OVER VIEW OF THE PUBLIC SECTOR STRENGTHENING (PSS) Channel

With funding from the Investment Funding (IF) committee at Marie Stopes International (MSI) and leveraging on funding from the Bill & Melinda Gates Foundation, Marie Stopes Kenya (MSK) is launching a Public Sector Strengthening (PSS) channel in line with MSI’s total market approach. PSS is an additional channel complementing the existing variety of MSK’s service delivery channels (centers, outreach, social franchising, and social marketing). The aim of the PSS channel in Kenya is to strengthen the capacity of the public sector, to offer quality assured services like Family Planning and Safe Postabortion Care. It is a pathway for sustainable access to these services by the public sector via structured support by the private sector.

Compared to the private sector, governments are in a better position to have commodity security, to provide a cost-effective service delivery channel, with a greater value for money than current channels. With a higher focus on Quality of Care (QoC), and systems strengthening by on-job coaching and supervision, including assurance of data quality and improved proactive demand generation, PSS offers an opportunity for MSK to garner a stronger goodwill, to work more closely with the counties for the desired health outcomes, and to strengthen its brand as a preferred provider of contraceptives i.e. LARCs and Permanent methods. It will position MSK for future funding from donors who are increasingly channeling resources to devolved units and strategies that foster sustainability of interventions and to improve access to quality-assured Family Planning (FP) and Post Abortion Care (PAC) services through the public sector.

The focus is on achieving sustainability of quality assured services delivered by the public sector, via training and disciplined support from the private sector and in close partnership with county-level government health sector human resources. This will be in furtherance of MSI’s mission - increasing access and availability by going closer to the client and improving the geographical spread of quality care into remote areas, and those with higher unmet need for FP and improved access to safe PAC. PSS will potentially improve access at public facilities by adolescents with more staff trained on youth-friendly services (YFS) and an enabling set-up for the services. The experiential learning of the PSS channel will be a potential resource for research and advocacy to guide future strategies and directions.

MSK will achieve this through leveraging our expertise in service delivery, training and direct supervision of health workers. Through PSS, MSK will transfer these skills, provide clinical quality assurance and implement demand generation strategies for MOH health workers.

The PSS channel is strategic for MSK due to the following factors:

It offers a sustainability pathway for MSK’s core services as it seeks to ensure continuity of services for Kenyan women by the public sector while complementing MSK’s private sector efforts.

• Offers an additional service delivery avenue for MSK to increase its impact and deliver service more cost-effectively for its donors by leveraging the public sector providers and the infrastructure already in place.
• It helps MSK, prepositioning itself for funding from the available donors given the trend of a changing donor landscape that is favoring channeling of their resources through GOK or initiatives that demonstrate the sustainability of their investments.
• Offers an opportunity for Public-Private Partnership (PPP) for MSK to further increase its visibility and demonstrate its capacity in an attempt to strengthen its position as a key stakeholder to both the central government and counties in the health sector.
• An opportunity for cost-efficient/low-cost scale up as more and more existing public sector facilities are capacity built.
• As a PPP, strengthen systems for data quality and improved proactive demand generation via community workers.
• Some level of commodity security as governments are in a better position to have stock and can be used for services in the public sector and still claim success through Significant Involvement Policy (SIP).
• Serves as a commodity access platform through county governments for outreach, centers and social franchise.

• The value proposition to the Counties.

1. Training (LARCs/Sayana, /PAC, Medical Emergency Management (MEM), Infection Prevention (IF), Value Clarification and Transformation (VCAT).
2. Support supervision (SS) - Quarterly and joint SS with County and sub- county RH coordinators)
3. Commodity management and security– Forecasting, consumption tracking, and general inventory management. Governments are in a better position to secure stocks, used for services in the public sector. MSK will claim success through Significant Involvement Policy (SIP)
4. Reporting – Promote adherence to timelines, data integrity & management for utilization and capacity building for staff. This is an essential prerequisite for accuracy of data to measure health impact, and allocation of resources by the governments.
5. Advocacy for the uptake of LARCS, and improving access to safe PAC services, and demand generation support by working with the county health promotion officer & Community Health Workers/Volunteers.
6. Cost-sharing of workforce costs, working space, commodities & MOH funding training activities and demand generation costs through an existing World Bank project to counties for Maternal, Neonatal and Child Health & Family Planning activities and from their own healthcare budgets.
7. Health financing assistance towards empanelment to increase revenue from NHIF reimbursement for SRH services including Postpartum IUD under Linda mama, PAC, Post abortion Family Planning (PAFP), and permanent methods.
8. Establishing appropriate and innovative client feedback mechanisms to aid in understanding client needs and service quality improvement needs. These will include, exit interviews, client satisfaction surveys and contact center client tracking calls, but also the potential use of MATE at public sector facilities.

Focus Counties.

The selection of PSS counties was based on following factors.

• Likelihood of fast-tracking signing of MoUs and acceptability of MSK’s partnership.
• Availability of relevant public sector facilities (Level 3 and above)
• CPR vs unmet need (particularly for LARCs and PMs).
• Likelihood of obtaining buy-in for co-funding from county governments and or donors.
• Previous FP performance – Jan 2019 to July 2019
• Target counties for Calculus of sex BMGF funded project.