Over the past several decades, Kenya has become one of East Africa's major economic hubs, making steady progress in addressing its population’s health needs. While the country has made changes to its governance structure to give greater authority to citizens and the local government entities that represent them, development has been uneven. Inequalities persist between the wealthy and the poor, urban and rural dwellers, and men and women. This leaves many with minimal access to high-quality healthcare or social services; costly out-of-pocket healthcare expenses impoverish thousands of Kenyan households every year. While nearly 64 percent of the 1.6 million people living with HIV are on antiretroviral therapy, in the face of declining external support, Kenya needs to mobilize more domestic resources for HIV and other core priority programs to further expand access to care. Both national and county governments are struggling to increase health resources amid competing needs from other sectors.
HP+ is using multiple strategies to boost sustainable health financing and strengthen health systems management in Kenya and throughout the East Africa region. These include generating new evidence to inform decision making, catalyzing national dialogue, building country-level capacity, developing new policies and guidelines, and mobilizing domestic resources for HIV and family planning. Specifically, we:
Generate evidence and advocate for health funding and core priority programs at national and county levels to increase sustainable financing and domestic resource mobilization for Kenya's health sector
Strengthen national and county linkages to facilitate planning for Kenya's health financing, policy development, and governance initiatives—with the goal of ensuring that health gains are sustained
Improve public financial management and fiscal transparency and accountability by strengthening the capacity of county government staff in budgeting, resource tracking, and budget advocacy
Support the Kenya government to enhance the participation of the local private sector in offering critical HIV services as part of a shared responsibility to provide sustainable health services
Assist regional health networks to develop a policy and legal instrument for promoting the uptake and portability of health insurance among East African Community member states in an effort to reduce high household out-of-pocket expenditures
Increased Budget Absorption for Family Planning Commodities Commended in Kenya
August 2022 —
The family planning logistics technical working group in Kenya commended the Ministry of Health’s Division of Reproductive and Maternal Health in July 2022 on significantly improved absorption of budget allocated for family planning commodities. The working group noted that for the first time, the division had absorbed all funding allocated to the family planning budget line, opening an opportunity to mobilize more funds from the national budget. Previously, poor absorption of family planning funds by the ministry had affected forecasting and quantification for the next year, with unspent funds in any year leading to a reduction in allocation for the next year. HP+’s support to track family planning allocation and the transfer of funds for the procurement of essential commodities helped the division locate and spend funding in a timely manner and avoid having the funds reallocated to other programs. At a meeting of the family planning logistics technical working group it was noted that HP+ support also enabled the division to harmonize various funding streams and procure commodities more efficiently.
Increased Government Funding for Family Planning in Kenya
June 2022 —
In Kenya, HP+ helped national and Mombasa county government actors in 2021 and 2022 make a strong investment case for family planning during the country’s elaborate budget process. Despite decreased revenue due to COVID-19, government allocation for family planning commodities went up by about 38 percent from FY 2021/22 (about US$8.2 million) to FY 2022/23 (about US$11.3 million). Mombasa county allocated its first domestic family planning funds for FY 2022/23, around US$46,000 (KES 5.4 million). With HP+ support, Mombasa county government officials also defined priority family planning activities and a family planning commodity security action agenda.
Kenya Ministry of Health Posts National and Country Health Budget Analysis
June 2022 —
The Kenya Ministry of Health, for the first time, published the National and County Health Budget Analysis, FY 2020/21 to its public website, demonstrating the importance of this report in providing evidence for the country’s health sector resource mobilization and health planning and budgeting efforts. HP+ supported Kenya’s Ministry of Health to develop the analysis report, which examines how public health sector financial resources were allocated for the 2020/21 fiscal year in comparison to the allocation patterns of the preceding two years. Findings show that while Kenya has not yet attained the recommended allocation to health contained in the Abuja Declaration, the government has made significant progress, increasing allocation to 11 percent of the total government budget in 2020/21, from 7.5 percent allocated in 2014/15. Continuing this trend will help Kenya progress toward achieving sustainable financing for health and reduce dependence on external assistance. Other findings show that county governments spend the majority of their funds on the payment of staff salaries, which can limit funds available for other key inputs such as drugs. Further, county governments allocate more funding to curative care than to preventive and promotive care. These and other findings in the report provide evidence for national and county policymakers and decisionmakers to inform public health budget allocation planning at both the national and county level. The report is also available on the HP+ website.
