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Saturday 13

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Saturday 13

    PROGRAMME JOINT DESIGN MISSION JAN-FEB 2007

    (version 18.12.2006)

    Table 1: Distribution of participants in the JDM by topic

    12TOPICS CONSULTANTS MOH Staff DP Staff

     Jarl Chabot (JC)

    TEAM 1

    Division of Malaria Control Service Delivery / PH & WB/Sjon and Andy O’Connel (EOC)

    Division of Reproductive Health Public Private Partnerships USG/David Elkins

    Sida/Nicholus

    Social Development & Eva Waldstamm (EW)

    Environmental Assessment

TEAM 2

    Div. Health Management and Systems: Planning & M&E Eddie Addai (EA) Italian Coop/Renato

    Information System

    Planning and Policy

    Development Department

    Human Resource Development Human Resources (HRH) Margaret Caffrey (MC) 22/01 DFID/Tony

     OR Jenny Huddard

     Fiduciary Risk assessment Derek Reynolds (DR) Sida/Bernt

    OR Jeffrey Ford

    Principal Procurement Officer Procurement & Mbuba Mbungu (MM) WB/Wacuka

    Infrastructure/Transport OR ?Jerome Dendura 22/01

TEAM 3

    Institutional Development & Kevin Brown (KB)

    Governance

    Public-Private Partnership HENNET/FBO DFID/Sandra

    Health Care Finance Health Financing & Mark Wheeler (MW) GDC/Carmen

    Economics

     thMeeting Room: ETC EA, Waiyaki Way, AACC Building, 5 floor.

    Secretary: Irene Kirimi; 020-444 5421.< rihs-secretariat@etc-eastafrica.org >

    Hire a taxi full time for the team (Ksh. 4,000 per day) ‘OPEN’: Please add interviews that you feel are necessary with MOH, DP or others. Ask Irene to help you with appointments and tel numbers.

HOTEL: Holiday Inn

    Parklands Road

    Westlands, Nairobi

    Tel: +254-20-374 0920

     1 MOH/MOF Staff are expected to participate in the field visits, the interviews, the two workshops and the

    internal discussions of the team. 2 DP Staff are expected to participate in the field visits and the two workshops. They are also welcome in the

    internal team meetings on a rotational basis (see overview of the programme).

     1

Table 2: WORK PROGRAMME JDM TEAM

PHASE 1: WARMING UP (2-3 days)

    DATE ACTIVITY VENUE COMMENTS December / January Preparatory Reading is expected (4-5 days!!) Home

    Saturday 13 Jan Arrival Team members All settle Holiday Inn Sunday 14 Jan 14.00 Meeting team in Hotel Holiday Inn Holiday Inn

    Settle inn, introductions, overview work programme;

    sharing of documentation (hard and soft).

    Monday 15 Jan th09.00-10.30 Meeting MOH/DP (PS: Clarify TOR, agree on MOH, 7 Floor

    programme, MOH expectations)

    thBriefing by DP: DFID: overview of issues 10.30-12.00 MOH 7 floor

    Lunch with interested MOH and DP staff 12.00-14.00 Fairview Hotel

    Team meeting: Discuss programme, TOC, Prepare 14.00-17.00 ETC EA

    issues/questions for interviews and field visits

     2

    PHASE 2: FIRST ROUND INDIVIDUAL INTERVIEWS (1.5 days)

    DATE TEAM 1 TEAM 2 TEAM 3

    Tuesday 16 Jan

    Andy: Dept Preventive Care/Dr ALL: HSRS/Gakuruh + Were + Both: DPPD/Muchiri, 08.30-10.00

    Sharif and Dept Curative Rose: (Systems devt) CFO/Karimba +

    Care/Dr Kimani PAC/Kakhame, Chief Health

    Admin Officer/Chau Eva: MOH/level 1/Dr Gakuruh.

    Andy: NASCOP/ Mohammed + Mark: DPPD/Muchiri + 10.30-12.00 Eddie: DPPD/Muchiri +Danida TA.

    TB/Sitienei Danida/TA (HFF). XXX: Dept HRM/Ms Rono

    Eva: Centre Rights, Education Kevin: Dept Standards and Derek: Join TBD?? 3and Awareness/ Ann Njogu ? Regulations/Dr Bwonya TBD: Procurement Dept /

     Momanyi

    12.30 Lunch Both: NCPD/Dr Richard Muga ALL: Resource Persons Karamaji All: Resource Persons Obonyo Meetings NCPD/Kenya ?, (Fairview) and Abebe, (Fairview) and Pendame, (Fairview)

    Andy: RH/Kibaru + Dr Both: Governance, Institutional 14.00-15.30 Eddie: HMIS Division/Ogara 4Salomon / Child Health/ and Coordination; PS XXX: MOH/Dept HRD+

    Wamay+Danida adviser Nyangito and/or DMS Nyikal Training/Okore

    (Gakuruh) Eva: Ministry of Gender, Derek/TBD: MOF, Directorate of

    Sports, Culture and Social Public Procurement/??

