Kenya with an estimated population of about 43 million is going through transformational changes with its new constitution. The Kenyan economy grew steadily from 5.1 percent in 2003 to 7.0 percent in 2007, but declined to a low of 1.5 percent in 2008 largely due to the post-election violence and the global economic crisis.
... See More + Kenya has maintained a stable macroeconomic environment despite challenges of financing the new devolved system of governance. The economy is projected to have grown by 5 percent in 2013, and it is expected to grow by 5.1 percent in 2014. Medium term prospects are stronger, with the growth in Gross Domestic Product (GDP) projected to improve to around 6 percent. According to the recent World Banks economic update, Kenya has made some notable progress during the past half century. Kenyans are living two decades longer, fertility and infant mortality have been cut into half, and school enrolment at primary and secondary level has more than doubled. GDP per capita has increased eightfold and Kenyas financial sector is now the third largest, after South Africas and Nigerias, in sub-Saharan Africa. Kenya now needs to reflect how such overall country progress helped to transform the lives of the majority of Kenyans. Nearly four in 10 Kenyans still live in poverty, maternal mortality is among the highest in Africa, secondary school enrolment is low and learning achievement levels are well below their potential. GDP growth, while solid, has yet to reach the takeoff level necessary to transform Kenya into a modern market economy and change the lives of ordinary Kenyans.
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Poor nutrition is a main cause of mortality especially among the vulnerable. About half (45 percent) of all deaths among children under five are due to one or more forms of under nutrition such as fetal growth restriction, stunting, underweight, wasting, vitamin A and zinc deficiencies and sub-optimal breastfeeding.
... See More + Anemia and calcium deficiencies are also reported to be important causes of maternal death (23 percent and 19 percent of total deaths, respectively). In addition, children who are deprived of adequate nutrition in utero and in the first 24 months of life, but have rapid growth after the age of two are more susceptible to chronic disease, which is attributable to over a quarter of mortality in low income countries. In Kenya, 790,000 children are estimated to die due to underweight and vitamin A deficiency between 2010 and 2030, if they are not addressed. Equally important, poor nutrition affects economic development and poverty reduction. Chronic under nutrition during the first 1,000 days from conception to the first 24 months of life irreversibly impedes physical growth and cognitive development to reach individual genetic potential. Therefore it limits schooling achievements, and reduces physical productivity, resulting in decrease in income potential in the later life. Also, poor nutrition increases health care and associated expenditures, contributing to poverty. According to the Copenhagen Consensus 2012, each dollar spent on reducing chronic under nutrition through a bundle of interventions could have at least a US$30 payoff. Global productivity losses due to poor nutrition are estimated to be 8 percent of gross national product (GNP) over the twentieth century at the global level while the estimation is reported to be higher at over 11 percent of GNP in Africa. The economic costs of under nutrition in Kenya are also vast: unless immediately addressed, Kenya is estimated to lose US$2.8 billion of its GDP annually as a result of stunting. An estimated KES 230 million will also be lost between 2010 and 2030, for example, due to cognitive underperformance and loss of productivity resulting from iodine and iron deficiencies. If the bundled interventions are implemented, Kenya is, however, estimated to benefit the increased earnings at the ratio of between 24 and 76 to one.
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As Kenya is going through a transformational change with the devolution and governments strong commitment to provide Universal Health Coverage (UHC) for all Kenyans, it is time to introspect how Kenya will put in place the building blocks required.
... See More + The author tried to reflect how Kenya can achieve this noble goal building on its primary health service delivery system. There is strong evidence that provision of primary health care is critical for achieving the health outcomes. Selective scaling up of primary health care services was a common feature among 30 low and middle income countries that achieved highest average yearly reduction of under-five mortality and high coverage for skilled attendance at birth. The family health program in Brazil helped to reduce Infant mortality rates by 13 percent betwee
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The World Bank along with the Government of Kenya (GoK) and other donors is financing the Health Sector Services Fund (HSSF). The HSSF has been providing small grants directly to health facility management committees of over 3000 Primary Health Care Facilities (Dispensaries and Health Centers) in Kenya.
... See More + This is a GoK led initiative to address the challenge of timely availability of operation and maintenance funds to health facilities as several public expenditure reviews identified that funds transferred to erstwhile districts were not reaching the facilities. This initiative builds on successful experiments undertaken in the Coastal region. These primary care facilities form the backbone of health care delivery in Kenya and the 2013 health care utilization survey increased (from 1.9 visits in 2003 to 3.1 visits in 2013), and the public sector remains the main source of care, especially for the poor. The HSSF becomes more critical with the announcement of new governments policy of free primary care aimed at further improving the access to essential health care. Currently, the Ministry of Health (MoH) is using the HSSF platform to transfer the Kenyan Shilling (KSH) 700 million provided by the National Government to compensate these health facilities for the loss of health revenues.
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Kenya is currently going through transformational changes in its health system with the ongoing devolution and strong commitment shown by the Kenyan Government to achieve Universal Health Coverage (UHC).