HP+ Kenya Gathers County and National Stakeholders for EOP Event
May 2022 —
Kenyans from national and county government, donor organizations, and stakeholders gathered in Nairobi and online May 24 to celebrate seven years of work by Health Policy Plus (HP+). The event marked the tangible results of the project in HIV and malaria response, family planning, maternal health, capacity building at the national and county levels, and sustaining work throughout the COVID-19 pandemic. Several speakers noted that HP+ helped Kenya adapt to the 2010 mandate that healthcare services and governance would shift from the national government to Kenya’s 47 county governments. David Khaoya, country director for HP+ in Kenya moderated the session that included invited dignitaries from USAID Kenya, the Ministry of Health, the Council of Governors, and the leadership of the County Executive Committee (CEC) health caucus, along with project director, Dr. Suneeta Sharma. Kisumu County assistant director of medical services, Dr. Kennedy Otieno, remarked that HP+ strengthened their capacity to analyze data to the extent that Treasury counterparts began requesting county guidance on financial analysis. “I really appreciate HP+ and the funders for this program, for democratizing esoteric information for so many technical officers…This reversal of roles has really enabled the county departments, especially Kisumu, to realize the potential of planning, especially financial planning, for service delivery.”
HP+ Support Contributes to Increased Budget Requests for Health Programs in Kenya
February 2022 —
During Kenya’s budgeting process for fiscal year 2022/23, HP+ provided technical assistance to the national strategic health programs (HIV, malaria, and reproductive, maternal, neonatal, child and adolescent health) to secure increased budget allocations to finance their priorities. During the budgetary discussions, program teams presented implementation priorities and defended their budget proposals before a resource allocation panel convened by the National Treasury. HP+ supported the program teams to develop their annual budget plans and justification summaries for their proposed budgets. The final budget proposals from all ministries will be consolidated and submitted to the national legislative assembly for approval in March 2022. In the previous year, similar efforts by HP+ led to increased allocations. If approved as submitted, the programs will receive increased allocations compared to the prior year. For example, the reproductive, maternal, neonatal, child and adolescent health/family planning program will receive KES 990 million, an increase from KES 863 million allocated in FY 2020/21
Kenya Launches HP+-Supported Health Financing Strategy
February 2022 —
President Uhuru Kenyatta launched the 2020–2030 Kenya Health Financing Strategy during the Annual Universal Healthcare Conference on February 7, 2022. The launch signals the government’s commitment to reform the health sector and achieve sustainable, high-quality services for all Kenyans. Among other priorities, the strategy recommends instituting mandatory pre-payment revenue generation from health insurance premiums, replacing out-of-pocket payment at the point of service, guided by fairness and affordability for different income levels. (This recommendation was adopted in a 2022 amendment to the National Health Insurance Fund Act, which has made membership in the fund mandatory for all Kenyans 18 years of age and above.) HP+ provided technical assistance to the Ministry of Health to develop and finalize the strategy, including facilitating stakeholder engagement and advocacy, generating evidence to inform policy priorities, and assisting with drafting the document. HP+ also supported the ministry to develop a communications and advocacy plan, an abridged version of the strategy, frequently asked questions, and a poster to facilitate dissemination. Read more about HP+’s support, lessons learned, and recommendations, including an interview with HP+ Kenya staff Stephen Muchiri and David Khaoya.
Kenya’s Turkana County Supports HIV and Reproductive Care Funding
September 2021 —
Turkana county health leaders pledged to reinstate budget lines for HIV (Ksh 500,000), as well as restore subprogram budget lines for reproductive, maternal, neonatal, child and adolescent health care (RMNCAH) (Ksh 6.4 million) interventions. As HP+ supported the Turkana County Department of Health to hold consultative discussions with the County Treasury, it presented data to illustrate how the county historically underfunded these programs and over-relied on donor support. It advocated for the county to not only finance these critical interventions, but also realign the county budget to a program-based budget approach and ensure they receive the money budgeted to them. These funds, once implemented, will support community-based interventions such as psychosocial support and adherence counseling, as well as nutrition, immunization, and reproductive health services. By improving service delivery and institutionalizing the funds for these interventions, the county aims to improve health outcomes across HIV and RMNCAH. Moving forward, HP+ will continue training county teams to monitor fund absorption and generate evidence to advocate for subsequent increased budget allocations. In doing so, it will strengthen the county’s capacity to efficiently allocate and execute its budgets as well as generate and use evidence to advocate for and promote sustainable financing of the key disease programs.
