What Will Health Work in Africa Look Like in 2040

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hey welcome everybody to this session  and then this session is about the   future scenarios and a novel approach  to produce more health workers in Kenya   my name is dai I am a chief technical  officer at the intra health international   I would like to intro ask janet and  then start to introduce themselves yes good afternoon good morning and good  evening my name is dr janet mariuki I’m   the country director of intra-health in Kenya  and also the program lead for the human resources   for health Kenya mechanism glad to glad that  you're able to join our session today thank you great good morning and good evening everyone my  name is suspicion daba I work for the USAID funded   human resources for health care mechanism I serve  as a training manager it's a pleasure to be with   you and looking forward to a fruitful discussion  on the future of health workforce in the country   great so today's session is a combination  of the two session ideas one was that my   area of the work which is to look at the  future but then what's really critical   is then if you we imagine the future how we're  going to address that so that's where that   the janet and then hospitals work is going  to come in and what they have been working   on around the health workers so the session  design is that I’m going to first talk through   and then about the future discussions and  then that will go to the Kenya's cases of the   their efforts in increasing the  health workers so I will just jump in so what we did in 2019 to 2020 is to started to  look at various factors like environmental factors   political factors technological factors social  demographic factors and economic factors and then   try to understand what would be the larger  external forces that will reshape our work or   health work in Africa if you remember year 2000  20 years before there was no global fund that   there was a time that the gabi was just announced  pepfar wasn't there and then 20 years can do a lot   of big difference make the big difference so what  we wanted to do was to think about what would be   the future look like for that what kind of the  health workers are there what kind of health   where do those health care are provided and then  also who are those health workers and then where   that they provide those skills how their provider  else works so that that's sort of like a is that   that expanding our imaginations and then  the boundaries in order for us to prepare   for the future was that the part  of the work that I was working on   just to give some of the external factors that  we identified one is a this is a 2019 Africa   venture capital reports and then indeed in Africa  there are more than two billion dollars has been   invested for a start-up of the to develop their  own indigenous technologies especially places like   Kenya where the the janet is located Nigeria south  Africa and then Egypt is beating and then also but   then also that the Uganda and then other countries  started to see a that increased investment   into the startup of the technology so that the  Africa-based technological evolution is really   on the horizon and it's really becoming a rapidly  active activated another issues that are coming up   again and again is the climate risks and then  we all go through this and if you this is one   of the data from the bbc but if we look at the  issues that bigger cities in Africa these red dogs   tended to be much more vulnerable and then  also the populations that are going to face a   the climate risks so finally like  that we cannot really ignore that we kind of knew that someday that pandemic  may happen but then who knew that was going   to happen in 2020 and then going into that 2021  I remember in march 2020 that the talking with   our office was closed down in north Carolina and  I was talking with my colleague that oh no this is   just going to be like a two or three months and  then we still have not going back to the office   so it's very difficult for us to predict the  future in that forecasting way because what   we know today and then what it's not  necessarily reflect to the future of   the predicting the future so what we are  trying to do is to understand what would   be the other factors may change how we think  about the health work and then considering   all those different uncertainties and then try to  envision that the different futures that that may   become real and then also that how we're going to  think about our health workers and then prepare   and work with that African government  to for the future was on this project so one of there are two major factors  that through our research came out   one is how the health workers power structures are  going to look like in the future what do I mean by   what I mean by this is that is the current  international power structure of the donors   and then international agencies like the wh  show setting the norms and then even within   the countries there are doctors having a holding  on to the power and the nurses and the midwives   and then community health workers and then also  that the private facilities of private sector   providers are these kind of power  structure going to be preserved   or there will be some major transition happen  and then and then the power structure is going   to be different or transformed for the future  so the one factor that we have to think about   is that who are the leadership who will  have the political and financial power   in determining that the health care is going to  be a one huge hacker do we have to think about another factor that came out again in our research  was ability of your health systems to harness or   take advantage of the benefits of the technologies  technology could be the digital technologies or   in health or digital health or could it be  a new diagnostics or medicines or vaccines   but then ability of the health systems both  including the public sector services and also   private sector systems how much of those  systems will be able to take advantage of those   the upcoming technologies and then able to  offer or is this going to be really patchy   and then some people