    Services/?? (DFID)

    16.00 Team meeting Short debriefing on the various interviews, first impressions

    Visits from GTZ and Clarifications on NHSSP II, JPWF and any other questions

    Italian Cooperation Logistic issues relating to field visits, AOB.

Wednesday 17 Jan

    Both: WHO/Okello + ALL: OP/PublicSectorRS/ Ms Kevin: Nairobi City Council 08.30-10.00

    UNICEF/Pearson + Merylin Nyamwea +Obongo. /Town Clerk/??

    (DFID) Mark: MOF/External

    Resources Department//?? And

    MTEF Co-convenors and

    GFATM/Funding

    Kevin: KEPSA/Health Sector 10.30-12.00 Andy: Open Eddie: Min Planning/ CBS/??

    Federation/Ookok (JC) Eva: Human Rights XXX: Open

    Commission/Mr Maina (DFID) Mark: MOF/IFMIS/?? Derek: Join TBD?

     TBD: PSI/David Walker (DFID)

    12.30 Lunch OPEN OPEN OPEN

    Meetings

    14.00 Departure

     3 Procurement includes not only the procurement of pharmaceuticals, but also commodity management, supply chain

    management and the overall rules and regulations that define the transparent and efficient procurement of health

    commodities (being pharmaceuticals, non-pharmaceuticals and equipment) and other support services. 4 Governance and Institutional issues relate to (i) the division of roles and responsibilities between the various

    stakeholders of the sector (MOH, NGO/FBO and DP) in the fora where they coordinate their work together, (ii) MOH

    structures and institutions at the various levels, (iii) capacity building and (iv) the relations with other GOK Ministries and

    institutions (para-statals).

     3

    PHASE 3: FIELD VISITS (3-4 days)

    Wednesday 17 Jan 14.00 Departure for field visits: Team A: Coast Province ?; Team B: Nairobi Province + Kajiado;

    Team C: Eastern Province and Team D: North Eastern Province ?

    Thursday 18 Jan FIELD VISIT

    Friday 19 Jan FIELD VISIT

Saturday 20 Jan Morning Field visit; Afternoon back in Nairobi

    10.00-12.30 Hotel: Share findings field visit; Changes in the next week programme; Sunday 21 Jan

    13.00-15.00 Tony’s house for a Lunch to be provided by DFID

     4

PHASE 4: PHASE 2: SECOND ROUND INDIVIDUAL INTERVIEWS (4 days)

    DATE TEAM 1 TEAM 2 TEAM 3 Monday 22 Jan

    Andy + Eva: Meeting with the Kevin + ??: Meeting with the 08.30-10.00 Eddie: MMU/Wamweya

    MOH/FBO TWG (Hennet, FBO, MOH/FBO TWG (Hennet, FBO, Margaret: OP/Public Service

    Supkem) (JC) Supkem) (JC) Commission/PSC/??

    Mark: MOF/Dept of Internal Derek : Join TBD?

    Audit/?? TBD: Procurement Consortium/

    Accountant General/?? Join Fredericks / Kandie / Crown Agent

    Team 2 on 10.30?? (DFID)

    Andy: Prepare first draft of Log Eddie: MOH/ Engineer Owino Kevin (+ Mark): MOH/ 10.30-12.00

    Frame for discussion later (see (infrastructure) Engineer Owino /infrastructure

    TOR, Annex 4B) OR Margaret: Clinton Foundation/

    Eva: CDF Committee of Alice + Gerald ? / Timau Plaza Mark: Meet Auditor General

    Parliament (DFID) Derek: Auditor General

    TBD: Chief Pharmacist/ Mbuva +

    Danida TA

    12.30 Lunch OPEN OPEN OPEN Meetings

    Andy: Malaria/ Akhwale + Ms 14.00-15.30 Eddie: Sam Ongayo (Planning) ? Both: PWC/ Philip Kinisu (JC)

    Greenfield (WHO) Margaret: Capacity Project/(DFID)

    Eva: Meeting Members of Derek: Open

    Parliament (MPs) (DFID) TBD: Kenya Institute Supply

     Management/?? (DFID)

    16.00 Team Meeting Debriefing on main findings from the interviews

    Visit from DFID and Special requests for visits, interviews, documentation etc.