Religious and Community Leaders Take on Family Planning in Kenya Radio Program
September 2021 —
A radio station based in Kenya’s southeastern coast recently hosted a live family planning discussion between a Muslim leader and a local Kilifi County government official. HP+ helped arrange for the interviews and discussed key talking points with the presenters. The discussion on Lulu FM between Muslim leader Ustadh Rashid and Kilifi County reproductive health coordinator Ken Miriti highlighted collaborative efforts between the county government and religious leaders to promote uniform messaging for family planning among interfaith communities in Kilifi. Kilifi County has among the lowest modern contraceptive uptake rates in Kenya and religion and cultural issues were identified in the county’s costed implementation plan as key contributing factors. Faith leaders in the area use different avenues to address existing myths and misconceptions about family planning through the lens of religious norms and beliefs. HP+ has fostered joint accountability between the county government and faith leaders from Christian and Muslim communities to implement family planning interventions. Throughout the COVID-19 pandemic, HP+ has supported this strong network of interfaith leaders from Christian and Muslim communities in Kilifi County to be more involved with family planning. HP+ will continue to support the Department of Health to engage with more leaders from established faith networks, to sensitize them on family planning, and enlist them as family planning champions in their communities.
County Governments in Kenya Adopt HP+ Recommendation to Institutionalize Health Planning Units
August 2021 —
Kenya’s Council of Governments, a consultative forum of all 47 county governors, recently adopted an HP+ recommendation to put in place county health planning units (CHPU) that will support health planning and budgeting. HP+ played an instrumental role in designing the CHPU model with the National Treasury and Council of Governments and promoted it with county health leaders. Once established, these units will help county governments streamline budget planning and implementation, generate evidence on health budget performance, track health financing indicators, and advocate for further increases in budget allocations for health. This will help counties meet the complex set of requirements and timelines outlined by Kenya’s Public Finance Management Act of 2012 that counties have struggled with, often resulting in poor prioritization of needs, loss of allocated funds, and missed opportunities to sustain increased budget allocations for HIV, family planning and reproductive health, and malaria. HP+ will provide technical assistance to USAID’s focus counties to establish the CHPUs with the goal of strengthening local capacity and promoting domestic resource mobilization.
HP+ Supports Kenya to Secure More Than US$440 Million from Global Fund
August 2021 —
The government of Kenya and the Global Fund to Fight AIDS, Tuberculosis and Malaria recently kicked off a three-year, US$440-million project to combat these diseases over the next three years. The Global Fund grant, executed in July, will enable Kenya to implement activities in HIV, tuberculosis, and malaria, as well as cross-cutting areas such as integrated service delivery and quality improvement, human resources for health, financial management systems, and health sector governance and planning. HP+ developed and implemented methodologies to cost the proposed interventions and identify counties that meet the co-financing requirement. HP+ also conducted the HIV funding landscape analyses and developed the malaria program’s plans for sustainability, transitioning, and health financing. With the Global Fund grant, Kenya will bring more HIV-positive clients into antiretroviral treatment with a goal of reaching 90 percent coverage by June 2025 and expand distribution of insecticide-treated nets, benefitting 21.6 million people. It will increase intermittent preventive treatment of malaria in pregnancy, and enhance community-based systems for service delivery, among other interventions. The government of Kenya and partners AMREF Health and Kenya Red Cross will implement grant activities and pursue a transition to sustainable financing.
Kenya Launches National Health Strategy
July 2021 —
The Kenya government officially adopted in July the 2020—2030 Kenya Health Financing Strategy, which provides direction on how the nation will mobilize resources to finance health services to improve access for all. HP+ supported the Ministry of Health this year in revising a draft of the strategy to accommodate new government policies and reflect new research evidence on healthcare financing since the previous version was developed in 2015/16. The strategy outlines how the country aims to achieve universal health coverage and increase access to services for all through strengthened health systems. When fully implemented, the strategy will help Kenya deliver quality care for all and increase the proportion of the total population covered under mandatory prepayment schemes to 85 percent. The strategy also calls for the government to increase its spending on health to 13 percent of total government spending. A national launch of the strategy is planned in the coming months followed by rollout of the interventions, including development of legal and structural instruments and other supportive systems for implementation of the KHFS. HP+ will provide technical assistance to the MOH to organize the launch, design communication and advocacy activities, and support stakeholder engagement on proposed health financing reforms.