get it  and some people may not get it   you know how this is going to look like  is also going to be shaping the future   so from this analysis that we came up with a three  scenarios of that how the future going to look   like the first scenario is called the father  together this is really like Africa will have a   the younger leadership the thinking about the  health care more as in the shape of the wellness   or going back to this definition of the health  in a more broader times improving the mental   health and then also that the pandemic addressing  the pandemic and then increase the regional and   then also kind of African corporations so maybe  this is the future that we're going to see   in this case is that the power structure will be  newly transformed and the new leader imagines and   then also that the system will be able to harness  these upcoming technologies another way to look   at the future is that there may be some degree  that harnessing the technologies will happen   but then the power structure will be maintained so  this is going to be a for example like in 2035 who   and then all the government declare the universal  health coverage is achieved but when you really   look at the carefully within the populations there  will be a some patchy inequity may still exist   and then also that because of the new technologies  being introduced that the new shape and format of   that inequity started to come into the play so  this is more like we will incrementally improve   there will still be a doctors and they'll  still be a nurses and then they may hold on   to the professional power and then and then  we will be modeling through to the progress   but then it's a slow and then painful that the  process another way to we looked at is a is like   a maybe that the power will transform and then  private sectors and communities and then patients   themselves will start to have much more power  but then in a way that the totally disorganized   and then also that the benefits of the technology  will be really up to the grads for the private   companies or governments or individuals  or like a direct sellers and then others   and this will really create a we not takes all  cyberpunk kind of chaos that for the future   so these are the three scenarios that we  came up with the technology calls the shots   the winner takes all societies there will be a  lot of technology boom but then there will also   be a harvesting of the data from the populations  or patients privacy is going to be challenged   and then some people take a lot of benefits maybe  that the father together will imagine whether   the universal health coverage is redefined new  leadership and then Africa is really becoming a   leadership place for the new generat the thinking  about the collaborations and the healthcare   and then the third one is more that the  status for business as usual and then we   will be really dragging through for the future  is the three scenarios have a panca Africa   there will be a health data harvesters of  the health walker there will be more like an   uber and then kind of like gig workers are going  to be there and providing the part-time supports   other health workers and the patient themselves  becomes a using that the smartphone and the   technologies and they themselves take the patient  will diagnose themselves and get the medications   in some cases it would be amplify the  capacity within the ai assisted tools   would be there and then frequently learning  and relearning skills because technology   were constantly changing and the help  and then health worker needs to be   really equipped to think about those privacies and  then how they're going to take out advantage of it   and then it's a really a highly fluid health  labor market with like just like a economy and   then taxi changed just like a transportation  that totally change health economy is going to   be hugely different in this cyber Africa sense so  your privacy but it's all about my profit world   mothering material I have already talked about  the existing tiers of licensed professional   would have the power maintain they will be able  to maintain a task shifting and then community   health workers may or may not get  some of the credentials and then   and then the specialty clinics and then  care providers started to emerge in the sun   the wealthy areas and then there may be a more  ncd work but there will be much more fragmented   and then the similar cares today with the more  technological tools but they're not really a   huge transformation would be that and then the  accelerated public and private bifurcation will   start to happen and an inequity next to continue  so in this case that the university of first cover   is really declared on the paper but then are  you really sure that that's what where we are   finally that the last one last scenario is powder  together this is really expanded set of the health   and well-being workers it's not just going to be  the care providers in the traditional sense but   then people think about those diseases and then  predict predicting that the what kind of like a   preventive measure has to be there people will  think about the mental health assisted by the   technologies and then there are a lot of enablers  to support that expanded services other health   workers in this world and then the more prevented  by the social work is going to be integrated   and then multi-sexual services becomes a norm  and then the condition will be a emergency of   the new health leadership and the technological  systems and then the stronger governance there   so these are the three major scenarios and  then how we are going to make sure that the you   your organizations are government or health system  and then also helps workers going to be keep   themselves relevant and then being useful  and then be able to contribute the health   impact is going to be a strategy that your  organizations and yourself have to think about this is my last slide before handing over to  janet just and then the software to think about   that how then we will be able to address that the  current issue will help workers that we need that   more competent high quality health workers we  desperately need