    Sida Start a ‘Common Problem Analysis’, as input in LFA to be prepared by Andy.

Tuesday 23 Jan

    Both: UNFPA/ Wanjé + Eddie: Ministry of Kevin: Ministry of 08.30-10.00

    UNAIDS/ Ms Jane Kalweo Works/Infrastructure Works/Infrastructure

    (DFID) Margaret: KMTC/?? Mark: Ministry of Planning/

    MTEF/co-convenors and? Derek/TBD: NASCOP/

    GFATM person Procurement/ ??

    Andy: Environmental Health 10.30-12.00 Eddie: Join Team 3? Both : Venue: Holiday Inn:

    Kepha Ombatcho (EIA) Margaret: OP/DPM/ Mbera EU/Pallares + Andrew;

    Eva: UNICEF/Human Rights Orwoba JICA/Yumiko + Kinyangi;

    approach/?? (DFID) Derek: Open Italian Coop/Correggio;

    TBD: MEDS/Ruth Njorogue + GFATM/Mutile Wanye;

    Jane Masiga (DFID)

    12.30 Lunch Eva: Dr Mua (RRI SD/ ALL: Resource Persons Karamaji All: Resource Persons Obonyo

    Meetings Community Health) and Abebe. (Fairview) and Pendame. (Fairview)

    ALL: Meet with HDWG at WB Office: DFID/Tony and Sandra, WB/Mills+Adam+Wacuka, Sida/Annika + 14.00-16.30

    Nicholus, Danida/Mogens and Rhodah, GDC-KFW/Klaus Hornetz + Katharina + Cynthia Macharia;

    USG/PEPFAR/David Elkins; UNICEF/Pearson + Marylin. (DFID)

    17.00 Team meeting

    Visit USG and

    UNICEF

Wednesday 24 Jan

    Andy Prepare first draft of Risk Kevin: Ministry of Education 08.30 Eddie: Open

    matrix experience with SWAP (DFID) Margaret: Open

    Eva: Attend Meeting on Mark: Open

     5

    DATE TEAM 1 TEAM 2 TEAM 3

    Community Tools + Meeting Derek: Open

    with TICH/Dr Kaseje TBD: Open

    Andy: USG/PEPFAR/ David ALL: USG/PEPFAR/ David ALL: USG/PEPFAR/ David 10.30 12.00

    Elkins/Stephen Haykin (DFID) Elkins/Stephen Haykin (DFID) Elkins/Stephen Haykin (DFID) 12.30 Lunch Open Open Open Meetings

    14.00-15.30 ALL TEAM MEMBERS: PS/Nyangito, DMS/Nyikal, HSRS/Gakuruh

    16.00 Team meeting Prepare next day programme / Consensus meetings on the ‘hot topics’;

    Visit by WB, Danida Prepare meetings with individual donors on specific topics: each to choose with who to meet. and JICA Discuss Log Frame and Risk Analysis (if time allows)

Thursday 25 Jan GENERAL CONSULTATION DAY

    Andy and Eva: Consultation Eddie: Consultation with Kevin: Consultation with MOH 08.30 12.00

    with Programmes and stakeholders in M&E: ?? and stakeholders on

    Departments involved in Governance and Coordination: Derek/TBD: Consultation with

    Service Delivery: Shariff and PS / DMS MOH and other stakeholders in

    Kimani + Programme staff. Procurement: Momanyi Mark: Consultation with MOH

    Obj: Seek consensus and and stakeholders in PFM: Margaret: Consultation with MOH

    ownership by bouncing ideas DPPD, CFO and PAC and stakeholders in HR: Rono and

    and punching holes. Okore

    12.30-14.00 Lunch OPEN OPEN OPEN Meetings

    14.00-15.30 All: Meetings with individual donor agencies on the basis of specific requests for information.

    My advice to meet at least: DFID Country Team; WB Country team; USG Staff; Others?

    Detailed debriefing on the discussions and outputs of the day, both from the morning programme (‘hot 16.00 Team Meeting

    and contested topics’) and from the afternoon programme (special requirements). What is to be used to

    present at the first workshop?

