Health Sector profile of Kenya

Health Sector Profile

The Vision 2030 expresses the commitment to provide an efficient and high quality health care system with the best standards focusing on public health, and by this reduce health inequalities and improve infant, child and maternal health. The general Health Sector goal is, ‘attaining the highest possible health standards in a manner responsive to the population needs’.

Kenya Health Policy 2012 – 2030

Policy Objectives

Eliminate communicable conditions
Halt and reverse the rising burden of non communicable conditions
Reduce the burden of violence and injuries
Provide essential health care
Minimize exposure to health risk factors
Strengthen collaboration with other sectors that have an impact on health

Characteristics of the health sector

Malaria is the leading cause of outpatient morbidity in Kenya,
Non-communicable diseases such as diabetes, cardiovascular diseases and cancers, and their related risk factors such as high blood pressure, high cholesterol, and excessive bodyweight are increasing in Kenya
Reduced infant and under five mortality rates
Increased contraceptive use but high fertility rate
Health worker: patient ratio is still low
Proportion of children fully immunized against communicable diseases increased

Financing

Analysis of the Health Sector Financial Landscape indicates that during the FY2017/18, a total of KES 60,889 Billion was allocated to the sector representing a 20% increase in resource allocation to the sector between the FY 2013/14 and 2017/18 period.

Government Health Agencies

The sector has seven Semi-Autonomous Government Agencies (SAGAs) which complements it in discharging its core functions through specialized health service delivery; medical research and training; procurement and distribution of drugs; and financing through health insurance. These SAGAs include the following

Health sector performance

In terms of health impact indicators, the Sector has made the following achievement overtime.

The Under Five Mortality rate dropped from 72 per 1,000 live births in 2009 to 52 per 1,000 live births in 2014,
Infant Mortality from 52 per 1000 live births in 2009 to 39 per 1000 live births in 2014;
Maternal Mortality ratio from 488 per 100,000 live births in 2008/09 to 350 per 100,000 live births in 2014.
Births attended by skilled health personnel increased from 43% in 2008/09 to 62 percent in 2014 (KDHS 2014) and the number of deliveries in public health facilities increased from 676,100 deliveries in 2013 to over one million deliveries in 2016(DHIS2). This is attributed to the free maternal services program in all public health facilities.
The Contraceptive Prevalence Rate (CPR) increased from 46% in 2008 to 58% in 2014.
Immunization coverage for basic vaccines improved from 71 percent in 2014 to 75 percent in 2016.
It is estimated that 1.51 million people are living with HIV in Kenya, out of whom 947,000 are on life saving ARVs. HIV prevalence rate realized a significant drop from 6.3% to 6% while stunting levels among children under five years have decreased from 35.3% in 2008/09 to 26% in 2014.
Malaria control program registered a reduction in number of confirmed malaria cases and low prevalence of 8% in 2015 compared to 11% in 2010 (KMIS).
Tuberculosis (TB) cases have also declined from 85,289 in 2014/15 to 78,394 cases in 2015/16.
In terms of the key strategic interventions, the Managed Equipment Services (MES), a total of 66 hospitals in 42 counties were fully installed with targeted specialized medical equipment while 11 portable clinics were installed and 8 are operational.
Under Health Insurance Subsidy Program (HISP) a total of 21,546 households were enrolled, an increase of 30% over the previous year while the program for the elderly and persons with disability (PWD) registered 219,200 members.

Prioritization of programmes

The financial year 2017/18-2019/20 Budget will prioritize the following;

Scaling up of policy interventions aimed at enhancing equitable access to high impact healthcare services;
Addressing challenges associated with devolution of health care and high turnover rate among health workers and
Controlling non-communicable diseases, maternal mortality and improving health service delivery in the country.