that the health workforce or   the health care needs to be provided and then  also in the way of that the patient send that away   but then what kind of health workers do we  need do we want to maintain the current status   and then also that the current job descriptions   do we re do we also how do we want to move our  interventions and then what kind of interventions   or like strategies are needed on the ground and  then work and then for the government so that the   future we want is going to be a brighter  and also a much healthier and an equitable   so that's a really a critical thinking that  we have to do now and then I’m going to stop   my slides and then we'll take that the questions  later once that we finished all the presentations   and then I will hand over to janet and then  to talk about the work in Kenya so I will yes thank you very much dave for that introduction  so welcome I think we are going to take you over   to Kenya and want to share our Kenyan experience  and this really aligns to the presentation that   dai has has already started with really how do  you want to look at the workforce so here in   Kenya we have been looking at an approach in  which more health workers can be churned out   from our medical training institution next uh so we have this product this is the afia limo  fund the an earlier limousine started in 2013.   this product is a joint collaboration  between the ministry of health the   ministry of education through the higher  education loans board we also have   donors such as USAID who have continued to support  this for the last seven years we also have brought   in the private sector funds players the banks are  foundations who have been instrumental in Kenya   we also do have a divorce system of health  with the national and county governments   and we have been engaging with county governments  to also putting resources into this fund   so the affair limo fund is really a low interest  loan that is provided to the mid tertiary level of education and it is for  students who would want to pursue   health courses they would either want to be nurses  clinical officers nutritionists health records   officers but this kind of traditionally because  they get diploma they undertake diploma courses   as their entry into the job market and support the  health sector have not been really been provided   with that opportunity to access a sustainable  way of educating themselves so this is where the   earlier affiliate fund comes in we have also had  high dropout rates of traditionally of students   at medical training colleges and this was up to  about 25 percent of the students who drop off when   enrolled because they lack the resources to pay  the annual school fees which is about two thousand   two thousand five hundred dollars every year so  what have we managed to do we have managed as   intra-health with the support of the ministry  of health and ministry of education through the   higher education salons board to have  a us id you have at least about 35 895   students benefit from this fund of those 11 878  have actually graduated they're in the job market   currently employed is close to about four thousand  five hundred of these students who are supporting   health services under uhc and they're in such  service areas like hiv reproductive maternal   child health malaria amongst others and then we  have those students as soon as they graduate they   usually do get a one year grace period subsequent  to that the higher education loans would mandates   through an act of parliament that the students  need to start beginning to repay their loans and   the loan repayment could be as low as five dollars  per month and today so far the students have been   able to repay those who have graduated I mean have  been able to repay close to 1.8 million us dollars   and this really helps provide additional resources  that can continue supporting other needy students   towards their medical education and this really  aligns well with USAID's journey to self-reliance next this is the evolution of the afghan limousine  since inception you can see we began that journey   as I shared in 2013 2014 the blue indicates  the resources that were mobilized at that time   and that was about 1.1 us million us dollars  and the students that are benefiting at that   initial stage were about 1942 so over the years  with fundraising from the private sector and we   have a board within the private sector about  six partners especially the banks foundations   that have really putting resources into this  some of the banks through their foundation had   a target for example they were looking at  issues of blindness and they were willing   to support students who were doing courses  such as ophthalmology or clinical medicine   very targeted and this is because some of our  arid and semi-arid areas in Kenya do suffer   from quite a bit of traucoma and other eye  infections so they were targeted in that they had   there was a need because these are neglected  diseases in some of these regions and they   is a workforce that is required to support eye  services in this arid and semi-arid areas of Kenya   so through such initiatives very tailor-made  over the year we have been able to raise at least 25.8 million us dollars towards the students  and this has supported the 35 plus students  

