Kenya Health Sector Reforms and Roadmap Towards Universal Health Coverage

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

% share Where the money comes from - Who pays in Kenya? 100 1 2 11 10 80 29 20 60 40 29 36 20 30 32 0 2009/10 2012/13* 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

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 Total Health Expenditure, Kshs Billions % of Total Government Spending Governments commitment to the health sector is shown through increased allocations Public health expenditure as % of total government spending 80 70 74 8.0 7.0 Budget allocations before and after the devolution 60 59 6.0 50 46 5.0 40 30 20 15.4 16.7 19.9 23.8 28.6 29.7 32.7 40.0 4.0 3.0 2.0 10 1.0 0 -

. 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)?

External Resources for Health: - Skewed towards one partner - A great proportion is off budget - A challenge on sustainability EU and European bilaterals 6% GAVI 7% Estimated split, FY 2012-13 Other 3% UN Family 5% Location of support, FY 2012/13 35% World Bank IDA 7% DFID 8% USG 53% 65% Global Fund 11% On-budget Off-budget Source: DPHK 2012

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

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

Key Sector Challenges/Issues 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

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