... See More + The Kenyan Ministry of Health (MoH), in collaboration with the World Bank Group (WBG) and the United States Agency for International Development (USAID), convened the Kenya health policy high level forum (HLF) in March 2014 to share national and international experiences and find options for achieving UHC. The HLF specifically focused on four themes: (i) delivering services to improve health outcomes among women and children, with emphasis on poorer segments of the population; (ii) enhancing governance and effectiveness of the health system to deliver quality health care in a devolved setting; (iii) ensuring sustainable health financing to achieve UHC; and (iv) promoting client safety and quality of health care. The forum was guided by the following principles: leadership by Kenyan experts and institutions with global experts and institutions sharing knowledge and experiences; learning with emphasis on practical know-how from countries with devolved health systems (e.g., Brazil, Ghana, India etc.); and providing analytical and advisory inputs to inform pros and cons of different options, and ensuring that choices are compatible with the Kenyan context. The HLF brought together Kenyan and international experts to share their hands-on experiences to help Kenya in identifying options that will ensure sustainable institutions and financing to achieve UHC. Representatives from national and county levels of Government actively participated in the HLF and experiences from Brazil, Ethiopia, Ghana, India and Mexico provided insightful directions for Kenya. The high level participation from the WBG, USAID and other key partners supporting the health sector reflects strong commitment from development partners to support Kenyas vision to achieve UHC.
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The health system in Kenya is currently going through a major transition with the implementation of the new constitution. The responsibility to deliver essential health services has been devolved to the 47 counties while the national government is responsible for policy making and operating the national referral hospitals.
... See More + The government is giving a high priority to the health sector and has waived user fees at primary health facilities and introduced free maternity care at all public health facilities to increase access to essential health services. The government is also committed to achieving universal health coverage. While these are notable measures, the challenge is to ensure that there are adequate resources available to meet these commitments. More importantly, given that the available public health sector resources are limited, it is necessary to ensure that they are optimally used for providing health services to the greatest number of people possible ensuring better value for money. Unfortunately, the Ministry of Health has limited information on the operational efficiency of the health system at different levels of care. The overarching objective of this study is to assess the efficiency in the public health sector. Specifically the study: i) estimated the technical efficiency of samples of dispensaries, health centres and hospitals in urban and rural counties; ii) reviewed critically the ongoing pilots on performance based financing and output based aid to highlight potential efficiency gains and policy options for national scale-up. The study applied the Data Envelopment Analysis (DEA) approach to analyse technical efficiency of randomly selected sample of twenty four district hospitals, two hundred and ninety five health centres and thirty-eight dispensaries using output and input data for FY 2012.
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Kenya's growth experience reveals that economic growth has been quite episodic, with high sensitivity towards macroeconomic instability and higher political risks.
... See More + Despite the improved economic growth, the economy still struggles with high levels of poverty, inequality, and employment. The main objective of this study is to explore the scope for establishing additional targeted transfers by undertaking comprehensive analysis of fiscal space. The study aims at analyzing the need, as well as the scope, for creating additional fiscal space to finance additional targeted expenditures, both in the health sector and more generally, by considering potential for: reprioritization of existing expenditures, additional donor grants, or borrowing. The focus of the study will be at national level, but it should include specific consideration of the new intergovernmental revenue sharing arrangements to be implemented from 2013-14.
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The Kenya Medical Supplies Authority (KEMSA) is a state-owned health logistics service company with the core mandate to procure, warehouse and distribute healthcare commodities to public sector health facilities and other public sector customers.
... See More + Since the inception of KEMSA in 2000 there have been multiple projects and initiatives to improve the performance of KEMSA. However, despite these efforts, and until recently KEMSA had struggled to effectively demonstrate any sustained improvements in performance. In the last 3-4 years, KEMSA under its new leadership has shown sustained improvements in performance, accountability and transparency. In the last year, the Government of Kenya has embarked on the devolution of health financing to the counties to ensure that services are delivered effectively and efficiently to communities. The devolution has resulted in a significant change in the way KEMSA receives monies for carrying out its activities. Of particular relevance is that the devolution has led to ordering and payment for drugs and health commodities by counties. This required KEMSA to reconfigure its business model to serve the 47 counties in Kenya as its customers. The World Bank, through its Health Sector Support Project (HSSP), capitalized KEMSA in order to meet working capital needs that would arise under the new devolved system of financing. Competitive pressures arising from devolution and the new business model, a new management structure with strong leadership and governance, technical support from development partners such as the World Bank and United States Agency for International Development (USAID), and greater flexibilities arising from KEMSAs change of status to a public authority together are converging to create a new KEMSA. It is an opportune time to study the state of reforms at KEMSA, highlight the successes, and develop ideas for meeting the challenges ahead. The ongoing transformation of KEMSA from a bureaucratic state-run medicines supply agency to a more independent and competitive medical logistics authority is an important milestone and it presents opportunities for other countries to learn from the successes and failures at KEMSA.
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