Establishment of HIV/Aids policies at the workplace has helped developing countries to make progress in the fight against the pandemic, a new International Labour Organisation report says.

The report says these policies have been drivers of attitude change at the workplace with a number of employees adopting habits that are supportive to co-workers living with the virus.

In Kenya, corporate chiefs added impetus to the fight against HIV/Aids when they took public HIV tests aiming to reposition testing as yet another weapon in the fight against the disease.

The new report, ‘Saving lives, Protecting jobs,’ tracks changes in attitudes related to HIV at the workplace and presents good practices and data collected from workplaces, ministries of labour, employers’ and workers’ organisations.

To bridge the statistical gap that has made it difficult for Kenya to measure the economic impact of HIV/Aids to companies, the Federation of Kenya Employers (FKE) says it has developed a monitoring tool that its members will use to come up with the numbers.

The tool captures the total number of illnesses and the total cost to business of such illnesses. The aim is to help organisations come up with plans to mitigate impact.

Publication of this report comes five months after the National Aids Control Council (NACC), the government arm steering the fight against the disease, announced that HIV prevalence had dropped from 5.9 per cent in 2005 to 5.1 per cent last year.

An estimated 1.4 million people are living with HIV and Aids in Kenya. This includes 934,000 people aged between 15 and 49 years.

Statistics also show that at least 1.8 million children have been orphaned by the disease since it was first diagnosed in Kenya in the early 1980s.

Labour sector researchers say absenteeism and turnover, loss of skills and declining morale that accompany HIV/Aids has the ultimate impact of increasing costs to employers and at the same time slowing down growth of profitability.

In recognition of the critical role that testing plays in managing the spread of Aids, NACC has set a target of having 80 per cent of Kenyans tested by 2010.

Dr Sophia Kisting, the Director of the ILO’s programme on HIV/Aids and the world of work, says a number of people have made significant progress in using the workplace as a platform for prevention, care and support as well as to tackle stigma and discrimination.

Over the past four years, the ILO has gathered data from managers and workers at partner workplaces in six pilot countries to measure the impact of HIV/Aids and non-discrimination policies.

Benin, Cambodia, Ghana, Guyana and Togo are listed as countries where workers attitudes towards people living with HIV have greatly improved.

In Ghana, the percentage of workers who reported having a supportive attitude towards co-workers living with HIV increased from 33 to 63.

In all the six countries surveyed, the proportion of workers who reported supportive behaviour towards co-workers living with the virus rose from 49 per cent to 63 per cent.

Attitude towards condom use also improved considerably in most countries with Cambodia recording the highest margin of improvement from 34 per cent rate of use to 68 per cent.

Workers who reported using condoms with non-regular partners rose from 74 per cent to 84 per cent.

The recorded changes in behaviour is partly attributed to increased access to HIV prevention services.

In the impact survey, it was found that 76 per cent of the participating enterprises had written HIV policies.

The ILO report shows that employers’ and workers’ organisations are increasingly using the ILO’s Code of Practice on HIV/Aids to develop policies and practices for the workplace.

Success in developing HIV policies is firmly rooted in collaboration between workers and their employers.

Overall, 16 of the 24 countries where the Strategic HIV/Aids Responses in Enterprises (SHARE), an international workplace education programme, is implementing projects have adopted a national tripartite policy or declaration on HIV and the world of work.

With 33.2 million people officially reported to be living with HIV/Aids globally — the majority of them in their most productive years — the workplace is thought offer a unique entry point for addressing the disease.

The findings, however, have faulted Kenya, saying its Aids policies at the workplace are disjointed

Kenya is on the verge of re-introducing the national health insurance scheme, nearly four years after failure to agree on a system which would guarantee affordable healthcare.

The first phase of the new scheme was to be introduced in July, but the post- election violence disrupted finalising of the financing model which is expected to guide the scheme’s roll-out.

Now, experts drawn from the private sector, the Government, faith-based and non-governmental organisations are finalising the financing model in readiness for a launch by January next year.

One of the main points the experts in healthcare financing are focusing on is the average number of times a Kenyan, of defined social economic groupings, visits a hospital and how much money each visit costs.

The data will show the cost of producing healthcare services in Kenya, which will then be used to come up with the best financing model especially in the case where a contributory model is agreed on.

This is a major strategy shift from the scheme proposed in 2003 by former Health minister Charity Ngilu, which failed to give the cost of producing healthcare services data thus raising scepticism on how much money it will require to be successful. Data generated from this process shows that the cost of producing healthcare services varies from region to region and among the different social economic groups.

Based on this reality, the new scheme will take into consideration these regional and socioeconomic disparities to enable equitable contribution and access to healthcare services.

What is, however, emerging is that it is highly unlikely that the healthcare services under the new scheme will be free, except perhaps to the poorest of the poor. However, such free services will not be as comprehensive as those paid for. Experts advising the government have also cautioned that free healthcare services are prone to abuse from both administrators and users.

