SP4PHC in Kenya
Under Kenya’s devolved system of government, counties are the main purchasers of primary health care services. They 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 collaborating with the Ministry of Health, the Council of Governors, and the three county governments of Isiolo, Kilifi, and Makueni to improve how county governments purchase primary health care – especially family planning and maternal, newborn and child health services. For more information, view our Kenya overview presentation and one pager. To see how our SP4PHC team in Kenya has helped its government respond to Covid-19, view 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, Kilifi, and Makueni counties to design and test policy reforms focused on enabling public facilities to increase participation in Linda Mama and improving public financial management policies and practices to grant facilities greater financial autonomy.
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, 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.
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. SP4PHC is assisting the government’s program management team track the overall performance of the THS-UCP and capture and share county best practices. SP4PHC is supporting Isiolo, 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 and Council of Governors, in addition to inter-county engagement fora, SP4PHC is sharing learning 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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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.
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.
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 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. Anecdotal evidence suggests that the evolution of health financing policies as well as the shift to devolution resulted in considerable variation across counties and level of care. A study by researchers from KEMRI Wellcome Trust and ThinkWell found that planning and budgeting processes for hospitals and health centers were not standardized across counties. Hospitals and health centers relied on revenue from user fees and donor funds, respectively. Health facilities spent over 80% of their funds on staff salaries leaving insufficient funds for commodities and other expenditures.
The Transforming Health Systems for Universal Care Project in Kenya: A Review
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. One hundred and thirty million of the US$ 191.1 million project is structured as performance-based financing to Kenya’s 47 counties. This brief, published in December 2020, provides an overview of this component of the THS-UCP.
A Review of the Transforming Health Systems for Universal Care Project in Makueni 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 Makueni County Department of Health to review the implementation of THS-UCP in Makueni, one of SP4PHC’s three focus counties. This brief, published in December 2020, summarizes the findings from the review and provides recommendations to improve implementation of THS-UCP in the county.
Purchasing Reforms and Tracking Health Resources
Countries are testing different provider payment methods as part of health financing reforms to achieve universal health coverage. Comprehensive data on funding flows to health care providers from different purchasers is needed to inform decisions on payment methods. Tracking the flow of funds is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This article in the Bulletin of the World Health Organization explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. This article was published online by the WHO in December 2019.
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.