we have already mentioned on next   so there's been that evolution and what has that  meant who are the students who have been being   supported these are nurses both at the diploma and  also at the certificate level we have a clinical   officers these are really like doctor assistants  just a slightly step down from the doctors   we've also supported them we also have our health  records and really to cater for the issues of   data science within our hospital systems the  record-keeping we have public health pharmacists   and pharmacy technicians and technologists the  lab systems the medical laboratory technicians and   technologists and not nutritionists and we really  would want to do more and I think this is where   this would tie to what are the other cuddles and  we're looking at community health yeah we call   them community health assistants I think this  is an opportunity really to also ensure at the   community level that level one that these adequate  there's an adequate workforce that can supervise   the community health volunteers and ensure  quality of services for the local communities next this is one of our success stories  this is a young man who is in rural Kenya   and a village in nyamira county he has been a  beneficiary of the afia elimu fund over the years   and his story is really that his father  fell ill he could not continue providing   for this young man in terms of paying for  his medical education he became desperate   because he knew if he did not get a way  out he would have to drop out from his um from his studies and along the way with engagement  of at his institution of a coordinator who was   dealing with the affiliate mufon he was able  to get to know about the fund he was supported   to enroll because we had educated  the coordinators on how to support   students in the enrollment process  and within a couple of months   after the advertisement had been run he was  able to receive his first graphically more fund   loan dispersed to him and over the years  subsequent applications he was successful and   he was able to complete his medical education as a  clinical officer in yamira this young man to date   actually owns his own private clinic in rural  nyamira and he's able to employ other health   workers so this is a difference he's making just  by getting that opportunity to be educated he's   able to make a change in his community by setting  up his own clinic and even hire other health   workers to support him in provisional services in  the in his community so this is really one of our   achievements and there are many others that would  share but really in view of time this is one of   the few we wanted to showcase today that there  is an entrepreneurial spirit that can come out   from this and it's not just about health workers  going to work in government facilities next so I want to hand it over to my  colleagues peter just to pick up   further on this discussion  thank you for your attention great thank you janet and thank you for that  exhaustive aspect of the af so basically I’ll   be touching a bit on what is required to  build a sustainable financial resource base   to support health workforce training especially  in context of universal health coverage   so in context of affair limo fund the first will  be a policy that to support resource mobilization   for increasing the health workforce training it's  worth noting that health workforce training is a   resource intensive undertaking for example you're  looking at the figures that have been discussed   earlier you're looking at around 25 million u.s  dollars currently being used up for training   of around 35 000 of these health workers over  the last seven years so in context of aef fund   resource mobilization is indeed one of the key  cornerstone of the program sustainability plans   my colleague has talked about the us USAID plans  of journey to self-reliance which essentially   looks at how we can add value to the  local entities and strengthen them   to take up three responsibilities that  are being undertaken by foreign entities   so it's worth noting that as we speak  the demand for the fund really outweighs   the resources currently available before  the start of the fund in the year 2012   the Kenya medical training college which is the  main college for training of diploma level health   workers had received over 35 000 applications  but only 4 500 were enrolled and this really   justified why we needed to come up with this  initiative so for us how we approaching the   resource mobilization for the fund is through  an oversight committee that we formed and this   committee is made up of the government entity  that is responsible for implementation of the fund   and this entity is known as the higher education  loss board including other partners including us   intra health and other banks and donors that are  playing a big role in in mobilizing resources   and this oversight committee essentially looks at  various ways we can mobilize resources especially   with the exit of several of the donors including  USAID and this will ensure that the sustainability   we're going forward of the funding second will  be to determine the kardash to be supported   based on a training needs assessment and it's  worth noting also that any training intervention   should be essentially be preceded by a robust  training needs assessment so that we ensure   that the resources are located for the cutters  or for the trainings are for the most critical   cadas especially in context  of universal health coverage   for example in context of our country Kenya  the nurses and especially the diploma level   nurses they play a big role in both primary and  also specialized health care and in fact as you   speak there is a huge gap that is currently  existing on our training of specialized nurses   due to an upsurge in the numbers of patients  with cancer cases and most importantly currently   with the advent of covid19 we have really seen  a need for training of most specialized nurses   especially at the critical care departments to  deal with these upsarge numbers so it's very   important as you're coming up with such a fund  to be able to really understand and determine   scientifically which coders are to be funded to  what to be prioritized because not all coders   are play the same role in the health sector  especially in universal health coverage   the third would be to determine the beneficiaries  eligible by use of a main testing instrument and   how we do this is by looking at various criteria  and for us the criteria we are using is to ensure   that there is equity in this opportunities  especially for those who live in the far-flung   areas the marginalized and disenfranchised areas  of the country and how we look at this is through   the governance structures that i've talked about  we have the affiliate fund oversight committee   that i've talked about earlier and this is the  committee that is responsible in ensuring that   we have a criteria to ensure that there's a proper  eligibility for access to this fund and how we   look at this is through a criteria that looks  at family income that is