     6

PHASE 5: BACK TO THE TEAM WORK (WORKSHOPS / WRITING) (12-13 days)

    DATE ACTIVITY VENUE COMMENTS Friday 26 Jan 08.30 Prepare presentations of the first workshop: Consensus on broad principles Saturday 27 Jan 08.30 Prepare Workshop Individually 20.00 Party time Sunday 28 Jan FREE DAY( start writing; see TOC)

    08.00 First Workshop JPWF: Consensus on DFID: 2 OPR Monday 29 Jan ? Fairview / Holiday Inn

    broad principles reports available Tuesday 30 Jan Continue writing on zero draft report

    ALL: Individual interviews where requested

    Wednesday 31 Jan Continue writing on zero draft

    16.00 Hand-in all sections (respect format!!)

    FEBRUARY

    08.00 Bring all sections and annexes together, 15.00 Debriefing Thursday 01 Febr ETC EA Office

    editing / lay-out (Irene) Dr Gakuruh (back

    from Geneva) and 12.00 Printing, distribution of hard copies

    Tony Daly 15.00 Reading for content and cohesion

    08.00 Internal Team Consensus on Zero Draft 20.00Dep Tony Friday 02 Febr ETC EA Office

    (page by page) Daly Saturday 03 Febr 08.00 Finalise Zero draft Report / soft copy

    Circulate soft copy of first draft report to Sunday 04 Febr DFID Office?

    stakeholders (Sandra from DFID Office)

    08.00 Second Workshop: Implement the joint Monday 05 Febr ? Fairview / Holiday Inn

    design advice to improve the JPWF

    Incorporate oral / written comments from Tuesday 06 Febr

    stakeholders (MOH, DP)

    Debrief with PS/DMS and other interested Wednesday 07 Febr Most team members leave

    parties; Include comments and finalise

    Thursday 08 Febr Finalise JDM Report (Second draft)

    Submit JDM Report (Second draft) to MOH Friday 09 Febr

    and DP

    Review JDM Report (second draft) by DP, Febr 12- 26

    DP/HQ, MOH.

    Presentation/Meeting with GTZ/KFW team Febr 17 GTZ Office

    from HQ

    Team members Febr 26-Mar 12 Completion JDM Report (final draft)

    on standby

     7

Programme of the First Workshop / Monday 29 January

Introduction

    The Team of the JDM has been visiting 4provinces and several districts. They have conducted interviews with MOH staff at all levels, most working in the Central MOH, but also staff from other GOK institutions (MOF, Planning, NCC), people working in NGOs and FBOs (Hennet, CHAK, KCS, Supkem), staff from most of the DP and various resource persons. The team members have looked at issues around the main „result areas of the JPWF, being Service Delivery, Systems Development,

    Finance and Governance.

    In earlier meetings they have discussed in various working groups some of the contentious issues and have tried to reach agreement and consensus on the practical ways forward. Therefore this first Workshop, is to share the conclusions of these meetings with a broader audience, seek approval and provide the JDM team members with the necessary information to start writing their report. The basic idea of this first workshop therefore is consensus building around the main findings and suggestions of the JDM Team and to agree on the broad principles for the possible ways forward and the operational improvements in the further development of the JPWF.

Objectives:

    The objectives of this first workshop are to:

    1. Present findings and suggestions from the JDM work over the last two weeks;

    2. Agree on the „broad principles‟ and their operational implications for each of the „JPWF result

    areas‟;

    3. Build ownership within the MOH and the CSO to improve the implementation of the JPWF;

    4. Inform the team on the practical and do-able ways forward that will inform the JDM Report.

Participants:

    Senior staff of MOH, MOF, NGO/FBO/Supkem and DP‟s (around max. 30?).

    To be elaborated further in detail

Proposed Programme: Consensus building on broad principles’.

TIME SUBJECT FACILITATORS / COMMENTS

    CHAIR PERSONS

    08.30-09.00 The JDM: TOR and Work Programme; The process Jarl / Nyamongo

    09.00-10.00 JPWF: Context and Relevance (poverty, PRSP, gender, Eva / Nyamongo Each facilitator will present

    equality) (See goal, purpose and outputs of the LFA) in less than 30 min his/her

    main findings and 10.00-10.30 Tea / Coffee

    suggestions as ‘issues for 10.30-11.30 JPWF: Service Delivery/KEPH /Programmes Andy / Shariff + Kimani

    discussion’ through 11.30-12.30 JPWF: Planning, M&E, HRH Eddie and Tim / Muchiri

    questions / statements. 12.30-14.00 LUNCH The other 30 minutes will 14.00-15.00 JPWF: Procurement, infrastructure and supply chain mgmt TBD / Momanyi be used for discussions 15.00-16.30 JPWF: PFM: HFF, Fund flows, funding mechanisms and Mark / CFO + PAC and conclusions / funding gaps; Summary FRA. Derek consensus building. 16.30-17.00 Tea / Coffee

    17.00-18.o0 JPWF: Governance, Institutional and Coordination issues Kevin / DMS

    18.00 Closure

     8

Programme of the Second Workshop / Monday 5 February

Introduction

    Based on the inputs from the previous workshop and the findings during field visits and (additional) interviews, the JDM team members have prepared a first draft of the JDM Report. From this draft they will to present the salient features, constraints, bottlenecks and issues for discussion and decision-taking. The intention is to find consensus on how to implement the suggestions for the implementation of the Joint Design. In the previous days and during the various interviews questions have been asked on “Who does what, where and with how much money. The outcome of these discussions will be

    reported and discussed in order to achieve consensus on the way forward in the implementation of the JPWF.

