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Kenya

HP+ More recent Kenya publications are available.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics. The survey provides critical evidence to inform the development of Kenya’s latest health financing strategy and policy decisions related to the future universal health coverage and the National Hospital Insurance Fund, and will support the wider national health accounts estimation process.

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • When it was established, Kenya’s Inter-Agency Coordinating Committee on Health Care Financing (ICC-HCF) was intended to provide a forum for health financing stakeholders to share knowledge, deliberate, and reach consensus on contentious issues. Yet the ICC-HCF became stalled in 2011. Shortly after, the Kenya government requested assistance from the Health Policy Project (HPP) to revitalize the forum. This brief provides an assessment on the impact of HPP’s support to the ICC-HCF, the constraints that affected Kenya finalizing its healthcare financing strategy, and offers a series of recommendations for how best to support the work of the ICC-HCF going forward.   

  • Based on the UTETEZI Project curriculum, Advocacy for Improved Access to Services for MSM: A Workshop Curriculum for a Multi-Stakeholder Policy Advocacy Project, this advocacy for policy change guide is designed for use by MSM (men who have sex with men) groups, community-based organizations (CBOs), civil society organizations (CSOs), and individuals working in HIV and MSM health to help them advocate regionally, nationally, and locally for improved HIV and health-related MSM policies. In particular, this guide can serve as an important tool for CSOs working on MSM issues in hostile legal environments.

  • Community-based models for HIV treatment and care have shown promise in some sub-Saharan countries, especially for improving patient outcomes and increasing the sustainability of the overall program. The Health Policy Project, in collaboration with the National AIDS and STI Control Programme, reviewed the state of evidence for implementing community-based approaches to care and treatment in Kenya. While some of the evidence suggests that such models can be applicable and beneficial, more data and Kenya-specific evaluations are required before concrete recommendations can be made. This brief serves a research agenda for Kenya in this regard.

  • The Government of Kenya, through the National AIDS Control Council, is developing the Kenya AIDS Strategic Framework 2014/2015 to 2018/2019 to provide guidance on the country’s priorities in HIV programming and increase the effectiveness of the national response. The framework will build on and succeed the Kenya National AIDS Strategic Plan 2010–2013 (KNASP III). To inform work on the new framework, from April to October 2014, the council collaborated on a study with the Health Policy Project (funded by the U.S. Agency for International Development and the U.S. President’s Emergency Plan for AIDS Relief). The study team examined the social, cultural, and political barriers to and facilitators of policies intended to support the four pillars in HIV programming: HIV prevention, treatment, and care and multisectoral mainstreaming. The team also considered how these barriers and facilitators, in turn, affect clients’ experience of HIV programs under previous HIV strategic plans. This information made it possible to assess the social feasibility of Kenya’s HIV programs.

  • In 2013, the government of Kenya abolished all user fees in public dispensaries and health centers. In 2015, the Health Policy Project conducted a nationally representative study to examine how the removal of user fees affected health utilization; whether facilities were adhering to the policy; how health workers and clients perceived the policy; and whether quality of service before and after the policy’s implementation had changed. This evaluation report provides findings from the study and recommendations for the successful implementation of Kenya’s abolition of user fees policy.  

  • Condom and lubricant (C/L) programming is a critical element of an evidence-based HIV prevention package for sex workers (SW), men who have sex with men (MSM) and transgender (TG) people, populations bearing a disproportionate burden of HIV in Africa. Policy impacts lubricant availability and access.The USAID- and PEPFAR-funded Health Policy Project adapted the Policy Assessment and Inventory Decision Model methodology in Burkina Faso, Togo, and Kenya to assess policies that impact SW/MSM/ TG access to services, including C/L, against international standards and best practices. This poster presents the methods and results of the study, and was prepared for the 20th International AIDS Conference in July 2014.

  • Healthcare in many developing countries, including those in sub-Saharan Africa, is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care and ensure families are not unnecessarily faced with financial catastrophe and impoverishment. Using data from the Kenya Household Health Expenditure and Utilization Surveys and descriptive analysis, the Health Policy Project, with support from USAID and PEPFAR, estimated the incidence and intensity of catastrophic healthcare expenditure and impoverishment in Kenya in 2003 and 2007. Among other findings, the Catastrophic Health Expenditures and Impoverishment in Kenya analysis revealed that in 2007 an estimated 2.5 million people were pushed below the national poverty threshold as a result of paying for healthcare. Results from this analysis provide strong evidence for the need to implement policies that offer more financial protection to the poor and vulnerable in order to achieve the country’s overall goal of universal health coverage.

