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Tracking spending on health to improve equity – Kenyan case

Tracking spending on health to improve equity – Kenyan case. Thomas Maina 24/04/2012. Health care financing policy and strategy in Kenya. Important decisions made by the government over the past decade with regard to HCF The strategies include: Decision to introduce user fees in 1989

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Tracking spending on health to improve equity – Kenyan case

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  1. Tracking spending on health to improve equity – Kenyan case Thomas Maina 24/04/2012

  2. Health care financing policy and strategy in Kenya • Important decisions made by the government over the past decade with regard to HCF • The strategies include: • Decision to introduce user fees in 1989 • Shift in focus from curative to preventive health care (HSSP II and KHPF) • Reform NHIF to enhance the benefit package and improve access to health care • Setting up a SHI scheme a flagship project of the Vision 2030 to improve equity in health care financing • Scale up Output Based Approach to improve access to health care by the disadvantaged • Development of a care financing policy

  3. History of NHA in Kenya • Kenya has implemented four rounds of NHA between 1997/98 and 2009/10 • The first round of NHA undertaken in 1998 and used data for FY 1994/95 • Financed by Danida and USAID through Partnership for Health Reform • HH contribution estimated using Welfare Monitoring Survey of 1994 • Key findings: • THE – Kshs. 31 billion ($US 560 million) • HH contributed bulk of the THE (53%)

  4. Sources of funding health care -1994/95

  5. Second round of NHA-2001/02 • Conducted in 2003 using data for FY 2001/02 • Financed by SIDA, USAID through Partnership for Health (ABT) and NHIF • A HIV/AIDS sub-analysis also undertaken • A Household Health Expenditure and Utilization undertaken to estimate HHs contribution • Key findings: • THE – Kshs. 47 billion (US$598 million) • Again HHs contributed bulk of THE (51%) • Public providers consumed 60% of the THE • HIV/AIDS sub account – THEhiv – Kshs. 8.2 billion (US$103 million with donors contributing 51%,HH 26% and Gov’t 21%

  6. Sources of funding -2001/02 –General Health and HIV/AIDS

  7. Percent distribution of public outpatient services

  8. Third round of NHA • Undertaken in 2007 and used data for FY 2005/06 • HIV/AIDS and RH sub-accounts • Financial and technical support by USAID through Health system 20/20 • HH survey also undertaken to estimate HH contribution • Key findings: • THE- Kshs. 71 billion (US$964 million) • HHs contributed 36% ( reduction of 15% from 2001/02) • THEhiv – Kshs 19 billion (US$256 million) • Donors financed 70%,HHs 23% and Govt 7% • THERH - Kshs. 9 billion (US$119 million –HHs 38%,Govt 35% and donors 24%

  9. Sources of funding – 2001/02,2005/06 and 2009/10

  10. Fourth round of NHA • Conducted in 2010 using data for 2009/0 • HIV/AIDS,RH,TB, Malaria and Child health sub-accounts • Financial and technical support from USAID through HS20/20, financial support also from WHO and World Bank • Key findings: • THE – Kshs. 122.9 billion (US$1,620 million) • Further reduction of HHs contribution from 36% in 2005/06 to 28.5% in 2009/10 • Doubling of donor support to 35% • THEHIV – Kshs. 30 billion – Donors 51%, private sector 28% and Govt 21% • THERH –Public and private major contributors (40% and 38% respectively • THEMalaria- 52% came from private sector including HH

  11. Cont’ fourth round of NHA • THETB – Donors contributed 39% • THECH – Donors contributed 44%

  12. Use of NHA by the government to inform policy – address equity and access issues Evidence • Results of 1997/98 and 2001/02 provided evidence on HH spending on health (over 50%) • The NHA of 1997/98 and 2001/02 also provided evidence that the rich benefit more from public spending on health – hospitals while the poor benefit more from – lower level health services Government response • HCF became a topical issue in many forums – Taskforce on HCF – SHI and OBA flagship projects of Vision 2030 • MoH lobbied for more resources from MoF – 30% increase in 2003/04

  13. Cont’ use of NHA by the government to inform policy – address equity and access issues • Measures to reduce OOP: • 10/20 policy (2004) – 50% increase in outpatient visits • HHES of 2003 reported stock outs leading to reduced access to health care – procurement of a 3 month kit of EMMS in lower level facilities leading to increased utilization • User fees accounted for 30% of O&M in health facilities – piloting of HFF in Coast and NE and scaling up of the same in all provinces (HSSF) • Mobilized donors to hire nurses for the lower level • All the above measures led to a reduction of OOP from 51% in 2001/02 to 30% in 2009/10

  14. Conclusion • Evidence provided by the several rounds of NHA impacted on policy process – pro-poor policies • The need to institutionalize NHA to continue providing evidence on HCF on regular and timely basis • Institutionalization efforts so far: • Msc in Health economics course – to increase the pool of graduates with knowledge on NHA • Standardized donors/NGO reporting tool – plans to computerize • Simplified NGOs tool • Piggy backing HH spending on health on regular surveys – KAIS in 2007 and 2012 • NHA as part of the PS performance contract to increase demand

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