Staff and Partners Share HP+ Results and Lessons Learned at the International Health Economics Association Meeting
July 2021 —
Sessions on presenting evidence and ideas on public financial management, the health impacts of COVID-19, and health insurance financing were among those delivered by HP+ researchers at this year’s International Health Economics Association (iHEA) online congress. Representatives from HP+ Kenya, Malawi, and Nigeria hosted an organized session on the need for a strong public financial management system and the challenges faced by many countries in delivering better spending in their journeys toward universal health coverage. HP+’s Rebecca Ross collaborated with the London School of Hygiene and Tropical Medicine to convene an organized session, presenting results from a mixed method study on the impact of Indonesia’s national health insurance scheme on the competitive landscape of public and private healthcare providers. View HP+’s sessions.
Kenya Pivots to Maintain Project Delivery During Pandemic
July 2021 —
HP+ Kenya is successfully reshaping its approaches to keep project activities running in the face of COVID-19 restrictions and, in the process, strengthening capacity and implementing sustainable processes that appear likely to outlive the current pandemic. HP+ has been adapting to the restrictions on movement imposed by the COVID-19 pandemic by training local county teams in data collection and analysis as well as planning and budgeting using virtual trainings. For example, HP+ trained a Kajiado County government representative on data collection of the geocodes required to map antiretroviral treatment sites and private pharmacies. Instead of recruiting independent research teams and sending them to the field, this alternative minimizes movement of people and strengthens capacity of local county staff.
Home-Based Care Guide for COVID-19 Adapted by Uganda
July 2021 —
Uganda has adapted an HP+-produced COVID-19 guide in support of the 75 percent of cases in the country that can benefit from home care. The document can guide health workers, village health teams, caregivers, patients, and family members on how to effectively implement home-based care activities and manage the disease. The adaptation was spearheaded by the USAID Uganda Health Systems Strengthening Activity and the USAID Social and Behavior Change Activity with the Uganda Ministry of Health.
Webinar Features Subnational Financial Management Strengthening in Kenya and Mozambique
June 2021 —
With special guests from the Center for Global Development, USAID Kenya and Mozambique, the Kenya School of Government, and the Mombasa Department of Health, HP+ convened an online discussion,The State of the Art in Health Financing Reform, on strengthening public financial management (PFM) in health at sub-national level as an enabling environment to advance meaningful progress towards universal heal coverage (UHC) and ensuring sustainable and adequate domestic public financing for the health sector. This discussion, featuring program-based budgeting innovations at the county level in Kenya and Mozambique and emphasis on innovative information systems and digital solutions in Mozambique, stressing the importance of capacity strengthening at local levels as an important component in strengthening efficiency, transparency, and accountability of health resources, as well as improving access to quality health care services. Sanjeev Gupta of the Center for Global Development set the scene for the discussion stressing the need to both increased funding and improved spending. Andrew Rori, the Deputy Director of Learning and Development at the Kenya School of Government, and an HP+ Kenya partner discussed the importance of building the capacity of county-level health officials at all stages of the budget cycle. Dhimn Nzoya of USAID Kenya and Adriano Nhabanga of USAID Mozambique shared USAID’s goals to catalyze domestic resource mobilization and capacity strengthening for long-term sustainability.
Policy Action in Kenya Encourages Local Malaria Control Funding
May 2021 —
At a meeting of the Lake Region Economic Bloc (LREB) last week, representatives proposed progressively increasing malaria control county budget allocations to procure at least 10% of their malaria commodities and supplies. This reflects a key HP+ health financing recommendation for malaria control in the eight bloc counties that are a focus of the President’s Malaria Initiative. In Busia, Bungoma, Vihiga, Homa Bay, Kakamega, Kisumu, Migori, and Siaya counties, HP+ analysis showed that underfunding for malaria control has persisted even as overall county health budgets have increased. HP+ data further showed that over the years in these eight counties, there has been low absorption—actual spending—of malaria control funds coupled with heavy reliance on donor funding for key malaria commodities. The evidence on funding will be used to inform county priority-setting in these counties, which are located in an endemic malaria zone and participate in the LREB.
Knowledge Success Blog Features New Tool to Advance Family Planning Health Equity
March 2021 —
HP+ has produced a tool that expands the definition of conventional inequities in family planning to include such concepts as quality of care and access to information and services. In a blog post published by Knowledge Success earlier this month, HP+ shared the Family Planning Equity Tool, which goes beyond the traditional metrics of family planning inequality such as contraceptive uptake. Application of the tool in Uganda suggests that unmarried and less-educated women may be underrepresented in traditional measurements of family planning inequality.