  • Given the importance of effective HIV-related programs for key populations in Kenya, several government entities, donors, and stakeholders expressed the need for country-specific data on the costs of providing oral pre-exposure prophylaxis (PrEP) to prevent HIV infection. Such data would contribute to the development of evidence-based oral PrEP policies and help ensure that the required resources are made available for appropriate implementation and scale-up. In collaboration with the National AIDS and STI Control Program and the Sex Worker Outreach Program, the Health Policy Project conducted a study to address the following questions: How much does it cost to provide oral PrEP to one sex worker for a year? And, how much would it cost to scale up oral PrEP to all sex workers country-wide? The findings show that the average, annual unit cost of providing oral PrEP to one sex worker is US$602 and the total cost to extend the intervention to all HIV-negative male and female sex workers in Kenya ranges from US$24 million to US$48 million, depending on coverage from 50 to 100 percent. The report concludes with recommendations for the Government of Kenya on factors to consider when planning any future scale-up of oral PrEP.

  • Knowledge of HIV status is essential for achieving universal access to HIV services. As such, HIV testing and counseling (HTC) are fundamental elements of all HIV prevention, care, and treatment programs. As the need for HTC expands in Kenya and resources dwindle, the efficiency and effectiveness of HIV spending is of utmost importance. One method to reduce HTC costs involves re-working the testing algorithm. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct an analysis, whereby incremental costs, defined as the costs in addition to that of the current algorithm, were calculated for three newly proposed algorithms. Based on the results of this analysis, which highlights the cost savings of each option, a recommendation for a more cost-efficient algorithm was proposed.

  • The Health Policy Project (HPP) helped countries achieve their health goals by building capacity for policy, advocacy, governance, and finance at multiple levels. The project developed global tools and best practices for policy work, promoted South-South sharing and collaboration, and carried out regional and country-specific policy initiatives. The files included in this zip document provide brief program overviews for each country highlighting key accomplishments. Individual briefs are available from the country pages.

  • HPP worked with the Kenya Ministry of Health to create 47 County Health Fact Sheets that provide a county-level snapshot of selected health indicators in Kenya. They display county-specific health data and compare those data to national figures. The fact sheets bring together data from a wide array of sources and are intended to be a quick reference for a broad audience, including advocates, policymakers, health sector stakeholders, and development partners. The facts sheets were last updated July, 2015.

    You may download individual fact sheets on this page.

  • This PowerPoint presentation was used to present HPP's new DemDiv model for projecting the demographic dividend, and preliminary results for the pilot application in Kenya. It will be presented to members of the Technical Working Group in Kenya for validation, scenario development, and refinement. 

  • This brief describes the potential for a demographic dividend in Kenya, based on the pilot application of DemDiv, a new modeling tool developed by the USAID-funded Health Policy Project that projects the demographic and economic effects of interacting policy changes in the family planning, education, and economic sectors. The DemDiv model was piloted in Kenya by a multisectoral Technical Working Group chaired by the National Council for Population and Development. Four scenarios for the period between 2010 and 2050 were developed. The results show that combined family planning, education, and economic policies boost investment and employment, with GDP per capita growing more than 12 times above current levels and a potential demographic dividend of US$2,500 per person. The brief includes specific and multisectoral policy recommendations for Kenya to successfully achieve the demographic dividend.

  • The Kenya Ministry of Medical Services and the Ministry of Public Health and Sanitation, in partnership with the Health Policy Project of the U.S. Agency for International Development (USAID), convened two meetings to discuss Kenya’s devolution of power from the central government to the counties and its impact on the health sector. The second meeting on October 24, 2012, brought together many representatives of government, development partners, and other sectors who have a stake in the implementation of this significant change in Kenya’s Constitution. The participants discussed the steps the ministries of health and other government authorities have undertaken to move the devolution process along, as well as identified priority activities as part of a roadmap for going forward. This report summarizes the meeting’s proceedings and the country's key next steps.