The Sustainable Development Goals (SDGs)

This call for government effort to move beyond meeting basic human needs in order to promote dynamic, inclusive and sustainable development and wellbeing for all at all ages by 2030. The emphasis will therefore be the reduction of the burden to the households and attainment of the highest standards care for sustained long-term growth and development it will include the following areas;

Reduce maternal mortality ratio to less than 70 per 100,000 live births;
End preventable deaths of new-born and children under 5 years of age, reduce neonatal mortality to 12 per 1,000 live births and under-5 mortality to 25 per 1,000 live births;
End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and
Combat hepatitis, water-borne diseases and other communicable diseases;
Reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being;
Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol;
Halve the number of global deaths and injuries from road traffic accidents;
Ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes;
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Regulatory Framework

Ministry of Health

Strategic Thrusts of the ministry

Improving equitable access to public health and sanitation services
Improving quality and responsiveness of public health and sanitation services
Improving efficiency of public health and sanitation services
Fostering partnership
Improving financing to the Ministry of Public Health and Sanitation

Kenya Medical Supplies Authority (KEMSA)

Kenya Medical Supplies Authority was established under the Kenya Medical Supplies Authority Act No. 20 of 25thJanuary 2013 with mandate as a medical logistics provider with the responsibility of supplying quality and affordable essential medical commodities to health facilities in Kenya through an efficient medical supply chain management system.

Kenya Medical Research Institute (KEMRI)

Kenya Medical Research Institute is a State Corporation established through the Science, Technology and Innovation (Amendment) Act of 2013, as the national body responsible for carrying out health research in Kenya. The mandate of KEMRI includes; conducting research aimed at providing solutions for the reduction of the infectious, parasitic and non-infectious diseases and other causes of ill health in Kenya.

National AIDS Control Council (NACC)

National AIDS Control Council (NACC) was established in November 1999 under the State Corporations Act and Legal Notice No. 170 with a mandate to coordinate the national response to HIV and AIDS. The overriding mandate of NACC is national coordinating for HIV and AIDS.

National Public Health Laboratory Services (NPHLS)

The functions of NPHLS include the following among others;

Laboratory monitoring and evaluation
Handle National HIV logistics
Food quality control
National microbiology reference
Medical engineering

Health Infrastructure

During the review period, the Ministry of health undertook the following infrastructure projects: Construction and equipping of a Maternity block at Likoni District Hospital, Construction of a 30 bed Maternity ward and Theatre at Ngong District Hospital, Equipped 40 Hospitals under Managed Equipment Services Project, Constructed 98 classroom (MTC), constructed Central Radioactive Waste Processing Facility (CRWPF), Upgrading of the Health facilities in the slum areas, initiating the construction of the East Africa’s Centre of excellence for skills & tertiary Education and construction of the burns unit at Kenyatta National Hospital amongst others . The above undertakings aimed at enhancing the quality of health services in addition to improving access of the health facilities to Kenyans.

The Government of Kenya through the Ministry of Health and in conjunction with county governments embarked on a comprehensive programme to upgrade 98 hospitals, 2 in 47 Counties (94) and 4 National hospitals with a view to improving access to specialized services countrywide. The upgrading was through equipping each of the facilities with critical equipment through a Managed Equipment Services (MES) arrangement and human resource capacity building.

Health Sector Challenges

inadequate skilled personnel, there is skewed distribution of skilled health workers with some areas of the country facing significant gaps while others have optimum/surplus numbers and uneven remuneration and disparities in the terms of service among the same cadres of staff in the public sector leading to low motivation and performance levels;
Communicable diseases accounts for the highest proportion of disease burden in the sector;
Childbirth related conditions continue to pose significant challenges, especially inadequacy of emergency services for delivery, under-utilization of existing antenatal services and inadequate skills and competences of health workers in this area;
Inadequate funding at present total government health expenditure as a proportion of the total budget (both national and county budget) is about 6.8 per cent, falling much below the 15 per cent agreed by African Government in Abuja in 2003;
There is inadequate infrastructure and skewed distribution of available infrastructure within the sector institutions and the country with a strong bias towards the urban areas;
Timely rehabilitation and supportive maintenance still remains a key challenge. there also exists obsolete health equipment that requires replacement with modern ones;
The sector lacks the necessary legal framework to support the constitutional right to health and especially on provision of emergencies services. There is also a lacuna in the institutional roles and accountability between the two levels of government on dealing with emergency care functions;
Funding for health research remains donor-driven, fragmented and uncoordinated. In addition, research agenda priority setting at both the national and international level is not based on evidence based requirements and
Health Management Information System Disparate reporting systems (HRIS, LMIS, DHIS, EMRS etc.), underfunding of the infrastructural system together with inadequate capacity in analysis is a major challenge. This has led to inadequate use of available data to inform policy planning both at the national and county level. In addition, reporting from the private healthcare providers is also weak. Innovations in e-health have remained at pilot level with none going to scale due to lack of funding.

Information under the health sector of Kenya is organized as follows;