SP4PHC in Kenya

Kenya women and children walkingUnder Kenya’s devolved system of government, counties control the bulk of government funds for primary health care (PHC) service delivery. Against this backdrop, ThinkWell and learning partner KEMRI Wellcome Trust have been working with the county governments of Isiolo, Kakamega, Kilifi, and Makueni since 2018 to improve purchasing arrangements for primary health care services, especially for family planning, and maternal, newborn, and child health. Focused on accelerating reforms to increase the autonomy of public facilities and their access to funds, the team has explored linkages between improved fund flows and service readiness. We are now building on this experience and expanding both our geographic and technical scope to support eight, and ultimately ten, county governments to ensure their purchasing arrangements enable the government’s UHC reforms to translate into improved access to quality primary health care services, particularly for poor and vulnerable people. We are also working at the national level to inform policy development by government agencies as well as enable policy diffusion and learning beyond our focal counties.

ThinkWell’s accomplishments in Kenya

  • Supported four county governments to improve facility autonomy. The  team focused on improving the flow of funds from the Linda Mama free maternal and child health scheme, to frontline providers. The lessons from this work have been used to support national policy and guideline development (e.g., the National Guidelines for Facility Improvement Funds) and will inform efforts to improve the flow of funds from other national health financing schemes.
  • Brokered the resumption of the Linda Mama scheme in Isiolo by facilitating engagement between the county government and the National Health Insurance Fund (NHIF).
  • Published key learnings through more than fifteen documents, including three journal articles together with the KEMRI Wellcome Trust Research Program (KWTRP) on the implementation of Linda Mama, its impact on maternal, newborn and child health services, and health facility financing in Kenya.

Current strategies and activities

Strategy one: Support ten county governments to enhance strategic purchasing for primary health care.

  • Track and support the implementation of the UHC program and other NHIF schemes to enhance the flow of funds to facilities.
  • Enhance facility autonomy and thereby provide facilities with a greater incentive to attract UHC program and Linda Mama clients. Support policy reforms to increase the use of facility improvement funds to improve service delivery—in particular commodity availability and HRH performance (in partnership with InSupply, the Chartered Institute of Procurement and Supply [CIPS] and the Africa Resource Centre [ARC]).
  • Conduct research in partnership with KEMRI WTRP to monitor and assess the impact of the rollout of facility financing arrangements and performance of the UHC program.
  • Review county-level data systems to track budget and expenditure data at the facility level (with the International Budget Partnership).
  • Pilot digital PFM solutions to enhance data visibility in 1-2 counties.

Strategy two: Leverage purchasing to support service delivery reforms and improve quality of care.

  • Work with Jacaranda Health to implement the Service Delivery Redesign pilot in two counties, with a focus on aligning health financing arrangements with service delivery changes.
  • Provide technical assistance to counties implementing Primary Health Care Network reforms.
  • Design and test approaches for counties to link their payments to facilities to existing metrics on quality standards.

Strategy three: Support national-level planning and coordination of UHC reforms.

  • Support the Ministry of Health and the National Health Insurance Fund (NHIF) to implement and monitor health financing reforms.
  • Inform policy by bringing lessons from county-level work and global evidence to national health financing policy discussions.
  • Pursue joint learning and knowledge sharing with the KEMRI Wellcome Trust and other partners.

More information about the SP4PHC project in Kenya can be found in this one-pager.

Featured learning products

The impact of COVID-19 on health financing in Kenya

October 27, 2023

Sudden shocks to health systems, such as the COVID-19 pandemic, may disrupt health system functions. On one hand, the capacity of health system functions affects the effectiveness of the country’s response to the pandemic, and on the other hand the nature, scale, health, and non-health impacts of the pandemic, and country response strategies affect health system functions in ways that influence the resilience of health systems. The health financing functions may influence the health system’s ability to support continued good quality service delivery. This study, published in October 2023, examines how the COVID-19 pandemic and government response impacted the Kenyan health financing system, the effect of the existing health financing arrangements on the capacity of the health system to respond to the pandemic, the adaptations made to improve the health system’s response to the pandemic, and the influence of the pandemic response on the effectiveness of health financing system to promote health system goals and universal health coverage.

Kenya’s new facility autonomy bill: Can we make a good thing even better?

October 11, 2023

By Nirmala Ravishankar, John Kinuthia, Agnes Gatome Munyua, Boniface Mbuthia, and Anne Musuva

The Facility Improvement Financing (FIF) Bill unveiled by the Government of Kenya in August 2023 is a win for health facilities in the public sector. If passed, the FIF Bill will allow them to directly receive funds and spend them on some operating costs. How big of a win the legislation will be depends on how easy (or complex) it is for facilities to use the funds. The FIF Bill is a step in the right direction, but some of the specifics remain to be fine-tuned.

Exploring facility financing arrangements in Kenya’s 47 counties

May 2023

Prior to devolution in 2013, government-owned health facilities in Kenya could retain and use the revenue they collected from user fees and other sources.  After devolution, this ability became dependent on how county governments interpreted the 2012 Public Finance Management Act. Most counties started requiring facilities to transfer all own-source revenue to the county treasury. Some have since put in place arrangements to grant more financial autonomy to health facilities. This brief, published in May 2023, summarizes the findings from our review of facility financing arrangements in Kenya’s 47 counties and offers reflections on potential implications for service readiness.

Examining health facility financing in Kenya in the context of devolution

October 13, 2021

Public health care facilities are not only a major avenue for the delivery of key health care interventions, but also consume a substantial amount of health sector resources. For instance, public hospitals are said to consume between 30 to 50% of health sector budgets in low- and middle-income countries. How health facilities are financed affects their performance and health system goals. This study, published in October 2021, examines how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.

Other learning products

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.