THE FACTS OF THE CONTRIBUTION OF CIVIL SOCIETY IN KENYA & IMPLICATIONS OF THE PROPOSED MISCELLANEOUS AMMENDMENTS OF THE PBO

ACT, CURRENTLY IN PARLIAMENT FOR KENYAS HEALTH 1. Civil Society supports the current PBO Act and was involved in its drafting and adoption by Parliament in 2012. PBOs do not oppose regulation. Rather, they are opposed to forms of regulation that will negatively impact the health and welfare of Kenyans. 2. Civil Society contributed to 15% of the Economy in 2012: Public Benefit Organizations, in particular Civil Society Organizations accounted for Ksh 152Billion (equivalent to over 15% of the 1 Trillion national budget), the bulk of which is within the health and education sector. The amendments will negatively affect economic growth as well as provision of quality health care and education to the majority of Kenyans. 3. Civil Society contributed significantly to foreign exchange: Over 90% of the 152 Billion was received in hard currency, making this sector a significant earner of foreign exchange. Much needed foreign exchange will earnings will drop meaning that prices of imports -and therefore inflation- will increase which will further impoverish ordinary Kenyans already struggling to make ends meet. 4. The PBO Sector employs 240,000 Kenyans: The implementation of the proposed miscellaneous amendments to the PBO Act will render more than 90% (>200,000) of these Kenyans jobless and reduce tax revenues. The consequent loss of purchasing power and increase unemployment rates is at odds with the aims of Vision 2030. 5. 53% of health care is delivered through private sector including PBOs and Faith Based Organizations (churches). The national health budget is 55% funded by donors through PBOs: Article 43 of the Bill of Rights - every Kenyan constitutionally has a right to the highest attainable standard of health. Currently government facilities can only provide much of HIV and reproductive health services with support from external donors whose funds are channelled through PBOs. Given its poor history of managing donor money, it is unlikely that these funds will be redirected to Government. The amendments therefore not only contradict the aims of the Constitution but also imperil the gains Kenya has made in combating HIV and reducing maternal and infant deaths. The Government will be forced to find funds to inject into the health sector meaning provision of services in other areas will suffer. 6. 89% of the HIV budget (including life saving ARVs for over 1 Million HIV-positive Kenyans) is funded by external donors through PBOs. Keeping the HIV prevalence low requires increased funds for ARVs and HIV testing and counselling that will now have to come from the Government budget. So either already onerous taxes will increase or government will have to cut back on services in other areas. 7. Health workers are supplemented through NGO efforts: WHO recommends more than 23 in the population. Kenya currently has less than 10 health workers for every 10,000 persons. PBO provide Community Health Workers to help make up the difference. These additional staff will not be available to and Kenyans health will consequently suffer.

ACTIONS: 1. THE GOVERNMENT MUST DROP THE NEW ADDITION OF THE FUNDING CAP PROVISION IN THE PBO ACT BILL. 2. PARLIAMENT MUST REJECT THE BILL

Health Issue HIV ARV Treatment for People living with HIV

CSOs contribution to health care in Kenya 240,000 (40%) people living with HIV access ARV treatment through PBOs 100% of Government facilities offering treatment are facilitated through PBOs Health worker training, Quality control, Patient Treatment adherence support

% donor funding to Kenya 89%

Impact of proposed amendments

600,000 people living with are currently on treatment in Kenya; another 1 million are in need of and not accessing treatment Clinical impact: reduced adherence levels; increased drug resistance; increased opportunistic infections and HIV related deaths Other development impact: Maternal health goals will not be achieved (HIV positive women not tested, eMTCT rates reduced) Unsafe sex contributes 30% of kenyas disease burden (STIs, reproductive related infections) Increased demand on the national health budget to cover for HIV increase in number orphaned children increased child deaths (HIV related) increase in procurement and use of counterfeit drugs increase in multi drug resistant TB Kenya is the first country to have a HIV and AIDS sustainable financing fund for HIV/TB/Malaria and noncommunicable diseases. A cap on funding to CSOs will compromise implementation of these plans Unavailability of VCT services Increase in new infections particularly among young people that are accessed mainly by PBOs as they do not visit hospitals normally The national prevention roadmap if implemented could reduce new infections from 80,000 in 2013 to less than 9000 by 2030. It will not be implemented retaining the rate of new HIV infections above 60,000 by 2030 of the most productive segment of the population (25-49 years of age) Key populations (Couples, men, sex workers, men who have sex with men, young women) are reached mainly by PBOs and FBOs and contribute the largest number of new infections Attainment of zero new infections, zero discrimination, zero AIDS related deaths is possible in Kenya, but only with combined efforts from all sectors Overstretched and overworked health facilities that are supplemented by PBOs. The service delivery burden on County Governments will increase 43% of women in Kenya deliver at home through

Prevention

6.8 million people were tested in 2012. 60% in health facilities that are facilitated through PBOs in employing counsellors, training, quality control (ensure accurate HIV results) 40% were tested in community settings through PBOs HIV prevention services offered by PBOs 1,757 CSOs deliver public health programmes and services in Kenya

100% HIV prevention funding is from donors

Human resources

Maternal

and child health

midwives and traditional birth attendants. PBOs facilitate home follow ups that increase hospital deliveries

Factsheet prepared by LVCT and KETAM