Key Health Programs in Kenya Retain Allocations Despite Constrained National Budget
March 2021 —
HP+ has helped the Kenya Ministry of Health retain its current allocations for national HIV, malaria, and reproductive health programs into the next fiscal year even in the face of economic constraints due to COVID-19. HP+ provided technical assistance to the Ministry of Health program teams to develop budget justification memos that supported the need to continue to fund these programs. The memos were used during the sector performance review and resource sharing process, helping to ensure that each program is able to continue supporting its respective critical disease area. In preserving budget allocations despite a tightened fiscal space, the health programs established their continued importance among the nation’s priorities, allowing Kenya to maintain stewardship and accountability for funding these programs. The FY 2021/22 funding for HIV, malaria, and reproductive, maternal, newborn, adolescent, and child health programs is US$12 million, $8 million, and $8.63 million, respectively.
Field, Kenya, Health
Domestic Resource Mobilization
Local Leaders in Kilifi County, Kenya, Create Messaging to Promote Family Planning
March 2021 —
Community and faith leaders have come together in Kilifi County, Kenya, to craft uniform, consistent messaging in support of family planning. At a workshop in February convened by HP+, the leaders developed messages they will use to advance family planning in their communities through their respective forums. One message, for example, posed the question: Did you know that family planning is not against our faith? The goal of the campaign is to foster a better understanding of family planning and address misconceptions that impede its uptake. The hybrid physical/virtual workshop was an outgrowth of an action plan developed with HP+ support during a workshop in November 2019. The activity is intended to encourage demand for family planning services and to address Kilifi County’s all-method contraceptive prevalence rate of 38 percent, lower than Kenya’s national rate of 58 percent.
Advocating for Critical HIV, Malaria, and RMNCAH Funds in Kenya
January 2021 —
HP+ Kenya has helped the Kenya Ministry of Health develop budget proposals that align with its health sector priorities and craft advocacy materials in support of these proposals. The MOH requested an additional US$12 million for HIV commodities, an additional US$8 million to procure first line anti-malarial drugs and to settle tax obligations arising from donor-procured malaria commodities, and an additional US$8.6 million for family planning. HP+ Kenya supported national performance reviews of HIV, malaria, and reproductive, maternal, newborn, child, and adolescent health programs to develop sector working group reports that inform the MOH and Treasury budget allocations.
Promising Results Illustrate Kenya’s Private Sector Potential to Support the HIV Response
December 2020 —
Survey results from Kenya’s Busia, Kajiado, and Nairobi counties suggest that 38 percent of HIV clients are interested in collecting antiretroviral drug (ARV) refills from private pharmacies. Ninety-five percent of private pharmacy owners in these counties are also interested in extending current services to include dispensing refill ARVs to stable, adult clients. Clients’ willingness to pay a dispensing fee to collect ARVs from private pharmacies is well-aligned with the pharmacies’ minimum dispensing fee, suggesting that a decentralized distribution model involving a hub antiretroviral therapy site and private pharmacies for ARV pick-up may prove successful. HP+ is using these survey results to design and implement a community pharmacy ARV refill pick-up pilot in each county, intended to eventually transfer more than 1,000 clients to private pharmacies to obtain ARVs.
New FP Equity Model
December 2020 —
Quality family planning information and services have not yet reached those with the greatest need. To support progress toward equitable healthcare, HP+ developed an approach for diagnosing inequity in family planning programs. This approach identifies inequities: 1) for a diverse range of disadvantaged subgroups; 2) for various programmatic components of family planning; and 3) at national and subnational levels. Replicable across countries, this approach enables users to easily transform demographic and health survey data to better understand the profile of inequity. This information can be used to develop evidence for policy, financing, and programmatic decisions at national and subnational levels. The new methodology and replication guide describes the approach and provides step-by-step instructions for running the open source code independently. Results from the application of the approach to Uganda can be found in the brief and in this webinar.
HP+ Hosts Second Watch Party Featuring Maternal Healthcare in Kenya
November 2020 —
HP+ hosted the second watch party in its Why Policy Matters series on November 10. “Free Maternal Healthcare in Kenya Saves Lives” features health officials, clinical staff, and patients in Port Reitz, where maternal deaths fell by 64 percent and newborn deaths by 87 percent just two years after the country’s free maternal healthcare policy, Linda Mama, was launched under the National Health Insurance Fund, with HP+ costing and data analysis support. Along with HP+ Kenya leadership, the watch party featured Dr. Isabel Maina, division head for health financing at the Ministry of Health and representatives from the Mombasa county government, Dr. Mercy Bruba and Emily Mwaringa.
