Kenya Economic Update 4th Edition

Consultative Meeting on Accelerating the Attainment of MDG 5in Kenya – August 27-28, 2014

Investing in Primary Health Care forreducing maternal & child mortality

Kenya’s health outcomes do not commensuratewith its aspirations of a middle income status.

Global evidence shows that improving maternaland child health outcomes lies in better PrimaryHealth Care.

Devolution provides a unique opportunity toaddress bottlenecks in delivering Primary Healthcare

Main messages

Areas of focus

Highlighting the challenges facing Kenya healthsystem;

Examining how reforms have improved PHC; and

Suggesting how Kenya can build on its devolvedsystem of delivering PHC services to achieve theMDG 4&5 and universal health care

Improving PHC services in Kenya’sNew Devolved System

Health outcomes are mixed

Despite having lowest child mortality in the East Africa regionin 1990, the decline is much slower compared to the rest andhigher among the poor

Kenya’s Maternal Mortality Rates Declined, but more modestly

compared to countries in the neighborhood

…inconsistent with its aspirations tobecome a middle income country

Life expectancy in Kenya in 2011 iscomparable to that of China in the 1960s

… and the total fertility rate is comparableto that of Brazil in the 1970s

Kenya spends about 6.5% of its budgeton health…

•Health sector continues to be predominantly financed by private sector sources (including byhouseholds’ out-of-pocket (OOP) spending);

•Public sector financing has remained constant over the last decade, at about 29 percent of THE;

•Donors contribution has more than doubled, from 16 percent in 2001/02 to 35 percent in 2009/10.

Sources of Health Financing

One in ten Kenyan households reportcatastrophic expenditure on health

PHC is key and cost effective

Provision of PHC is critical to improving health outcomes.

The family health program in Brazil helped reduce infant mortality by 13%within five years (Macink et al 2007).

PHC is cost-effective.

Hospitals and specialist care consume 70% of health care costs, but serveonly 30% of the population (Logie et al 2010).

In India, a 2% increase in resource allocation for PHC was associated withincreases in patient load (64%), cost-effectiveness (51%), drug supply(49%), and patient satisfaction (13%) (Varatharajan et al 2004).

Kenya is moving in the right direction.

Sustained focus on PHC in Kenya helped to double outpatient utilizationbetween 2003 and 2013, raising the per capita outpatient visits from 1.7 to3.1 (Kenya Household Healthcare Utilization and Expenditure Survey 2013).

Expenditure on public health facilitiesenhances equity

Kenya is well positioned to reform itshealth sector

Kenya is particularly innovative at developing home-grown solutions

The private health sector is vibrant with specializedhospitals and pharmaceutical industry and FBOsoperating facilities in the most remote areas of thecountry.

Government actions have alreadyimproved PHC services

Kenya’s new constitution guarantees rights to health care anddevolves responsibility for delivering health care to thecounties.

Some of the important initiatives helped in improving primaryhealth care:

Launch of the Health Sector Services Fund (HSSF) in 2010;

Use of Economic Stimulus Package funds for devolved recruitment ofmore than 3,000 nurses; and

Introduction of a pull system of supplying essential medicines.

Health Sector Services Fund isstrengthening the PHC provision

HSSF aimed to improve the equitable supply of good-qualityhealth care by the facilities closest to communities byaddressing the financial uncertainty.

The HSSF is initiating a process of change that couldrevolutionize service delivery in Kenya:

improving the management and accountability of resources;

Involving local communities in the management of the health facility;

fostering social accountability;

exploring the possibilities of contracting out services to NGOs andcommunity/self-help groups closest to the community; and

creating a platform for horizontal linkages with other sectors important tohealth.

Local participation has increasedunder HSSF program

The supply of essential medicinesand medical supplies has improved

Kenya now has better modalities of financing,procurement, and distribution for rural health facilities.

All public PHC facilities in Kenya are now covered bythe demand-based “pull” system of receiving essentialmedicines and medical supplies.

Most Counties are now following this approach.

Availability of medicines hasincreased under the pull system

Counties started responding to thechallenge

During the first quarter of 2014, all but three counties allocated at least30 percent of their medicines and medical supplies

Proportion of health facilities offeringBasic-Emergency Obstetric care

KENYA CAN GET MORE HEALTH FROM MONIES BEING SPENT

Focus first on making existing public PHC facilities operational

One out every 10 PHC facilities are reported to be non-functional.

Devolution provides new opportunities to strengthen the delivery of PHC.

Reduce maternal mortality by improving access to basic emergencyobstetric care

Counties need to ensure that all PHC facilities with maternity wards offer basicemergency obstetric care, before creating new infrastructure

Effective use of the Health Sector Services Fund

HSSF can used to improve facility performance and enhance accountability toboth the community and the county.

Build partnership with all stakeholders

Counties need to take advantage of all stakeholders (e.g., private sector,FBOs, NGOs, DPs) to address supply gaps; and communities to improveaccountability

How can the government addressremaining challenges?

Thank you.