  • In 2010, the new Kenyan constitution mandated the devolution of power to 47 counties. This process has had wide-ranging implications for the health sector in Kenya as stakeholders struggle to understand the impact of the new political structure on their programs and services. Starting in 2012, the Health Policy Project (HPP)/Kenya began working with various governmental and non-governmental stakeholders to guide public management and structural reform, in line with the devolution process. This brief gives an overview of HPP/Kenya’s role in the devolution of Kenya’s health system including supporting national level stakeholders to consider the implications of devolution; incorporating legislative guidance on decentralization into health sector planning; facilitating county-level institutional reform; and ensuring that county health management teams have the structures necessary to respond to the challenges of devolution. Finally, the brief highlights challenges to the devolution process and illustrates how the Government of Kenya, HPP/Kenya, and other key stakeholders are working together to overcome these challenges.

  • The Health Policy Project assembled this directory to help government agencies, development partners, and other local and international organizations identify Kenyan institutions with the skills and experience to support their health policy, finance, and governance needs. The directory is also designed to promote information sharing among the institutions it lists, as well as collaboration and partnerships, both international-local and local-local. The capabilities and accomplishments of 14 Kenyan organizations and consulting firms are highlighted, along with their mission, program and geographic areas, and contact information.

  • Family planning (FP) advocacy plays a key role in policy development. Despite a significant body of evidence-based advocacy promoting family planning, there are few systematic studies on decisionmakers’ opinions of such advocacy; how advocacy and evidence are used by decisionmakers; what types of evidence and advocacy are persuasive from the perspective of decisionmakers themselves; and how and why decisionmakers support FP policies. This USAID-funded Health Policy Project study was designed to address these issues. The findings draw from structured interviews in three countries: Ethiopia, Kenya, and Malawi.

  • The 2013 Kenya Household Health Expenditure and Utilisation Survey (2013 KHHEUS), explores the health-seeking behavior, use of healthcare services, out-of-pocket health spending, and health insurance coverage of Kenyan households. The first health survey to take place since Kenya decentralized its government; the 2013 KHHEUS collects data from the country’s 47 newly-created counties. By interviewing members of 33,675 households and comparing results with those of previous years (2003 and 2007), the 2013 survey provides important insights into how healthcare utilization, spending, and insurance coverage have changed in Kenya over the past decade. This brief summary highlights the key findings from the survey which will be used to inform Kenya health and health financing policy and will support the national health accounts estimation process. The 2013 KHHEUS was conducted by the Kenya Ministry of Health with support from the USAID-funded Health Policy Project and in conjunction with the Kenya National Bureau of Statistics.

  • Tackling undernutrition and achieving food security will require cross-sector collaboration, innovative approaches, and optimizing the use of all available interventions. In 2014, the USAID-funded Health Policy Project conducted two reviews of the empirical evidence on the impacts of one intervention—family planning—on food security and nutritional status, respectively. 

    This brief on nutrition shows that when women exercise their freedom and right to access voluntary family planning to meet their fertility intentions, there is a natural decline in the prevalence of high-risk and unintended pregnancies; and that by averting such pregnancies, improvements in key maternal, infant, and child nutrition outcomes can be achieved. 

    The accompanying report is available here, and a companion brief on food security is available here.

    Also see the companion desk review synthesizing the programmatic experiences of integrating family planning with food security and nutrition. It was conducted by the Food and Nutrition Technical Assistance III Project (FANTA) and is available here: http://www.fantaproject.org/focus-areas/food-security/desk-review-programs-integrating-family-planning-food-security-and-nutrition. 

  • The USAID-funded Health Policy Project applied its new ImpactNow model to estimate the near-term benefits of achieving family planning goals in Kenya. This brief describes some key benefits associated with achieving these goals, and offers recommendations for the government of Kenya and development partners to increase investment in and improve family planning services in the country.

  • In June 2013, President Uhuru Kenyatta of Kenya announced policies to remove user fees in dispensaries and health centers and to provide free maternal health services in all public health facilities. This report presents the findings of a study conducted in Kenya by the USAID-funded Health Policy Project (HPP) to establish baseline measures for evaluating the impact of these policies. The Kenya Ministry of Health, with support from HPP, identified the need to monitor and evaluate the impact of the policies on utilization, service provision, and revenue collection, among other indicators.