They will therefore be highly limited to only those who cannot afford minimum contribution. Provisional data on the cost of producing healthcare services shows the abject poor make the highest number of hospital visits, a total of 16 every year, but use the lowest amount of money (Sh1,637) every year to pay for their healthcare services.

The “rich” make the lowest number of hospital visits averaging 9.6 and use Sh2,704 on average per visit. In between the two groups are the “lower middle” income group who visit 14 times and pay Sh3,565 per visit.

The “middle income” 10.4 visits and pay Sh3,073 each time, while the . The “second rich” makes 10 visits and pays Sh3,635 for each. Additional data on outpatient expenditure indicated that the number of hospital visits and expenditure varies.

The highest number of hospital visits were recorded in Nairobi (17.7 per person per year, followed by the Rift Valley at 13 visits, Central at 11.5 visits and Coast at 7.8 visits.

Eastern province tops in terms of outpatient expenditure at Sh4,531, followed by Central at Sh4,038 and Nairobi at Sh3,594. The lowest spender is North Eastern at Sh1,054.

Dr Edward Rukwaro, AAR’s general manager for Healthcare and Groupcare, who is one of the experts working with the government to develop the National Healthcare Financing Strategy said this data has become a major step in helping to decide how the new scheme will be financed.

The experts are considering three main financing models, including mandatory health insurance for all, direct healthcare access (fee-for-service) and social health insurance. In the mandatory model, the proposal is to make the National Health Insurance Fund (NHIF) just one of the players in the provision of affordable healthcare unlike in the earlier proposal where it was central to the scheme.

This raised concern that its past record of service delivery ineffectiveness and corruption would lead to the collapse of the scheme. The fund, for instance, uses only 30 per cent of contributions to pay for medicare, while the rest goes to administration.

In contrast, private healthcare providers use up to 80 per cent of the members’ contribution on medicare. Although the fund has made improvements in increasing its membership, it is yet to enlist 15 million eligible workers to its health insurance programme.

In this model, the Government is required to define the poor based on income and subsequently offer free medical services based on the definition. The model will involve heavy investments in the information communication technology to eliminate fraud and facilitate efficient service delivery.

It will also facilitate proper capturing of informal contributors to the health care scheme expected to be through the personal identification numbers (PIN).

The contributions are expected to create a pool of resources making its easier to finance healthcare needs. Last year, the International Finance Corporation, the investment arm of the World Bank recommend that financing system that allows citizens to pay for medical services through regular deposits in insurance premiums could help Kenya improve access to healthcare.

It said the system known as risk pooling is the best way to pay for health care in economies that are characterised by low incomes. Kenya currently uses the out-of-pocket payment system that the IFC says is a burden to many low-income earners.

“Risk pooling arrangements are powerful tools for encouraging the development of higher-quality, better organised private sector service providers,” says the report on opportunities for health investments in Africa. These options are to be debated with an aim of getting consensus on the best financing model and presented to the Government through the National Economic and Social Council (NESC).

The agreed model is expected to be implemented over a period of up to 10 years starting with the most vulnerable group of people. Dr Amit Thakker, the managing director of Amini Management, a healthcare services management company, said the private sector needs more in-patient facilities which offer quality services at an affordable price.

“It needs an enabling regulatory environment. We must manufacture more drugs locally that meet international standards. These drugs should then be sold at a cost effective price to the consumer. This way, basic drugs used in primary healthcare would be procured locally decreasing the overall healthcare costs considerably and promoting access to more Kenyans,” he said.

On the public sector, the Government will need to progressively increase the level of funding to the health sector from the current nine per cent of the budget to a proposed 15 per cent.

The government should also allow parallel importation of generic drugs to reduce the overall cost of medicine and establish a Health Benefits Authority to act as a regulator in the healthcare services management industry.

Dr Rukwaro said the implementation of the scheme will require patience by potential beneficiaries since it will take time for its effects to trickle down and be felt by all Kenyans.

“It will require some reasonable upgrade of the service delivery infrastructure to be able to provide equal standards throughout the country,” he said. The contributory financing model is being favoured because at present, households still provide the main source of health funds.

They account for 51.2 per cent of the sources of health services financing, followed by the Government at 29.6 per cent, donors 16.3 per cent, private companies at 2.3 per cent, local foundations 0.6 per cent while 0.1 of the sources are not specified. The model becomes even more acceptable because of the glaring disadvantage on the ability of Kenya to finance health access from its budget when compared to other countries which have free healthcare schemes.

For instance, Kenya’s per capita health expenditure or the amount it spends per person per year on health, is Sh1,500 compared to Philippines (Sh3,800), Germany (Sh188,000), and the United Kingdom (Sh104,900).

Kenya’s average public expenditure on health as a percentage of total expenditure at 25 per cent is low compared to that of Philippines 45.9 per cent, Germany 75.8 per cent, and the United Kingdom 83.3 per cent.

Written by Steve Mbogo