SP4PHC in Kenya
Under Kenya’s devolved system of government, counties control the bulk of government funds for primary health care delivery through public facilities. They also determine whether public facilities can retain and spend any funds they collect from user fees or reimbursements from the National Hospital Insurance Fund (NHIF), the country’s social health insurance agency. Against this backdrop, ThinkWell and learning partner KEMRI Wellcome Trust are working with the county governments of Isiolo, Kakamega, Kilifi, and Makueni to improve purchasing arrangements for primary health care services, especially family planning and maternal, newborn, and child health services. The team is also supporting the National Government shepherd health financing reforms for making progress toward universal health coverage (UHC) in the country, including tracking its implementation on the ground in real-time.
More information about the project can be found in this one-pager, while this presentation provides an overview of key results. To see how the SP4PHC team in Kenya has helped its government respond to COVID-19, please visit our COVID-19 response page.
SP4PHC has four key strategies to strengthen primary health care access and quality in Kenya.
Strategy 1: Strengthening county purchasing
SP4PHC is supporting counties to explore how their purchasing policies and practices create incentives and disincentives for public sector facilities to deliver priority primary health care services, especially under the Linda Mama free maternity scheme. SP4PHC is collaborating with the county departments of health in Isiolo, Kakamega, Kilifi, and Makueni counties to introduce public financial management reforms to increase facility autonomy and to enable public facilities to participate in Linda Mama.
Strategy 2: Leveraging purchasing to promote quality
SP4PHC is supporting counties to explore approaches for using purchasing to improve the quality of family planning and maternal, newborn, and child health services. In Isiolo, Kakamega, Kilifi, and Makueni counties, SP4PHC is working with the county government, facility managers, and other key stakeholders to determine how to improve quality of care through levers of purchasing such as contracting and provider payment. SP4PHC is also partnering with Jacaranda Health to explore how purchasing can be used to promote service delivery redesign to enhance the quality of maternal and newborn services in Kakamega county.
Strategy 3: Strengthening results-based financing to counties
Under the Transforming Health Systems for Universal Care project (THS-UCP) financed by the Global Financing Facility (GFF), the national government provides results-based financing to county governments to improve the delivery of reproductive, maternal, neonatal, child, and adolescent health services. For two years, SP4PHC provided embedded technical support to the Council of Governors to track the overall performance of the THS-UCP and capture and share county best practices. SP4PHC continues to support Isiolo, Kakamega, Kilifi, and Makueni counties to better use THS-UCP funds, focused on designing and testing provider payment systems to improve the delivery of family planning and maternal, newborn, and child health services.
Strategy 4: Influencing national policy dialogue
Through participation in intergovernmental working groups on health financing led by the Ministry of Health, in addition to inter-county engagement fora, SP4PHC is sharing learnings from its work with counties to inform national dialogue on health purchasing and advocate for harmonization of purchasing schemes.
These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal & newborn health services, and a broader overview of purchasing in Kenya. Each factsheet also highlights some of the activities the SP4PHC country team is working on with local stakeholders within that topic area. These factsheets are updated annually (latest in May 2021).
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A Review of the Transforming Health Systems for Universal Care Project in Kilifi County
With support from the World Bank, the Global Financing Facility, and the Government of Japan, Kenya implements the Transforming Health Systems for Universal Care project (THS-UCP) to improve reproductive, maternal, newborn, child, and adolescent health outcomes in the country. ThinkWell supported the Kilifi County Department of Health to review the implementation of THS-UCP in Kilifi, one of SP4PHC’s three focus counties. This brief, published in December 2021, summarizes the findings from the review and provides recommendations to improve implementation of THS-UCP in the county.
Experts Agree: Improving Kenya’s Maternal Health Policy Will Help Achieve Universal Health Coverage
Following a webinar ThinkWell hosted in partnership with KEMRI Wellcome Trust and P4H on November 9, 2021, a new blog recaps experts’ key takeaways for how Kenya can continue recent progress and increase access to the country’s free maternity program, Linda Mama. The blog also highlights findings from a recently published study by KEMRI Wellcome Trust and ThinkWell, with findings also described here, and explores the gaps between the design and implementation of the program.
Financing of Public Health Facilities in Kenya’s Devolved System
In a new blog for P4H, KEMRI Wellcome Trust and ThinkWell discuss the latest findings from an assessment of resource flows to public health facilities in five Kenyan counties. The study provides critical insights for public finance management practices and health financing arrangements in Kenya, as well as lessons for other low- and middle-income countries exploring ways to enable direct facility financing.
Examining Health Facility Financing in Kenya in the Context of Devolution
Financing arrangements for public health facilities in Kenya changed drastically in 2013 when the country embarked on a process of devolution. Against this backdrop, researchers from KEMRI Wellcome Trust and ThinkWell set out to document the variation in facility financing arrangements across counties and levels of care. Findings from a newly-published study in BMC Health Services Research show that hospitals raise revenue from user fees and health insurance reimbursement, but they have limited financial autonomy in four of the five study counties to retain and spend those funds. Instead, they are required to remit their revenue to the county treasury.
In contrast, health centers in all study counties received allocations from the county government financed by grants from donors, which they could spend at their discretion. In only two counties did health centers receive any payments from the National Hospital Insurance Fund. To improve service delivery, the team recommends that Kenya should consider transitioning public facility financing away from a reliance on user fees and donor funding, facilitate direct facility financing, and enhance financial autonomy for public facilities.
Linda Mama Progress in Makueni County
Linda Mama is a publicly funded program which aims to ensure that all Kenyan pregnant women and their infants have access to quality and affordable health services. ThinkWell supported the Makueni County Government to track the implementation of Linda Mama in the county which has led to considerable improvements in the program’s performance. This brief published in August 2021 documents the progress made in fiscal year 2019/20 and discusses measures that the County Government can take to further improve claims submission and the rate of reimbursement.
Impact of Free Maternity Policies in Kenya: An Interrupted Time-Series Analysis
In sub-Saharan Africa, one in 37 women die from preventable causes related to pregnancy and childbirth. To help women equitably access maternal health care, Kenya instituted the Linda Mama free maternity program. An evaluation by researchers from KEMRI Wellcome Trust and ThinkWell found that the policy yielded mixed results in increasing access to maternal health services. This article in BMJ Global Health underscores the need for coupling user fee removal policies with measures to improve service readiness.
Examining the Implementation of the Linda Mama Free Maternity Program in Kenya
Linda Mama is the Government of Kenya’s flagship universal entitlement program for free maternity services. Researchers from KEMRI Wellcome Trust and ThinkWell examined the implementation of the Linda Mama program. Our findings show challenges associated with its implementation, some of which are consistent with experiences from other low- and middle-income countries. This article in the International Journal of Health Planning and Management highlights the need for programs’ process evaluation to track implementation, ensure continuous learning, and provide opportunities for course correction.
SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.