  • The Kenya AIDS Strategic Framework 2014/15–2018/19 (KASF) is the overarching strategic document guiding the HIV response in Kenya’s devolved governance system. The implementation of KASF goals will contribute to the achievement of Vision 2030 targets by ensuring universal access to comprehensive HIV prevention, treatment, and care. Kenya has also committed to reaching UNAIDS’ ambitious 90-90-90 targets by 2019. These targets call for 90 percent of all people living with HIV (PLHIV) to know their status, 90 percent of those diagnosed to be on antiretroviral therapy (ART), and 90 percent of people on ART to be virally suppressed. Several resource gaps for HIV programs have been estimated in the past. This brief attempts to harmonize the methodologies used in estimating HIV commodity gaps in the past. To do so, major stakeholders (Clinton Health Access Initiative, National AIDS & STI Control Programme, and National AIDS Control Council) were consulted in arriving at the assumption and targets used in the resource-gap estimation model. In this model, two scenarios are considered: financial needs for key commodities under the current guidelines, and a more ambitious “scale-up” scenario. In addition to harmonizing the way Kenya estimates HIV commodities gaps, the model will also support the mobilization of resources toward attaining the 90-90-90 targets.

  • As part of the USAID-led PEPFAR Sustainable Financing Initiative to increase domestic resources for HIV, the USAID- and PEPFAR-funded Health Policy Project created 31 macro-fiscal and health financing profiles for 18 countries that are transitioning to a higher income status, have high HIV burdens, and/or rely heavily on donor funding. These country profiles assess past trends and future projections in key indicators related to a country's ability to grow economically and dedicate more financial resources to health, including HIV.

    The macro-fiscal profiles provide overviews of each country's economic growth, political economy, and government revenue and expenditure. The health financing profiles analyze government, external, and out-of-pocket spending on health; health financing functions, including revenue contribution and collection, pooling, and purchasing; and HIV financing trends.

    You may download individual briefs on this page.

  • The USAID- and PEPFAR-funded Health Policy Project (HPP) in Kenya helped the Ministry of Health (MOH) secure an allocation of KSh 2.9 billion (approximately US$30 million) in the 2015/16 national budget to purchase HIV commodities and other strategic health commodities. Of this, US$21 to 23 million will go to purchase antiretroviral drugs (ARVs) and HIV testing kits. The remainder will supplement the purchase of malaria and tuberculosis commodities. HPP also helped secure the reinstatement of a line item for an annual allocation for HIV commodities in future national budgets. HPP is also working with private sector pharmacies and hospitals to stock ARVs that can be accessed by those who can afford them. As part of this initiative, the Kenya Medical Supplies Authority has already earmarked ARVs for 10,000 patients to help trigger sales. Innovative efforts, like increasing ARV sales in the commercial sector, can further enhance the sustainability of Kenya’s HIV program and increase access to ARVs and HIV services for those who cannot afford private care.

  • Kenya’s Health Sector Intergovernmental Forum (HSIF) brings together health sector managers from national and county governments, the Public Service Commission, the national treasury, and development partners to share experiences in managing devolved health services. In October 2014, the Health Policy Project/Kenya supported a two-day meeting of the HSIF to deliberate over issues affecting health service delivery under devolution, including management and financial inefficiencies. Published by the Government of Kenya, this report presents a summary of the meeting.

  • In order to expand and ensure widespread access to healthcare services and protect households from what are termed "catastrophic" health expenditures, Kenya needs alternative and sustainable healthcare financing mechanisms. The Health Policy Project supported the government of Kenya to analyze the long-term health delivery costs and health financing options available to the country. Employing a number of economic and health financing tools, the analysis, Healthcare Financing Options for Kenya: FY 2013/14–2029/30, revealed a need to increase domestic financing and improve the efficiency of the service delivery and social health insurance systems. Results from the analysis will be used to support the country’s move toward universal health coverage.

  • In 2010, Kenya adopted a new constitution which both guaranteed the right to health and devolved health service delivery to Kenya’s 47 counties. A few years later, in 2014, counties became responsible for delivering health services. Although funding to support service delivery has also been devolved to the counties, it remains inadequate for county health needs, forcing the health sector to compete with other priority sectors for scarce resources.