Establishing Health Budget Priorities and Processes in Mombasa County
November 2020 —
In Kenya, HP+ supported Mombasa County to finalize Sector Working Group reports under the three-year budget plan, called the Medium-Term Expenditure Framework. These budget reports, used at national and county levels, are required to secure stakeholder input on family planning and other health spending priorities. HP+ provided technical and logistical assistance to develop the reports, highlighting priority needs and programs to guide resource allocation. Through HP+ support, these budgets and budget processes are better positioned to respond to citizen needs and resources specific to the county’s context.
Identifying Key Bottlenecks and Providing Recommendations to Improve the Health Budget in Kenya
November 2020 —
An analysis of Kenya’s national and county health budgets revealed that, while there has been a significant increase in resources allocated to health, gaps in implementation remain. HP+ conducted the study, which found that resources for health comprise just 9 percent of the total government budget; this falls short of the 15 percent recommended by the Abuja Declaration. Furthermore, county budgets continue to be dominated by recurrent expenditures—such as personnel salaries—raising concerns about resource allocation for effective and quality service delivery. The report provides evidence to support key recommendations for national and county governments to more effectively allocate resources to health.
Virtual HIV Costing and Management Training Delivered in Three Countries
August 2020 —
In August, HP+ facilitated a virtual training for research institutions and government representatives in Kenya, Tanzania, and Uganda on applying the Activity-Based Costing and Management methodological approach to HIV services. HP+ strengthened the capacity of these institutions and participants to implement data collection; conduct analysis; develop research protocols and data collection instruments; secure ethical clearance; facilitate stakeholder consultations; and develop reports using the approach. Findings from the analysis can help policymakers and partners to more effectively allocate resources, improve monitoring efforts, optimize investments, and drive efficiencies through improved delivery of services.
Can Decentralization Accelerate Countries’ Journey to Self-Reliance?
August 2020 —
Why do countries decide to decentralize their health sectors? What challenges do they face in assigning functions appropriately and agreeing on stewardship roles? Does financing follow function? An HP+ webinar on July 29 tackled these complex questions and more. Featuring the experiences of two countries that have engaged in large-scale attempts at decentralization of health sector financing and governance—Kenya and Indonesia—“Health Sector Decentralization: Can it Still Deliver?” focused on the essential question of whether decentralization can accelerate countries’ journeys to self-reliance. Among the presenters was Meral Karan, a Senior Governance Adviser at the Center of Excellence on Democracy, Human Rights, and Governance.
Kenyan Counties Adopt New Health Planning Unit to Support Budget Allocation and Advocacy
June 2020 —
On May 6, representatives from Kenya’s health leadership at the county level adopted a prototype of a new County Health Planning Unit (CHPU) for each county, created to address gaps in planning and advocating for budget allocations for strategic programs such as HIV, family planning, and malaria. HP+ supported the establishment of the CHPU through multisectoral collaboration with individual counties, the Ministry of Health, the Council of Governors, and the National Treasury. Moving forward, HP+ will support CHPU capacity strengthening and mentorship to institutionalize planning and budgeting at the county level, underscoring long-term sustainability on Kenya’s journey to self-reliance.
County Governments in Kenya Commit over US $5 Million to Improve Mother and Child Health Services
June 2020 —
With HP+ technical assistance, seven counties in Kenya have collectively committed over US$5.2 million in the upcoming budget cycle to improve mother and child health in public facilities—a 40 percent increase over last year’s allocation. HP+ also trained staff on Kenya’s medium-term expenditure framework planning cycle to influence budgetary allocations for critical programs. The increased allocations will enable counties to increase access to antenatal care services and skilled care deliveries, and improve family planning coverage. Mombasa County intends target improvement of antenatal care visits from 27,775 to 41,598 and deliveries under skilled care from 36,057 to 38,538 between this fiscal year and the next.
Webinar Introduces New Approach for Diagnosing Inequities in Family Planning Programming
June 2020 —
An HP+ webinar on May 28—Diagnosing Inequities in Family Planning Programs: A Case Study from Uganda—introduced a new, replicable approach for diagnosing inequities across family planning programming outputs and outcomes at both national and subnational levels. Presenters showcased results from its application to Uganda, focusing on the sub-regions, disadvantaged sub-groups, and family planning components for which inequities are most pervasive, and demonstrated its applicability to other countries. Use of the model is intended to increase the quality of family planning information and services for women.
