Kenya health sector reforms and roadmap towards uhc by Dr Isaaq Odongo, MOH Kenya

Kenya Health Sector Reforms and Roadmap Towards

Universal Health Coverage

Dr. Izaaq Odongo Head, Department of

Curative and Rehabilitative Health Services Ministry of Health, Kenya

Outline

Introduction – Policy and Legal Environment for UHC

Selected Health Indicators

Financing of the health sector

Some key reforms/programmes towards UHC

Key sector challenges/issues

Moving forward - Roadmap

Policy and Legal Environment for UHC

Kenya Vision 2030 – Affordable and quality healthcare for healthy and productive population

The Constitution of Kenya 2010: – The right to health, including the right to emergency

care and reproductive health – Devolved system of government

The Kenya Health Policy, 2014-30 – achievement

of universal health coverage Kenya Health Bill, 2014 – mirrors the

Constitution

Status of Selected Health Indicators

The health sector recorded improvements in some of the health indicators in recent years:

Infant Mortality Rate declined from 77 per 1000 live births in 2003 to about 52 per 1000 2010

Under Five Mortality declined from 115 to 74 liver births over the same period

Newborn Mortality Rate declined from 33 to 31

per 1000 over the same period

Full immunization against major illnesses improved from 58 per cent in 2003 to 83 per cent currently

Status of Selected Health Indicators Cont..

Maternal Mortality Rate increased from 414 per 100,000 in 2003 to 488 per 100,000 women in 2010

HIV/AIDS prevalence declined from 13 per cent in 2000 to 5.6 per cent in 2012

Family planning has increased from 39 to 46 per cent

Life Expectancy has increased from 58 years to 60 years between 1993 and 2010

The Financing of the Health Sector

Where the money comes from - Who pays in Kenya?

30 32

29 36

29 20

11 10 1 2

0

20

40

60

80

100

2009/10 2012/13*

% s

har

e

Households Government Donors Employers Others

Key messages: o High out of pocket spending – a challenge to access o Government funding has increased in nominal terms – a good

development o Donor funding going down – a good indicator for sustainability

Governments commitment to the health sector is shown through increased allocations

Public health expenditure as % of total government spending

Budget allocations before and after the devolution

15.4 16.7 19.9

23.8

28.6 29.7 32.7

40.0

46

59

74

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

0

10

20

30

40

50

60

70

80

200

2/0

3

200

3/0

4

200

4/0

5

200

5/0

6

200

6/0

7

200

7/0

8

200

8/0

9

200

9/1

0

201

0/1

1

201

1/1

2

201

2/1

3

Tota

l H

ealt

h E

xpen

dit

ure,

Ksh

s B

illi

on

s

% o

f T

ota

l G

ove

rn

men

t S

pen

din

g

.

Total per capita expenditure on health has been increasing

It is currently estimated at about 66 – NHA 2012/13 against a benchmark of 60 (WHO)?

• Source: DPHK 2012

External Resources for Health: - Skewed towards one partner

- A great proportion is off – budget - A challenge on sustainability

USG

53%

Global

Fund

11%

DFID

8%

World

Bank IDA

7%

GAVI

7%

EU and

European

bilaterals

6%

UN Family

5%

Other

3%

Estimated split, FY 2012-13

35%

65%

Location of support, FY 2012/13

On-budget Off-budget

• Source: Household Health Expenditure and Utilization Survey, 2013

Catastrophic health spending – ( Households in 25 counties spend >/= 40 % of Non-food

Expenditure on Health)

Some Key Reforms and Programmes Towards UHC

Free maternity services in all public health facilities since 2013 – facility utilization has increased from 43 to 67 per cent

Free primary healthcare in all public primary healthcare facilities (about 3,300 facilities)

Major programme to equip major public hospitals across the country with modern diagnostic equipment (94 facilities) – contracts already signed with suppliers

A National Referral Strategy has been

developed and already being piloted

Some Key Reforms and Programmes Towards UHC – Cont…

Strengthening of PPP initiatives, including the Beyond Zero Campaign

Health insurance subsidies through

NHIF targeting disadvantaged groups

County governments: Provision of infrastructure and equipment

for health facilities e.g. new wards, Provision of Ambulances, Recruitment of additional health workers

High direct Out of Pocket Expenditure limiting access to the poor and highly inefficient

Government allocation to health, though increasing is still inadequate

Inefficiencies – in allocation (mismatch) and utilization

High external resource contribution:

Non-alignment / un-harmonized

Fragmented and mostly off-budget

Limited insurance/pre-payment – Less than a quarter

NHIF is the major insurer (18 – 20%) of the population

Private insurance coverage also low - < 2 per cent

Key Sector Challenges/Issues

Moving Forward - Roadmap

Increase funding to the sector through government, donors and private sector

Minimize fragmentation of financing pools – both insurance and general tax revenue

Define and provide a basic package of essential health services to be purchased from both public and private sector using pooled funds

Strengthen the National Hospital Insurance Fund to expand coverage

Moving Forward Cont…

Reform the provider payment mechanism to focus on results and efficiency (includes general tax funding)

Strengthen the quality assurance and accreditation system

Create an enabling legal and regulatory framework for both public and private sector to provide defined packages

Strong government leadership of the sector

Thank You