Laying The Foundation For A Robust Health Care System In Kenya – Kenya Public Expenditure Review, Dec 2014.
The health sector in Kenya is undergoing far-reaching transformation as service provision for health services is devolved to the county level. Amid this transition, health outcomes and utilization of health services have improved significantly: child mortality has reduced, more children are being immunized, and the impact of communicable diseases has lessened. But not everything is rosy: communicable diseases, maternal and perinatal conditions are responsible for the biggest disease burden in Kenya. Absenteeism by health personnel and knowledge practice gaps are also undermining efficiency of the sector.
This health sector review expenditure and policy review provides a baseline assessment on the equity, efficiency and effectiveness of health provision. It observes that while total health expenditure has increased in recent years, almost a third of that spending is from out-of-pocket payments by individuals and households. And while the government has taken measures to increase the share of expenditure in primary health care, public health expenditure is stagnant and remains lowest in the region.
The policy note offers suggestions for increasing efficiency and equity to create a more robust health system. Overall, reduce reliance on out-of-pocket payments and move towards pre-payment solutions financing mechanisms; increase preventive primary
health care expenditure; and harmonize donor support for the sector.
Devolution also provides a unique opportunity to address long-standing inefficiencies as well as inequities. County governments have an opportunity to address historical inequities in access to health services. Counties can also benefit from effective sharing of resources (networked hospitals) rather than new investments (building new hospitals). And incentives need to be created for health staff, and health facilities equipped with adequate essential medicines and supplies. The sector should adopt cost effective preventive care interventions to enhance service delivery and improve health outcomes.
Diariétou Gaye,
World Bank – Country Director for Kenya, Rwanda and Eritrea