    To help County Departments of Health secure greater allocations for the health sector, this how-to guide provides a summary of each of the main stages of the budget cycle and key milestones, suggests actions that county leaders can take during the budget process to influence county budgets, and highlights some of the potential bottlenecks at each stage. 

  • A new study released by the Health Policy Project, examines the experience of stigma and discrimination among male and female sex workers and how these experiences affect sex workers’ utilization of health services. Measuring the prevalence of four types of stigma: anticipated, witnessed/heard, experienced, and internalized; the study revealed that over 80 percent of male sex workers and over 70 percent of female sex workers avoided or delayed needed health services in the year preceding the survey. This and other findings provide critical evidence for the need to address stigma and discrimination to both improve health outcomes of and control the HIV among the key populations most affected by HIV.

  • To generate evidence to support Kenya’s investment in family planning and motivate elected leaders and decisionmakers at the national and county levels to act, Kenya’s National Council for Population and Development (NCPD) and the USAID-funded Health Policy Project (HPP) applied the ImpactNow policy model. The Microsoft Excel–based model uses different scenarios to quantify the short-term health and economic benefits of family planning. Since most existing models focus on the long-term gains of increased family planning uptake, ImpactNow fills an important knowledge gap in family planning policy and advocacy.

  • The USAID-funded Health Policy Project applied its new ImpactNow model to estimate the near-term benefits of achieving family planning goals in Kenya. This PowerPoint presentation describes some key benefits associated with achieving these goals, and offers recommendations for the government of Kenya and development partners to increase investment in and improve family planning services in the country.

  • This brief, produced by the USAID- and PEPFAR-funded Health Policy Project, provides an introduction to conditional grants and how Kenya can use them to strengthen its health systems during the transition to a devolved system of government and a decentralized health infrastructure.

  • This report by the USAID- and PEPFAR-funded Health Policy Project provides and introduction to conditional grants and describes how Kenya can use them to strengthen its health systems during the transition to a devolved system of government and a decentralized health infrastructure.

  • This USAID- and PEPFAR-funded Health Policy Project report synthesizes the findings of the County Health Accounts (CHAs) of 12 selected counties for financial years (FY) 2013/14 and 2014/15. The 12 counties are Bomet, Isiolo, Kakamega, Kisumu, Makueni, Migori, Mombasa, Nairobi, Nyeri, Siaya, Tharaka Nithi, and Turkana. The report compares health expenditures in the 12 counties to provide evidence of a pattern for sources and uses of health funds. It pays special attention to key financing sources for healthcare, the role of financing agents in managing healthcare funds, providers of healthcare goods and services, and the services purchased with these funds.

  • In March, the Kenya Ministry of Health convened an international consultation forum in collaboration with the World Bank Group and the United States Agency for International Development (USAID) through the Health Policy Project to deliberate on the challenges of providing universal health coverage (UHC) to all Kenyans, regardless of their ability to pay, and to explore strategic and sustainable health financing options. The Kenya Health Policy Forum reviewed options and lessons learned from other countries, and proposed recommendations on how the country can improve efficiency to achieve UHC.

    The meeting brought together local and international experts with diverse expertise spanning the health sector, including both the public and private sectors. Participants from Kenya included representatives from both levels of government, nongovernmental organizations, faith-based organizations, and the private sector. International speakers shared experiences from Brazil, Ethiopia, Ghana, India, and Mexico. Development partners who support Kenya’s health sector were also represented, including the USAID, the UK Department for International Development, the German Federal Enterprise for International Cooperation, and the World Bank.

  • Published by the Kenya Ministry of Health, the Kenya National Health Accounts 2012/13 (NHA 2012/13) details the flow of resources in the country’s health sector. The NHA 2012/13, which tracks who provides goods and services and how resources are distributed across the health system, presents data by total health expenditure and by major disease area. Findings from the NHA 2012/13 will help to inform policy processes and form the basis for policy dialogue in health financing.

