One month ago, the Government of Kenya released four new health bills to accelerate progress towards the goal of universal health coverage. If passed, the bills will set in motion far-reaching reforms to how health services are financed and delivered in Kenya. Among these bills is the Social Health Insurance Bill, which proposes extending health insurance to all Kenyans based on member contributions, with government-subsidized coverage for the poor. It also mandates the creation of three funds to cover different types of services and a new government agency to manage it all.

To unpack what the Social Health Insurance Bill aims to do, why, and how, ThinkWell will host a Counterpoint webinar with the bill’s primary architects, county stakeholders, as well as leading health financing experts on October 3, 4-5:30 PM-EAT (9-10:30 AM-ET).

Register here

Counterpoint is ThinkWell’s signature series of webinars, which offers a platform for free and frank debate about questions related to health system strengthening. In this edition, ThinkWell’s Regional Director for East and Southern Africa, Dr. Anne Musuva, will host a discussion about Kenya’s new Social Health Insurance Bill featuring four panelists:

• Dr. Elizabeth Wangia, Director, Healthcare Financing, Kenya Ministry of Health
• Dr. Daniel Mwai, President’s Advisor on Health and Standards, Office of the President, Kenya
• Mr. Felix Murira, Country Program Manager, ThinkWell Kenya
• Dr. Joy Mugambi, County Director of Health Administration and Planning, Nakuru County, Kenya

Some of the questions the panel will explore include the following:

1. What overarching objectives is the Social Health Insurance Bill trying to achieve?
2. What drove the specific design choices (e.g., three separate funds, means-testing for everyone not employed in the formal sector, and a new health authority)?
3. How do the reforms envisioned by this bill align with the service delivery reforms set out in the other bills, especially the reorganization of all primary and secondary care facilities into networks?
4. What is the role of counties in implementing these reforms?
5. What are the biggest hurdles we can expect on the way to implementing the bill successfully?

We are looking forward to welcoming our peers and partners from around the world for this discussion. In the meantime, please contact our team with any questions or concerns.

By Boniface Mbuthia, Janet Keru, Geredine Kandie, Felix Murira, and Anne Musuva

The availability of essential medicines and supplies is critical for accelerating progress towards universal health coverage (UHC). Since Kenya embraced devolution in 2013, its 47 newly formed county governments have become responsible for allocating financial resources for health supplies on behalf of public sector health facilities in their jurisdictions. Exactly how they go about this and its implications for the availability of commodities—which include essential medicines, reagents and non-pharmaceutical supplies—has not been well documented.

To fill this gap, ThinkWell collaborated with inSupplyHealth and the Chartered Institute of Procurement & Supply (CIPS) to holistically map processes for forecasting and financing existing bottlenecks, procurement of commodities, and the implications for the availability of health supplies. The team undertook a rapid landscaping analysis in four focus counties during the last quarter of 2022 and spent the first quarter of 2023 validating findings with each county government.

On March 28^th, ThinkWell, inSupplyHealth, and CIPS organized a meeting in Nairobi, Kenya where officials from the Ministry of Health (MOH), Council of Governors, delegations from the four counties, development partners, and other stakeholders met to discuss emerging insights from the county deep-dives. The MOH delegation included officials from the country’s Division of Health Products and Technologies. Isiolo, Nakuru, Trans-Nzoia, and Kakamega Counties all sent teams to join the meeting. Supply chain partners such as Africa Resource Centre (ARC), Kaizen joined the discussion. The dialogue focused on three key themes:

1. Insufficient allocation for health supplies: Counties are not allocating sufficient resources for health supplies. In collaboration with partners, MOH developed a systematic, step-by-step approach to forecasting and quantifying health commodity requirements and costs; however, counties are not following these guidelines. Consequently, their allocations are lower than the need.
2. Low execution of the budget for health supplies: Less than 50% of the budget allocated for health supplies is being spent. This is attributed to several factors including pending bills from previous financial years, delays in the government transfers, and delays in the approval process for local purchase orders.
3. Health facilities with financial autonomy are better positioned to fill gaps: A best practice was observed in Nakuru County where the public hospitals were able to use their own-source revenue to source funds for health supplies. The county government has established health facilities as procurement entities so that they can engage suppliers directly and account for their expenditure using processes that follow public procurement and public financial management regulations of the country. Hospitals in the county were noted to have better availability of health supplies as a result compared to hospitals in counties that did not allow autonomy.

The team is now working on a detailed technical brief documenting the findings from the landscaping analysis on these three topics. We expect to publish it later this year. So, stay tuned!

Header image: From left to right, Dr. Claver Kimathi (Isiolo County), Dr. Eunice Gathitu (MOH), Dr. Emmanuel Wamalwa (Council of Governors), Dr. James Riungu (Chemonics), Mr. Josephat Ngesa (CIPS), and Dr. Anne Musuva (ThinkWell)

The IHEA congress is an international convention of health systems experts to discuss the latest data, methodologies, findings, and tools in the pursuit of improving health care around the globe. It will take place in both buildings of the Cape Town International Convention Centre (CTICC).

