Country Background information

Kenya is a lower-middle income country whose 47 county governments enjoy devolved fiscal, political and administrative authority from the central government. Economic growth has been positive over the last five years (6.32% in 2018), with the main economic activities being agriculture and the service sector. However, high levels of poverty and informality of labour persist

47 -Million+

Kenyan Population (2019)

3808 - USD

Current health expenditure (CHE) (USD): (2017)

1710 .51 USD

GDP per capita (USD): (2018)

77 -USD

CHE per capita (USD): $77 (2017)

27 .713 USD

Out-of-pocket expenditure (% of CHE): $27.713 (2016)

COUNTRY INDICES

47 -Million+

Kenyan Population (2019)

3808 - USD

Current health expenditure (CHE) (USD): (2017)

1710 .51 USD

GDP per capita (USD): (2018)

77 -USD

CHE per capita (USD): $77 (2017)

27 .713 USD

Out-of-pocket expenditure (% of CHE): $27.713 (2016)

Health system governance

Health system governance

The health system is governed at two levels:- (1) National (in charge of national referral facilities, health policies, national level government agencies, and technical assistance to counties), (2)County (health service delivery at county level, ownership of publicly owned health facilities and public health services)

Health service providers

Health service providers

Health service providers (public, private for profit and private not for profit) are organized in these levels:From community health services (Tier I or Level 1), Dispensaries and health centres (Tier II/Level 2 and 3), County and sub-county hospitals (Tier III/Level 4), Regional hospitals (Tier IV/Level 5) and national referral hospitals (Tier V/Level 6)

Main Challenges

Main Challenges

There are main challenges with overall health service readiness including: -Availability and distribution of human resources for health, Health products and technologies,Infrastructure and information systems.

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PURCHASING FUNCTIONS
ItemNational Hospital Insurance Fund (NHIF)National Government (Ministry of Health MOH)County Governments (County Departments of Health CDOH)
Benefit specificationThe National Scheme’s benefit package (Supa Cover) covers wide range of outpatient, inpatient services, specialised services (e.g. renal dialysis, specialised diagnostics) and treatment outside of Kenya. The managed (government-funded) and enhanced (commercial) schemes access similar benefits though these may be tailored to the specific schemeKenya essential package for health (KEPH) covers a wide range of population and individual health services and is to be read together with the list of essential medicines, supplies and diagnosticsKenya essential package for health (KEPH) covers a wide range of population and individual health services and is to be read together with the list of essential medicines, supplies and diagnostics
ContractingSelective empanelment and contracting applied more to private providers.Performance contracting for public (integrated) providers. Various forms for private providers including memoranda of understandingVarious forms for private providers including memoranda of understanding.
Provider payment systemsCapitation for outpatient, case-based group payments (e.g. for day surgeries or outpatient renal dialysis), fee for service (e.g. for diagnostic procedures).Inputs (e.g. salaries, fuel, human resources) are paid for on a line-item basis within programme budgets.Inputs (e.g. salaries, fuel, human resources) are paid for on a line-item basis within programme budgets.
Monitoring and Information systemsInformation systems for claims submission, tracking and financial reporting.Information systems for public financial management (budget formulation, execution, reporting), facility and health system performance management.Information systems for public financial management (budget formulation, execution, reporting), facility and health system performance management

Findings on Strategic Purchasing

The county governments, NHIF, private and community-based health insurance – show that they do not meet the ideals of strategic purchasing. Ongoing reforms to address these challenges and achieve universal health coverage (UHC) include:

  • Greater budgetary allocations to health
  • piloting of free-of-charge access to services in 4 counties
  • Strengthening of the NHIF
  • Regularisation of management of human resources for health
  • Investments in service delivery elements such as community health services