a key priority for us   offend status we look at gender we looked at we  look at disability status and also the county   of our region as my colleague has talked  about the counties in Kenya play a big role   in health provision in our country the health  sector is a bit different from other countries   the health sector in Kenya is highly decentralized  to local entities that are known as counties   so we have to look at the counties of  origin to ensure that there's equity   especially in distribution of these beneficiaries  across the country so that we have a universal   health coverage that is covering basically  looking at the whole country in totality   the next would be to establish a framework for  revolving of the fund and this to us has been   one of the key lessons learned it's worth noting  that when we initiated the fund in the year 2013   it was in form of a scholarship and as you  know scholarships are one-off payments and   the beneficiaries essentially are not supposed  to required rather to refund the money   however we realized over time that the  scholarship schemes are not sustainable   especially when you have the exit of the donors  and they also indeed do create a culture of   dependency so with this in mind we changed the  framework from a scholarship to a revolving fund   which my colleague has talked about with  a minimum interest of four percent annual   which is much lower than the commercial interest  charged on loans in Kenya that go as high up to   as high as 14 percent so currently affiliate fund  graduates have paid over the last seven years an   amount equivalent to 1.8 million us dollars which  we are now turning back to the fund to enhance the   sustainability and to benefit other beneficiaries  the fifth uh requirement to be to put up a model   for public private partnership and for us  this has also been one of the lessons learned   and a key success story that these public-private  partnerships amongst working with the government   entity known as a higher education lawsuit  have really benefited the loan because this pp   public private approach has gradually exposed the  higher education lawsuit to increasing level of   private sector participation in a way to ensure  transfer of skills and this goes hand in hand   with the mantra of our donor usage where we are  looking at how do we empower the local entities   to take up this responsibility going forward  especially with the exit of several donors so this   ppp approach for us has been a way to transfer  this knowledge base to the government entity   to be able to prudently manage the fund the  sixth requirement to be growing the fund   where health disprints disciplines are funded  including master's level so as alluded earlier   one of the lessons learnt is that we need to  grow the fund further from funding of diploma   level graduates to even special specialized  trainings because of the changing dynamics in the   health sector and also changing dynamics in the  disease patterns once again covid19 has exposed   the challenges that we face as a country  especially in specialized healthcare   and we have now realized that we need more  nurses we need more clinic officers to specialize   in critical care we need even more nurses to  specialize in Renault Renault disciplines and also   oncology so we are hoping that going forward  this fund is going to be not only transformative   in terms of the basic aspects of health care  but also specialized care which we have found   as a key gap going forward over the last seven  years finally you need to develop a framework   for employment of af graduates unfortunately this  has been a challenge we have realized that there's   a mismatch between the numbers of graduates and  the absorption capability of the health sector   and this is partly because of what I said  earlier our health system is developed   and the local entities have what I would call  semi-autonomous or rather autonomous ability   to hire health workers so it's for  us we're finding it as a challenge to   ensure that there's 100 percent absorption due  to disparities amongst these counties many of   them have not come up with very good strategic  plans many of them are grappling with issues of   governance issues of corruption which have really  led to less and less finances for absorption of   these graduates so going forward and I think as  a way of sustaining the fund is to ensure that   now we have a framework that will ensure once we  have graduated these beneficiaries they're able   to be employed in the counties and indeed one of  the success stories is to have the counties also   come up with their own funds or chipping into  the affiliate fund and once the graduates have   finalized their training they're able to be  bonded and they give back to the counties   in in form of service delivery so this is what  we have in terms of what is required to build   a sustainable health workforce training  program and back to you thank you so much   great thanks I think that that we will be able to  take questions and then from the floor the first   question is have any specific strategies  being defined for implementation of health   care worker training programs associated with  this funding mechanisms or funding mechanisms you know that sorry I had so I think that's  what's been covered in that last slide by   sauce peter these are the strategies we have  actually put in place at the moment and by just   having that policy for resource mobilization we  have a tool that is able to identify the students   appropriately so that you actually are catering  for the very needy the country also has a national   training policy we have one here in Kenya and  the suspicion did allude to that it does define   the different types of training how a county  should have even a training selection committee   our trainings based on needs I think that's  critical as anybody is being called upon to   undertake training both short term and long term  so there is power in the training needs assessment   and having training projections because those will  actually guide budgets around some of those areas   and then affair limo fund itself has become  that model so that's the strategy on public   private partnership