Below you can find an agenda of all of the organized sessions, oral presentations, and poster presentations ThinkWell will be organizing for the main congress. The main IHEA congress will be held July 10-12, 2023. As more details around schedules become available, this page will be updated.

IHEA Congress Agenda

Congress Registration

ThinkWell’s Pre-Congresses

Organized sessions

Florence Tochukwu Sibeudu, Olusola Oresanya, Christina Banks, Annette Ozaltin

Tuesday, July 11, 10:30 AM-12:00 PM

Stephen Muleshe, Angellah Nakyanzi

Monday, July 10, 10:30 AM-12:00 PM

Mursaleena Islam, Nirmala Ravishankar, Najibullah Syed

Wednesday, July 12, 11:00 AM-12:30 PM

Oral presentations

Find all the details for our oral presentations by accessing the IHEA 2023 agenda and searching “ThinkWell.”

Richard Ssemujju

Mutia Astrini Pratiwi

Ruli Endepe Al Faizin

Diah Evasari Husnul Khotimah

Eric Tabusibwa

Marie-Jeanne Offosse Ngbesso

Nirwan Maulana

Edward Sutanto

The 15th IHEA World Congress on Health Economics will be held July 9-12, 2023, in Cape Town, South Africa, and our teams are prepping for our biggest attendance yet. Our projects will be featured in five pre-congress sessions all listed below, all of which are available for FREE virtual attendance.

The IHEA Congress is an international convention for health systems experts to discuss the latest data, methodologies, findings, and tools in the pursuit of improving health care around the globe. This year’s theme is “Diversity in Health Economics.” The event will take place in both buildings of the Cape Town International Convention Centre (CTICC). Find more information on ThinkWell’s IHEA pre-congress sessions, how to register, and the agenda below.

As more details around schedules become available, this page will be updated. See you in Cape Town!

Attend Pre-Congresses Virtually

Pre-Congress Registration

Pre-Congress Agenda

Pre-congress sessions will run July 8-9, 2023. ThinkWell will participate in five sessions detailed below.

Saturday, July 8

9 AM-12:30 PM

Organizers: ThinkWell, Center for Global Development, and KEMRI Wellcome Trust Research Programme

There is growing consensus that channeling funds to health facilities and granting them more autonomy will improve the delivery of primary health care services. In this session, we will explore the evidence about the impact of direct financing for facilities on access to health products, especially essential medicines.

People-Centred, Efficient Health Care Services: Rethinking Sustainable Health Care Financing in the Context of the African Union’s ALM Declaration on Domestic Financing for Health

1:30 PM-5 PM

Organizers: ThinkWell, The Global Fund, AUDA-NEPAD, Eastern African Community, ODI, and SADC

In uncertain times, the need to ensure that adequate, effective, and efficient financing for healthcare in Africa remains a political priority has never been clearer.  This is the goal at the heart of the African Unions ALM initiative on domestic financing for health. We hear from the organizations tasked with implementing that ambitious agenda, together with member states implementing their own health financing reform agendas.

9 AM-5 PM

The Immunization Economics Special Interest Group welcomes researchers to join a two-day meeting to take stock of the latest evidence and research projects, exchange research approaches and methods, and to discuss research priorities. Topics on the agenda will include costing, value of vaccines, immunization financing, and the use of economic evidence for policy and programming.

Register for this session here

Sunday, July 9

8:30 AM-12 PM

Organizers: ThinkWell, R4D, and WHO

This bilingual session (English-French) brings together diverse country experiences to discuss the latest research on contributory social health insurance and non-contributory/free healthcare schemes. The session facilitates an exchange between African, Asian, and Latin American speakers, explores the politics behind these reforms and how these schemes can be improved to achieve UHC.

1 PM-4:30 PM

The SDGs push all countries to achieve UHC by 2030; however, UHC will not be achieved unless sustainable health financing is in place. Many countries have inadequate comprehensive analyses of sustainable health financing. This session explores several health financing models and the respective performance of current UHC in four LMICs: Indonesia, the Philippines, India, and Sri Lanka.

8:30 AM-4:30 PM

The main IHEA congress will be held July 10-12, 2023. The detailed agenda for each presentation can be found HERE. Please visit this page to access titles, times, and descriptions for each presentation.

IHEA Congress Information

Congress Registration

Attend Pre-Congresses Virtually

On June 1, 2023, at 9:00 AM-EST, ThinkWell hosted the third installment of the Counterpoint webinar series titled “Financing health facilities directly: What is all the fuss about?”

During this webinar, we explored the topic of financing health facilities directly.

