1. 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

2. 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

3. 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

4. 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

5. 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

6. The Financing of the
Health Sector

7. 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*
%share
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

8. 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
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
TotalHealthExpenditure,KshsBillions
%ofTotalGovernmentSpending

9. .
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)?

10. • 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

11. • Source: Household Health Expenditure
and Utilization Survey, 2013
Catastrophic health spending – ( Households in 25
counties spend >/= 40 % of Non-food
Expenditure on Health)

12. 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

13. 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

14.  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

15. 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

16. 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

17. Thank You