1. Consultative Meeting on Accelerating the Attainment of MDG 5 in Kenya – August 27-28, 2014 Investing in Primary Health Care for reducing maternal & child mortality

2. 2 Kenya’s health outcomes do not commensurate with its aspirations of a middle income status. Global evidence shows that improving maternal and child health outcomes lies in better Primary Health Care. Devolution provides a unique opportunity to address bottlenecks in delivering Primary Health care Main messages

3. Areas of focus Highlighting the challenges facing Kenya health system; Examining how reforms have improved PHC; and Suggesting how Kenya can build on its devolved system of delivering PHC services to achieve the MDG 4&5 and universal health care 3 Improving PHC services in Kenya’s New Devolved System

4. Health outcomes are mixed

5. 5 Despite having lowest child mortality in the East Africa region in 1990, the decline is much slower compared to the rest and higher among the poor

6. 6 Kenya’s Maternal Mortality Rates Declined, but more modestly compared to countries in the neighborhood

7. …inconsistent with its aspirations to become a middle income country 7 Life expectancy in Kenya in 2011 is comparable to that of China in the 1960s … and the total fertility rate is comparable to that of Brazil in the 1970s

8. Kenya spends about 6.5% of its budget on health…

9. 9 Health sector continues to be predominantly financed by private sector sources (including by households’ out-of-pocket (OOP) spending); Public sector financing has remained constant over the last decade, at about 29 percent of THE; Donors contribution has more than doubled, from 16 percent in 2001/02 to 35 percent in 2009/10. Sources of Health Financing

10. 10 One in ten Kenyan households report catastrophic expenditure on health

11. PHC is key and cost effective Provision of PHC is critical to improving health outcomes. The family health program in Brazil helped reduce infant mortality by 13% within five years (Macink et al 2007). PHC is cost-effective. Hospitals and specialist care consume 70% of health care costs, but serve only 30% of the population (Logie et al 2010). In India, a 2% increase in resource allocation for PHC was associated with increases in patient load (64%), cost-effectiveness (51%), drug supply (49%), and patient satisfaction (13%) (Varatharajan et al 2004). Kenya is moving in the right direction. Sustained focus on PHC in Kenya helped to double outpatient utilization between 2003 and 2013, raising the per capita outpatient visits from 1.7 to 3.1 (Kenya Household Healthcare Utilization and Expenditure Survey 2013). 11

12. 12 Expenditure on public health facilities enhances equity

13. Kenya is well positioned to reform its health sector Kenya is particularly innovative at developing home- grown solutions The private health sector is vibrant with specialized hospitals and pharmaceutical industry and FBOs operating facilities in the most remote areas of the country. 13

14. Government actions have already improved PHC services Kenya’s new constitution guarantees rights to health care and devolves responsibility for delivering health care to the counties. Some of the important initiatives helped in improving primary health care: Launch of the Health Sector Services Fund (HSSF) in 2010; Use of Economic Stimulus Package funds for devolved recruitment of more than 3,000 nurses; and Introduction of a pull system of supplying essential medicines. 14

15. Health Sector Services Fund is strengthening the PHC provision HSSF aimed to improve the equitable supply of good-quality health care by the facilities closest to communities by addressing the financial uncertainty. The HSSF is initiating a process of change that could revolutionize service delivery in Kenya: improving the management and accountability of resources; Involving local communities in the management of the health facility; fostering social accountability; exploring the possibilities of contracting out services to NGOs and community/self-help groups closest to the community; and creating a platform for horizontal linkages with other sectors important to health. 15

16. Local participation has increased under HSSF program 16

17. The supply of essential medicines and medical supplies has improved Kenya now has better modalities of financing, procurement, and distribution for rural health facilities. All public PHC facilities in Kenya are now covered by the demand-based “pull” system of receiving essential medicines and medical supplies. Most Counties are now following this approach. 17

18. Availability of medicines has increased under the pull system 18

19. 19 Counties started responding to the challenge During the first quarter of 2014, all but three counties allocated at least 30 percent of their medicines and medical supplies

21. 21 Proportion of health facilities offering Basic-Emergency Obstetric care

22. KENYA CAN GET MORE HEALTH FROM MONIES BEING SPENT Focus first on making existing public PHC facilities operational One out every 10 PHC facilities are reported to be non-functional. Devolution provides new opportunities to strengthen the delivery of PHC. Reduce maternal mortality by improving access to basic emergency obstetric care Counties need to ensure that all PHC facilities with maternity wards offer basic emergency obstetric care, before creating new infrastructure Effective use of the Health Sector Services Fund HSSF can used to improve facility performance and enhance accountability to both the community and the county. Build partnership with all stakeholders Counties need to take advantage of all stakeholders (e.g., private sector, FBOs, NGOs, DPs) to address supply gaps; and communities to improve accountability 22 How can the government address remaining challenges?

23. Thank you. 23