with regards to the various  disciplines being trained I think that has also   been alluded to quite well by so spita and then  employment I think that's the last huddle that we   really have to look at we have tried this in terms  of having forums where the employers come into the   into the meetings dialogue have an interaction  one-on-one with the students themselves with the   principles and able to actually look at how can  these students therefore be benefit we've looked   at employment by advertising for opportunities we  since we are actively engaged with the counties   we do have access we gain access to their job  advertisements and we post that to our students   and encourage them to take up those employment  opportunities in the public sector but as I shared   their successes of self-employment and I think  we do not want to restrict our students to just   the government sector but how can they  themselves also be entrepreneurs and open   up their their own clinics yeah thank you  I hope that is a response to that question thanks janet and then second question is are  continuing medical education required and then   and then for the different health cutters in  Kenya and then if you know the other countries   that's also great about other countries that  would be great yes thank you chair yes could   continuous medical education is is actually  a cornerstone of education for the in the   for the health sector especially for nurses  and clinic officers we have what you call   health professional associations that really do  encourage the health workers to undertake this   continuous medical education and once they  do this they gain what we call continuous   professional development points cpds which are  also linked to their licensure so we have the   regulatory bodies that are working closely with  these health professional associations to ensure   that the health workers do indeed continue  gaining expertise in different areas and once   they do not reach several quite a number of these  professional points they lose their registration   so this is encouraged in all cadas we have this  going on for the nurses for the clinic officers   for the doctors and the key cards that  are required for universal head coverage great thanks is john anything to add to that or uh I think sausage has adequately addressed  that question thank you dave I have actually   questions to both of you that this is  really interesting and great success   stories and then it's very amazing  that now you have 25 million dollar   the assets there and then my question  is if the other countries wants to   start similar kind of program what do we  recommend and where should they start um yes thank you dave that's a good question I have  to say that affiliate mufund has been a journey   and has evolved over the last seven years I  started working with intra health when this   product was actually a scholarship and it took  a bit of lobbying to actually have stakeholders   convinced that this was the right time for a  loans product and especially at a diploma level   I think in Kenya and even globally student  loans have mainly targeted degree programs   so what's the value out of this I this is what our  stakeholders came back asking us and we say that   scholarships have a good place that  means you're able to educate somebody but   once they're employed how do they give back  how do you also keep that how do you sustain   will you get people especially philanthropists  foundations corporates giving money every year   but there is nothing left on the table for  the future generations so that's where now   the loan comes about and I think this was really  transformative but we had to talk to the ministry   we had to talk to the higher education sloan  sport because they were like diploma students when   they graduate they will get employment they will  repay and I think we have proven them wrong that   it's easier for a student who has graduated  from a health course to get employment   easily as compared to the other courses  either we looked at engineering or accounting   somehow the uptick into employment is  better for health oriented students so   because there is a need there's a big gap  here in Kenya we're still below the who standards for employment we so there's a huge gap  and even now with covid I mean the health workers   are overstretched and they still need they need  to put more health workers to support uhc and also   the specialized services as suspicious has alluded  to we're in a crisis where carders like critical   care nurses doctors uh are really wanted in view  of the pandemic so I think that stakeholder buying   is critical the other thing was the private  sector we had to sit down with them and engage   luckily within the then usid funded  project were able to get on board a partner   drawn from the private sector who showed us the  ropes really on how to do resource mobilization   it needed somebody who's trusted for purposes  of getting that goodwill of the ceos the the   managing directors and going even to individual  philanthropists really to bring in those open   their wallets and bringing the resources into the  fund we also did this with the county government   I i really want to acknowledge one that's our  caca mega county the governor there had a dream   during his first time of appointment he put  he's been building a hospital and he realized   this hospital is going to require human resource  to manage and also provide services so as the   hospital was being constructed he put in resources  through his department of education and department   of health into the afer limousine and within a  year or so that hospital is actually going to be   opening and the health workers whom he has  supported from his county actually going to   be available now to provide those services so I  think you need people who are visionary in doing   this so we hope other countries can learn from  that look at your infrastructure what is needed   in three or four years what's a human capital  required to manage that infrastructure so I think   those are some of the pointers I would share with  other countries on how to make this fund a reality   and I think lastly is working with also a state  agency