kenya designed
by the Higher Education Loans Board (HELB) in collaboration with the
Ministry of Medical Services and the Ministry of Public Health and
Sanitation, and supported by USAID-funded FUNZOKenya to link would-be
students with the fund. The project targets bright and needy students who
are committed to becoming health workers and in-service health workers
who would like to further their studies. This year one of our students was
awarded a Kshs. 135,000 scholarship. It being our first year engaging with
FunzoKenya, we hope to have more students from our Nursing School and
Community health courses receive scholarships.
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Incinerator
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PPPs examples at the NWH/GVRC:
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Project title and timeframe: Establishing of hospital waste management
according to NEMA (2009/2011)
Implementer: The Nairobi Women’s Hospital
Key stakeholders: The government, hospitals and clinic (public and private),
waste collectors, general public
Technical support from: The GIZ health sector
Geographic areas and target group: Nairobi and its environs - key stakeholders
Objective: Implementation of best practice in biomedical waste management
and proper institutionalisation of waste management in Kenya
It was designed by the GIZ and NWH team using local government body, NEMA
and available international guidelines on healthcare waste management
Through a social marketing campaign the project is able to inform, educate and
empower the community on proper healthcare waste management
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Incinerator specifications:
Surefire Manual load medical/general waste
incinerator-TS200/4
Waste Density:
Waste CV:
Moisture Content:
Estimated Ash Residue:
Nominal Capacity:
Secondary Chamber:
125-350kg/M
3,000KCAL/kg
10-25%
5-10%
200Kg/hour batch load
0.5 second at 850◦C
Environmental:
World Bank & World Health Organization Emission
Standards, UK Clean Air Act 1999, BS3316 1987
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Cost:
Initial outlay
Amount in Kshs.
Enviromental Impact Assesment EIA)
175,000.00
Submission of report to NEMA
10,000.00
purchase of incinerator
14,544,032.80
Installation site
1,391,203.10
Incinerator Operating license-Application form
3,000.00
Incinerator Operating license (Annual Fee)
75,000.00
Truck
2,500,000.00
Weighing Scale(500kg)
50,000.00
Safety Attire (2)
80,000.00
Metallic ash bins(200L)(3)
6,000.00
Storage cage(2)
80,000.00
Signage
5,000.00
Additional Equipment-Fire extinguisher & First
aid kit
10,000.00
Total
18,929,235.90
Recurrent Costs
Garbage collection
Fuel(NWH waste only)
Maintenance/service)
Total
Grand total
80,000.00
2,064,000.00
12,000.00
2,156,000.00
21,085,235.90
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Challenges:
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Before GIZ support the NWH had no
technical knowledge/experience on health
waste management
The GIZ technical consultant found technical
differences in what had been ordered and
what had been delivered
The project had a huge initial outlay (>Kshs.
20 million)
Being located in a residential area the
incinerator had to be of unique specifications
(for example, the chimney had to be 3
metres taller than the tallest building)
The tower
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Conclusion:
We at the NWH/GVRC believe that PPPs do work and we are
grateful to GIZ for the help it has given throughout these projects.
We plan to implement the waste management project in all our
branches and future branches outside Nairobi - in Nakuru, Kisumu,
Mombasa. To conclude, I would like to urge the private sector and
the government to come together and find suitable PPP models for
health care, as this is a win-win partnership for all parties involved.
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The incinerator launch,212011