Objectives

    The objectives of the second workshop are:

    1. Present sections f the JDM Report, being the Programme Implementation (How);

    2. Present the Logical Framework for comments and inputs together with the Risk Matrix;

    3. Initial consensus on division of tasks and timeline of implementation.

    4. Discuss constraints and outstanding issues of the JDM Report

Participants

    Senior staff of MOH, MOF, NGO/FBO/Supkem and DP‟s (around max. 30?).

    To be elaborated further in detail

Proposed Programme: Implementation of the joint design to improve the JPWF’.

TIME SUBJECT FACILITATORS / COMMENTS

    CHAIR PERSONS

    08.30-09.00 The JDM: TOR and Work Programme; The process DMS / Jarl

    09.00-10.00 Governance and coordination: the framework Kevin / DMS Each facilitator will present

    in less than 30 min his/her 10.00-10.30 Tea and Coffee

    main findings and 10.30-11.30 PFM: HFF, funding mechanisms and DP budget lines Mark / Muchiri

    suggestions as ‘issues for 11.30-12.30 Procurement procedures and contracting TBD / discussion’ through 12.30-14.00 LUNCH questions / statements. 14.00-15.00 Logical Framework, Risk Matrix and Risk mitigation Andy / Gakuruh The other 30 minutes will 15.00-16.00 Monitoring and reporting framework Eddie / Muchiri be used for discussions 16.00-16.30 Tea / Coffee with questions like: who 16.30-17.30 Accounting, Audit and FRA Derek / CFO does what where and with 17.30-18.00 Overall Discussion: Next steps DMS / Jarl how much money.

    18.00 Closure DMS

     9

FIELD VISITS

1. Objectives

    The objective of the field visit is find out to what extent the reform process is now reaching the provincial, district and health facility levels. Although not in any way a formal evaluation, it is hoped that the field visits will provide the team members with the elements needed for inclusion in the Joint Design Mission Report. Therefore, it is suggested to follow basically the same format a given in the JPWF and focus our questions on relevant parts.

    ; Service Delivery: activities, outputs, cost estimates and funding gaps by level of care

    ; Systems Development: Planning, HRH/HRD, Infrastructure, transport and

    communication, Procurement and Commodity supply management, Financial

    Management System, and Performance Based Monitoring and Evaluation. For each

    of these systems attention should be give to objectives, strategies, activities, costs

    and funding gaps.

    ; Financing the Health Sector (by GOK, DP, House Holds and National Social Security

    Fund, NSSF) and the Costs of financing the JPWF.

    ; Governance, Stewardship and principles of partnership: SWAp, Governance,

    Partnership, the DHMB, the DHSF and the recent COC.

2. Participants in the field visit

     thTable XXX. Team Members on Field visits 17 20 January 2007.

    TEAM A TEAM B TEAM C TEAM D

    COAST PROVINCE NAIROBI PROVINCE EASTERN NORTH EASTERN

    + KAJIADO DISTRICT PROVINCE PROVINCE

    Dr Kahindi (0722-Mr Mucharia /NCC and Dr. Njogi (??) Dr Omar Ahmed

    480624) Dr. Sam Ocholla Andrew Akeye (0722-607 485)Dr

    Dr Jan Borg (0723-DMOH/Kajiado (0722-725257) Boussery (0733-

    489011) 813898)

    Marc Wheeler Andy O‟Connell Kevin Brown Mbuba TBD

    Addie Addai Derek Reynolds Eva Waldstamm Klaus Hornetz

     Jarl Chabot

3. Where to go?

It is suggested to visit ALL the levels (level 1 5) of Health Service Delivery during your visit to the

    Province, starting from the Office of the PMO, to DHMT, Health Facility and Community. At each level you might want to see different service providers (public, FBO, NGO and private-for-profit) and different levels of care (Managers, Boards, Hospitals, DHMB, and DHSF). If time and distances allow try to visit two districts during these two days, a well performing district and a poorly performing district. The rating of the districts is given for last year AOP 1 (July 2005 - June 2006) in the MOH Health Sector Performance Report (page 56-57). On the basis of this Table, each team can discuss with the PMO the districts they want to visit.

     10

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