that can actually go out there and collect   debt because I cannot go out there and do  that neither can intra help neither can us id   neither can the ministry of of health but working  with a state agency that already has been mandated   to give loans and to go and collect them once  our students have graduated I think that was also   uh it changed the thinking around the affair  limo fund and that's where the recovery is as   it stands at 1.81 million so yes thank you I wish  all the other countries all the best if they on   this journey but they are welcome to learn from us  here in Kenya that's a great story thanks and then   so do you have any additions like you from your  perspective like what kind of advice would you   give to the other places or organizations  that wants to start similar kind of program   oh thank you dai I think just to add to what  janet has said I think for us what worked for   us would be the justification and why we needed to  do this it was a huge injustice to have 80 percent   of those who work in the health sector especially  dealing with both promoting and preventive health   care are not included in a government loans  board for higher education so for us we had   a huge justification to ensure that we have  the buy-in not only from the government   but also from the private sector and in  retrospect this has worked very well because   this loans product from the feedback we have  received from the government it has it's   been one of the best performing because we there  there's a huge gap and there's a huge demand for   the health workers who we are turning out as  beneficiaries so many of them are getting more   employment these are the other products that are  for bachelors or undergraduate or masters who   are still seeking employment especially in their  humanities who are really seeking employment and   struggling so this this fund for us has been  a life-changing fund for many students and   we are hoping that going forward we are going  to not only expand it to look at specialties   but also link up with the counties to ensure  that it's sustainable beyond the donor funding   great thanks and then I’m so glad that the  janet mentioned the kakamega because kakadu   county is where I worked about a year and then  that was still there so I’m just so touched   there's a lot of questions that thank you for your  presentations and how was the training program   affected by the pandemic and you  know the relationship between the   loan program and also the how the schools and  the students be able to go to the education   is there any kind of like additional challenges  that you have experienced yes indeed and I think   the pandemic in terms of the training  has been like a double-edged wood for us   we have learnt many lessons especially on  how to institutionalize virtual training   it's worth noting that the main training college  for middle level healthcare workers is known as   the Kenya medical training college we have work  together with them not only to ensure that their   virtual trainings are in shape but also to include  covered 19 content in their training curricula   so for us there are many lessons we have learned  as per the pandemic since we started off last year   in march but most importantly is known is what  noting that there has been an effect especially   not only in training but also an uptick of of  these health workers in the public health sector   there have been huge demands for the beneficiaries  but in the private sector due to reduced traffic   partly because of the stigma that was associated  with covet 19 many of them lost their jobs so we   found it interesting that there was a movement  from a private sector to the public sector which   has been the inverse in previous years so there  are quite a number of lessons we have learnt from   the pandemic but as we speak right now we have  stabilized and many of these colleges the middle   level colleges are using virtual training to  continue with the training of the earth workforce anything else from janet uh yes I i think I could add something to what  um sauspita has so eloquently shared I think the   other thing that plays out in this period and  it would align very well to the future together   is how the government and the technology companies  could work together this is a time when content   conversion of a lot of our curriculums  have an opportunity to be undertaken it's   pivotal at this particular time so I think that  collaboration is something that they would look at   we have seen one of our our providers that we  work with for the education sector even come ahead   and negotiate with the telecom companies  for discounted rates for faculty we have   seen discounted rates also for the students  where they buy the air time the data bundles   much cheaper and that is in recognition  that this time round lessons have to be held   virtually so I think that's the power  that kavit has brought on the table   yes the disease is there but they are also the  good sides of this experience so content conver   conversion is key what we think I think we need to  really bring out is when universities and colleges   are training on in medical education this I think  it's an area that they need to give more attention   to ensure that the educators are churned out  technology serving we also need to look at   ensuring that the infrastructure is well  laid out not all colleges and universities   have the fiber connection that internet connection  so I think this is the time to actually put that   so private sector I think come cross over  to the health sector let's work together in   this production of the workforce and also at the  hospital level there's a lot more at play to bring   about this as a lasting change not just reactive  here in Africa when it comes to health thank you   that's a great point janet and I really appreciate  that we are about like seven eight minutes to   the top of the hour but then I think that we  just finished all the questions and then I really   appreciate everybody who came to our  sessions and then also janet and then   we really had a great discussion  and I appreciate everybody thanks

2021-09-05

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