Kenya’s Mombasa County Dramatically Increases Allocation to Health in New Fiscal Year
March 2020 —
Kenya’s Mombasa County has chosen to increase its allocation to health by 25% over the previous year’s allocation as a result of a report by the Mombasa County Health Sector Working Group. The report, which aligns with the country’s Domestic resource mobilization agenda, identifies resource needs and allows the county to negotiate for additional funding within the health sector. HP+ provided technical support in the areas of expenditure analysis and budget estimates, supporting the working group through a consultative process. As a result of the report, Mombasa County will now allocate KES 3.5 billion in fiscal year 20/21, which will allow facilities to stock pharmaceuticals and supplies, ultimately reducing out-of-pocket expenditure for clients.
Enhancing Domestic Resource Mobilization in Kenya Through Legal and Policy Analysis
February 2020 —
Kenya’s Public Financial Management Act requires that all funds collected at health facilities be channeled to a country revenue fund, blocking local health departments from control of revenue and compromising quality of care as a result. To address this challenge, HP+ supported the Kilifi Department of Health to assess the legal and policy environment and identify a strategy to redirect US$1.25 million in user fees back to the health sector to support purchase of commodities and cover operational costs. Returning control of domestic resources for health to the health sector is expected to improve quality of care and accessibility of commodities at health facilities.
PEPFAR Minimum Requirements Webinar
February 2020 —
HP+ led a webinar on January 30th to discuss how countries -- with examples from Botswana, Nigeria, Tanzania, Kenya and Indonesia -- have met PEPFAR’s minimum program requirements for policies and practices essential for success. With special guest Sylvain Bowra of the State Department in Botswana, HP+ contributors shared a new resource illustrating the status of each of the minimum requirements across all PEFPAR countries.
Scaling up Locally-owned Accountability Tools to Strengthen Collaboration and Make Progress Toward FP2020 Goals
July 2019 —
HP+ worked with Uganda-based Samasha Medical Foundation to scale-up its Motion Tracker—a locally-produced, civil society led tool that strengthens accountability and helps countries make progress toward their FP2020 commitments. HP+ supported its scale up from Uganda to Tanzania and Zambia, which resulted in broader community and stakeholder involvement and stronger FP2020 commitments in both countries that can be tracked and monitored. HP+’s work with Samasha helped cement the Motion Tracker as a sustainable, locally-grown approach to strengthening self-reliance and joint accountability, with Samasha receiving additional funding from the World Health Organization and the New Venture Fund to continue their work in Uganda, Zambia, and Tanzania, and further expand to Nigeria.
Kenya Launches New Malaria Strategy with First-ever Financial Sustainability Plan
May 2019 —
HP+ supported Kenya’s National Malaria Control Programme to develop the next iteration of its national malaria strategy—one that includes, for the first time, a financial sustainability plan. The resulting costed Kenya Malaria Strategy (KMS) 2019-2023 guides the country’s malaria control strategy for the next five years and informs the Ministry of Health’s planning and prioritization of key malaria interventions. The financial sustainability plan outlines resource needs, resource availability, and funding opportunities to help close the identified Ksh 24 billion funding gap. The Kenyan government estimates that three-quarters of its population is at risk for malaria and, through the KMS, aims to reduce malaria incidence and death by at least 75% (of 2016 levels) by 2023.
Kenya Malaria Program Review Wraps Up
November 2018 —
In late September, HP+ participated in the Kenya Malaria Program Review to inform development of a comprehensive report documenting the program’s achievements, enabling factors, and challenges. As part of the end term report, HP+ Kenya conducted a comprehensive financial analysis of the program. The team also participated in the program review in several other ways, including conducting a desk review; participating in an external review by the World Health Organization to inform financial analysis; undertaking field visits to Nairobi and Kwale, Kilifi, Kisumu and Busia counties; and hosting a consensus meeting with county directors of health and the third Kenya National Malaria Forum. These engagements revealed inadequate finances for program interventions and a high level of dependence on external sources for key commodities. The Kenya Malaria Program Review end term report will inform the design and implementation of the next iteration of the Kenya Malaria Strategy, which HP+ is supporting.
Ministry of Health concludes the Global Fund – Grant Making Process
October 2017 —
Ministry of Health (MoH) Kenya engaged stakeholders’ preparation of the grant for securing Global Fund resources for HIV/AIDS, Tuberculosis and Malaria. The grant making process which took more than a month involved review of program interventions and targets, costs and cash forecast for the next three and half years. As a result, Kenya application of US$ 356 million is expected to go to full GFATM Board for approval in November 2017. HP+ supported MoH to cost the proposed intervention and in realignment of the grant distribution so as to facilitate the absorption capacity of the grant over the 3.5 years for the three diseases.
