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.