  • This poster was presented at the 20th International AIDS Conference in Melbourne, Australia, in July 2014. It summarizes a study of HIV-related stigma and discrimination, which pose barriers to accessing HIV testing and treatment services and, in healthcare settings, can be especially damaging for people living with HIV (PLHIV). This cross-sectional study is part of a collaboratively funded global effort led by the USAID- and PEPFAR-funded Health Policy Project to develop a brief stigma-measurement tool for health workers. This tool allows assessment and monitoring of stigma in healthcare settings. 

  • The Policy Analysis and Advocacy Decision Model for Services for Key Populations in Kenya provides stakeholders—including policy makers, service providers, and advocates—with tools to assess and advocate policies that govern accessibility and sustainability of services for key populations (men who have sex with men, sex workers, people who inject drugs, and transgender people). By comparing existing Kenyan policies to the global normative guidelines and best practices, the model reveals gaps and challenges in implementation. This document, prepared by the USAID and PEPFAR-funded Health Policy Project for the National AIDS Control Council of the Ministry of Health, analyzes more than 120 policy and program documents related to HIV and key populations.  It also makes policy recommendations for enhanced service scale-up and uptake by key populations in Kenya. 

  • To improve understanding of political will for the devolution of Kenya’s health sector, the USAID- and PEPFAR-funded Health Policy Project (HPP) conducted a series of semi-structured interviews with key informants in January 2015—involving the national government, three county-level governments, and consultants—to explore what incentives are driving political will for the devolution of Kenya’s health sector. HPP found that the desire for improved health outcomes is one of many factors driving political will for health sector devolution. The need to meet constituents’ and political stakeholders’ expectations also influences political will. A greater understanding of the various factors that influence political will can help the national government take a leadership role to incentivize and encourage counties to make decisions for improving health outcomes, and move devolution forward.

  • HIV, hepatitis A, hepatitis C, and syphilis are all transfusion-transmissible infections that can arise from the use of unscreened blood. In collaboration with Kenya's National Blood Transfusion Services (NBTS), the Health Policy Project examined the current status of blood screening in Kenya and two key steps that could help reduce the risk of transmissible infections. Relevant research questions revealed that Kenya, like other sub-Saharan African countries, needs to completely screen, in both facilities and donation centers, the blood of all family replacement donors as well as voluntary donors. It also needs to increase the total supply of screened blood to meet the needs of a growing population. This brief summarizes the analysis conducted, presents the cost-benefit results of completely screening the existing blood supply (in terms of infections averted), and outlines cost-efficient steps for increasing the total screened blood supply.

  • Like many sub-Saharan African countries, Kenya is exploring the adoption of the World Health Organization Option B+ strategy as the standard of care for its program to prevent mother-to-child transmission of HIV. The Health Policy Project (HPP) was invited by the National AIDS and STI Control Programme (NASCOP) to help conduct a cost-effectiveness analysis of scaling up Option B+ versus other strategies. Results of the analysis suggest that implementing a scale-up of Option B+ will avert infant and adult infections but at a significant additional cost. Kenya should consider these results to assess whether Option B+ is affordable given the available resources.

  • The public expenditure tracking survey with service delivery indicators (PETS-Plus) survey was a comprehensive exercise conducted in 2012 by the Ministry of Health, Kenya in collaboration with the USAID- and PEPFAR-supported Health Policy Project, Kenya Institute of Public Policy Research and Analysis, the World Bank, and the Kenya Medical Research Institute. The PETS-Plus combines the expenditure tracking surveys previously conducted in Kenya with health service indicators (SDI) to provide a comprehensive view of health facilities' overall performance and the impacts of key policy reforms in the sector. Data collected from 294 sampled facilities across 15 counties provide information on the adequacy of infrastructure, medical equipment, medical drugs, human resources for health, and financial planning and management at the facility level. Levels of adherence to key health financing policies on user fees (10/20 policy) and the Health Services Sector Fund/Hospital Management Service Fund (HSSF/HMSF) were also measured, providing critical insights into levels of readiness for devolution in the health sector and the implementation of policies such as free maternal healthcare and removal of user fees at the primary level. 

