Note from the editors: For the past year, CHMI’s in-country partners have profiled health market innovations globally. Now will periodically feature highlights from CHMI’s country surveys. Here, Maureen Nafula, Executive Director at the Institute of Health Policy Management & Research (IHPMR), CHMI’s partner in Kenya, discusses the challenges and promising innovations defining the country’s health market.
Kenya continues to suffer from a high burden of communicable diseases, a high maternal and infant mortality rate – about 488 per 10,000 live births and 52 per 1,000 live births respectively – and high levels of poverty. Additionally, the country is seeing an increase in lifestyle-related communicable diseases such as cancer, diabetes and hypertension.
One of the major contributors to these indicators is a significant gap in human resources for health. According to the Human Development Plan, Kenya has 1.36 health workers per 1000 population – this is lower than the 2.5 ratio recommended by the WHO. Kenya also has a shortage of specialised doctors (out of the 6,897 registered doctors, 1,589 have specialist qualifications); this is one of the contributory reasons for Kenyans who can afford it seeking medical treatment abroad.
The public and private sectors, including a large number of Faith Based Organizations (FBOs), play an important role in care delivery - the private sector own 58% of all healthcare institutions. Because private facilities are generally better equipped and resourced, they provide services such as laboratory and imaging, which are not usually available in public health facilities. However, about 60 percent of care is delivered in the public sector.
Health Market Innovations can play an important role in leveraging the strengths of both sectors to expand access to care. Below are a number of observations from the Kenya landscaping effort:
Emphasis on Public Private Partnerships (PPPs). The Kenya Government recognizes the valuable role the private sector plays in health service delivery. This is expressed in a number of policy and strategy documents, including the Kenya Health Policy Framework 1994–2010 (KHPF), National Health Policy Framework (2011-2030), and Vision 2030. The National Health Policy Framework (2011-2030), sees the private sector as a crucial partner both as a source of financial resources and for ensuring programme delivery competencies. Vision 2030 is the country’s current development blueprint. It aims to transform Kenya into a newly industrializing, “middle-income country providing a high quality life to all its citizens by the year 2030”. The plan envisions Kenya as a regional provider of choice for highly specialised health care, mainly through PPPs. In line with its Strategic Plan for 2008-2012, the Ministry of Medical Services (MOMS) is at an advanced stage of developing a policy on PPPs.
Care delivery through clinic networks. With the government’s current policy of divesting from service delivery and focusing more on policy formulation, target setting, monitoring and evaluation, the private providers' role in health care delivery is set to increase. Driven by a need for providers to maximize economies of scale to remain competitive, the country may see a growth in service delivery networks, chains and franchises such as Caroga, Tunza and AMUA.
- Innovations in technology for health. The high mobile phone penetration (currently estimated at 55%) will encourage increased mobile phone-based applications in health. Changamka, for example, leverages mobile phone networks and smart card technology to encourage clients to save for maternal and child care services. The smart card allows users to deposit as little as Ksh. 50 (USD 0.56) at a time to go toward medical bills, including hospital delivery. An estimated 8,000 families are using the Changamka smart card. Since its introduction, hospitals such as the Pumwani Maternity Hospital in Nairobi, have reported a 30% increase in utilization of antenatal clinics and hospital delivery. Mamakiba is using mobile phone technology to encourage women to save for future healthcare needs. An SMS-based savings calculator and prepayment tracking tool helps low-income women save and prepay for maternal health services such as ante-natal care (ANC) and clinical delivery. The prepayment deposits are “locked-in” towards a specific service and deductions are made only after the service is delivered, unlike a standard prepayment.
- Health financing through the demand-side. Kenya’s new constitution includes the right of all citizens to health care services. Implementing this constitutional requirement will necessitate greater uptake of health financing schemes such as the OBA Voucher Program. The OBA Voucher scheme offers a safe motherhood package of antenatal services and attended delivery by qualified health workers, long-term family planning methods and gender-based violence recovery services at accredited facilities. The safe motherhood voucher cost to clients is Ksh 200 ($2.70) and the Family Planning voucher is Ksh 100 ($1.35). Unlike many other voucher schemes, this program works with both private and public sector facilities allowing for greater competition and better service coverage.
See all Health Market Innovations identified in Kenya here.
While Health Market Innovations are contributing to efforts to increase access to health care, significant improvements in the country’s health indicators will have to be met with additional health systems strengthening efforts such as stepped-up recruitment and retaining of trained health care staff, particularly in rural areas, improvements in infrastructure and the supply chain for essential medicines, and increased financing for health – current government spending as a percentage of GDP is around 5%, far below the 15% agreed upon in the Abuja Declaration.
However, Vision 2030 and the ongoing dialogue on public-private partnership and establishment of a Health PPP council are good indications of government’s commitment to involving the private sector more in health service delivery. Other encouraging signs of additional private sector involvement include support in the form of medical commodities and seconding of health personnel to faith based organizations. If these trends are an indication of the future, implementation of health market innovations is set to increase.
For more information on Kenya’s health system, read the Kenya Country Profile developed by IHPMR.