New Kenya Law Ensures Access to Health Services
August 2017 —
The Kenya Health Act, 2017 mandates provision of a range of health services, ensures free maternity care and immunizations for children five and under, and formalizes collaboration between county and national governments. To further regulate and reorganize Kenya’s health sector, the Health Act, 2017 establishes the Human Resources for Health Advisory Council and the Kenya Health Professions Oversight Authority. To safeguard health workers’ welfare, the advisory council will review and advise on policies, norms, and standards related to the deployment of healthcare staff. The authority oversees healthcare professionals and regulatory bodies, including complaint resolution and the professional conduct of health staff. The USAID-funded Health Policy Project (HPP), the Health Policy Plus (HP+) project’s predecessor, provided extensive technical assistance to Kenya’s Ministry of Health in the development of this law, facilitating advocacy and consensus-building efforts and providing guidance on linking the law with the Kenya Health Policy. Under HP+, our team continues to support implementation of other aspects of the Health Act, including implementation of the Linda Mama Boresha program, which provides free maternity, neonatal, and infant care for Kenyan women and children. Read our full article.
With USAID technical support, new Kenya law ensures access to health services
August 2017 —
The USAID-funded Health Policy Project (HPP), the Health Policy Plus (HP+) project’s predecessor, provided extensive technical assistance to Kenya’s Ministry of Health to develop the KenyaHealth Act, 2017, which was introduced into law last month (July 2017). The act obliges Kenya to provide access to health services to vulnerable groups, mandates the provision of emergency and specialized care, and ensures the provision of free maternity care, vaccinations for children under age five, and workplace breastfeeding facilities. The Health Act also formalizes collaboration between national and county governments with the legalization of the Health Sector Inter-governmental Consultative Forum—a positive step in the country’s continued devolution. Read the full story.
Budget Training Leads to Increased Health Allocations
November 2016 —
In 2015/16 health budgets, 12 of Kenya’s counties collectively committed US$2 million to HIV programs, enhancing these programs’ sustainability. These budget commitments come as a result of program-based budgeting (PBB) training provided to county health teams by USAID through the Health Policy Plus (HP+) project. Additionally, in Turkana county, the health department’s budget allocation increased in the 2016/2017 budget by 16 percent. These increases were informed through the PBB training and the USAID-supported county health accounts, which provided evidence to support the request. HP+ is now in the process of training a further 14 counties to improve program-based budgeting.
Kenya’s free maternal health program expands services and reach
November 2016 —
Kenya’s free maternity care program was first introduced in 2013. Since then, facility deliveries rose from 44 percent before the policy was in place to 66 percent in FY 2012/13. The maternal death rate also declined by 7.9 percent. After several months of intensive work, Kenya has launched Linda Mama—a revamped free maternity services program that expands the types of services available to mothers and babies and access. The program will be offered at all public health facilities and a combined 2,700 private sector and faith-based facilities. USAID, through the Health Policy Plus project, supported Kenya’s Ministry of Health and National Health Insurance Fund to redesign the program; cost the program’s benefits package; determine the resources required for implementation; ensure adequate government allocations; inform the program’s reimbursement rates; and prepare technical, implementation, and funding policy documents. The new program will reach an estimated 700,000 women each year.
HP+ Kenya/East Africa supports proposed East Africa Community Health Policy
September 2016 —
HP+ Kenya/East Africa provided technical assistance to an East Africa Community (EAC) workshop, held in Kampala, Uganda, to review and validate the proposed EAC Health Policy. For the past two years, the EAC secretariat has worked with its five member states and various stakeholders to develop a regional health policy to enhance collaboration in all areas of health, including disease surveillance and epidemic prevention and control. With USAID support provided through HP+, the secretariat convened representatives from member states’ ministries of health to review and validate the draft policy, so that it can be tabled for endorsement and adoption by the East African Community Council of Ministers later in the year.
Insurance Fund Bill Advances, Potential to Increase Access
July 2016 —
Supported by USAID's Health Policy Plus project, Kenya's parliamentary health committee adopted an amendment bill to the National Hospital Insurance Fund (NHIF) act. The proposed reforms impact delivery and financing of the mandated benefits package (inclusive of FP and HIV), supporting Kenya's efforts to achieve universal health coverage (UHC). The amendment will facilitate an increase in the number of individuals with health insurance, reducing out-of-pocket expenditure and ultimately reducing catastrophic health expenditure. If adopted, the bill will streamline administration at the NHIF, freeing up resources to be used for service delivery, contributing to domestic resource mobilization for health, and increasing access to essential health services. The bill now moves to the National Assembly for discussion and full adoption by September 2016.