    Results of the survey suggest that counties in Kenya need to pay urgent attention to essential drug availability and improve human resource levels by reducing absenteeism and through redeployment. Access to IT equipment and electronic data record systems is needed. Adherence to past user fee policies has been non-uniform, suggesting that implementation of current user fee removal policies should be carefully monitored, and the delivery of HSSF/HMSF funds needs to be improved and strengthened. The PETS-Plus report is supported by three focused policy briefs that examine the results from different perspectives, diving deeper into the findings: effective implementation of the health financing policies; quality of primary healthcare services (using the SDI results); and county readiness for healthcare delivery (a comprehensive look across health inputs). These briefs are available on this page alongside the main report.

  • The OneHealth Model (OneHealth) is a tool for medium term (3 to 10 years) strategic planning in the health sector at the national level, ideally suited for public sector planners. It estimates the costs by disease program, as well as estimating the costs of utilizing the health system building blocks in delivering the targets involved in the disease programs. In Kenya, at the request of the Ministries of Health, HPP provided technical assistance in applying OneHealth to cost the Kenya Health Sector Strategic Plan III, 2012-2017, reflecting the interventions under the Kenya Essential PAckage of Health, as well as national disease strategies for programs that include HIV/AIDS, tuberculosis, malaria, non-communicable diseases, maternal, reproductive and child health, etc. The results include an assessment of the overall financial gap between resources needed and the government and donor resources available for all years of the analysis. This brief is intended for a policy audience in Kenya to support sustainable health sector planning, and may be of interest to other countries in the region who wish to apply OneHealth or similar approaches to assessing costs and financial gaps.

  • In 2013, each of Kenya’s 47 newly established county governments created a county department of health (CDOH) to oversee the delivery of health services, as outlined out in Schedule IV of the 2010 Constitution. To deliver health services and meet the challenge and promise of devolution, county governments require strong and accountable departments of health. As they strive to create effective governance and financing mechanisms, these departments can benefit from the experiences of other county governments. Counties have attempted to create new health management structures that provide strong organizational management.Unfortunately, many of these efforts have been weakened by political intransigence, entrenched interests, and bureaucracy. Mombasa County, however, overcame these hurdles to create a unified CDOH with defined staffing structures aimed at achieving a clear set of objectives. This brief reviews the factors that made this organizational restructuring possible.

  • Kenya's Health Sector Coordinating Committee, a joint forum of government and development partner representatives, commissioned a study in late 2012 to determine the implications of a lack of Global Fund resources for Kenya related to HIV, tuberculosis, and malaria. Conducted in 2012, and later revised in 2013, the assessment was carried out by Health Policy Project in partnership with the German technical support agency, GiZ. The study analyzes changes to the Global Fund, (e.g., the New Funding Model) and considers Kenya’s policy risks related to future Global Fund resources. The risk analysis also includes projected financial gaps for the three diseases and set of policy recommendations to the Government of Kenya to mitigate the risks of a decline in Global Fund resources and the potential challenges of implementing grants under the New Funding Mechanism.

  • The 2013 general election in Kenya took place on March 4, 2013, giving citizens a chance to elect new leaders, including a new President, for a five-year term. To help maintain and further progress in the health area, the Health Policy Project documented the pledges, commitments, and promises made by the 2013 presidential candidates about the health sector in Kenya. This report outlines what the candidates and their parties promised to do about different health issues and how these promises align with current health sector aspirations described in the government’s existing short- and long-term policy and planning documents. The goal is to provide stakeholders in the health sector with a reference point from which to hold the incoming government accountable on its public promises and a tool for advocacy in pursuing further commitments that can improve the public health sector.

  • The National AIDS and STI Control Programme (NASCOP), a department of the Ministries of Health, Kenya, is considering a major change to the process in which clinical health workers in the public sector are provided training on HIV/AIDS. This involves a new, harmonized HIV curriculum and a related process involving self-learning, placement (off-site face-to-face interaction with mentors), ongoing clinical practice, and ongoing mentoring. NASCOP and the Health Policy Project collaborated to analyze the potential efficiency gains of the harmonized curriculum process over a past practice of uncoordinated off-site trainings and limited mentoring for health workers. The analysis included comparing the cost of different methods to provide ongoing mentoring. Results suggest that the harmonized curriculum process will save significant resources for Kenya, and a district-based mentoring process will be an efficient choice. The brief provides evidence to support the policy change and is also instructive for training discussions in other vertical programs.