Watch the recording

There is a growing consensus that granting health facilities in the public sector more funds and greater autonomy is critical for improving primary health care (PHC) delivery. This was one of the themes highlighted by the Lancet Global Health Commission on financing primary health care, which found that public sector PHC facilities could retain and manage funds in fewer than 40% of low- and middle-income countries (LMICs). The report noted that direct financing for public facilities will allow them to improve service readiness and responsiveness. It is also a necessary precondition for them to feel incentivized by signals from public purchasing entities attempting to advance health system goals like improved access, equity, quality, and efficiency. There has been a spate of papers on the topic recently, including by the World Health Organization (WHO) and the World Bank.

And yet, giving health facilities greater financial autonomy is not a new idea as such. Many types of management entities to produce goods and services have been around for centuries. More critically, the merits of granting hospitals autonomy have been debated extensively as part of the new public management discourse since the 1980s. Not everyone is convinced. Some feel that local governments are better positioned operationally to manage service delivery instead of expecting each facility—including small health centers and dispensaries—to manage their own affairs.

In this webinar, we had a candid conversation with two leading voices on the topic about why the push for getting more funds and management of service delivery to the frontlines and why some continue to challenge the idea. We discussed why this is an important issue for LMICs to explore as they develop and execute strategies to make progress towards universal health coverage. ThinkWell Senior Fellow, Nirmala Ravishankar hosted the webinar featuring two experts:

Nirmala Ravishankar is a Senior Fellow at ThinkWell.

Sheila O’Dougherty is a health financing and management expert who retired from her position as Vice President at Abt Associates in 2020. Sheila led USAID-funded health systems strengthening project implemented by Abt Associates that supported far-reaching government reforms to enable direct financing for public facilities in Central Asia and Tanzania. She is the lead author of joint WHO-World Bank brief on direct financing for health facilities.

Edwine Barasa is the Director of the Nairobi Program of the KEMRI Wellcome Trust Research Program in Kenya. He was instrumental in documenting how health facilities lost financial autonomy when Kenya devolved key decision-making powers from the central government to newly formed county governments and has published extensively on the question of decentralization and facility autonomy.

Some of questions we posed to these experts are as follows:

1. What does it mean to directly finance facilities? Why the focus on financial autonomy?
2. Have countries done this before? What does their experience teach us?
3. Many countries have pursued devolution of decision-making powers to local governments. Is that the same thing? Is that not enough?
4. Are there any risks to giving more money and control to public facilities? How can they be mitigated?
5. Where is this agenda headed? What should health financing analysts be exploring? What should health financing policymakers and practitioners be doing?

Counterpoint is ThinkWell’s signature series of webinars that offers a platform for free and frank debate about questions related to health system strengthening. Through these honest discussions, we strive to both challenge dominant paradigms and scrutinize new trends to ascertain their merit.

DECEMBER 2022 UPDATE

Two of the posters that Technical Advisor Geminn Apostol presented were honored with best poster awards at the conference. Click the links below to find the posters:

Mapping the Complex and Multiple Financing Roles and Expenditure Flows for Family Planning (FP) in the Philippines: A nationwide study from 2018-2019

Challenges to Achieving Contraceptive Self-Reliance in Devolved Health Systems: Insights from the Philippines, Indonesia, and Kenya

In November 2022, members of the ThinkWell team participated in the International Conference on Family Planning (ICFP).

About ICFP

This is the world’s largest gathering of family planning (FP) and reproductive health professionals. Over the years, ICFP has “grown into a platform for researchers, advocates, governments, and communities; a movement towards achieving access to family planning for all; and a growing community guided by the spirit of partnership, inclusivity, innovation, and scientific rigor.

“As the larger family planning community looks ‘beyond 2020’ to realign [global] goals and reposition for the future of family planning, ICFP 2022 will be a strategic benchmark as the community prepares to recommit to a goal of universal access by 2030.”

ThinkWell at ICFP

Members of the ThinkWell team from an array of projects led several oral presentations, as well as satellite and poster sessions.

Dr. Marie-Jeanne Offosse gave two oral presentations as part of a larger panel session. One presentation covered the costs and demands for family planning in Burkina Faso; the other offered health care provider perspectives on free family planning services. From ThinkWell Philippines, Geminn Apostol led a session on how to expand family planning access through public-private health care provider networks in the Philippines.

Other members of the ThinkWell team presented at ICFP include Sarah Straubinger who gave an oral presentation titled “Understanding family planning counseling for Burkinabé women: Study results to confirm the quality-of-care measures for routine service monitoring,” the result of a 27-country global desk review.

Edward Sutanto of ThinkWell also presented findings from a study on “experience, perception, and preference among Indonesian contraceptive users.” A ThinkWell learning partner, Dr. Pip, of University of Philippines Visayas, led oral presentations and poster sessions on our family planning work in Indonesia and the Philippines. For a more detailed list, please see below.

Our team and partners participated in an insightful, inspiring, and exciting ICFP 2022!