Presented By: Ruth Charo. October 2007

Transcription

1 Kenya Makes a Quantum Leap in Health Sector Wide Approaches International Conference on PBAs in Health October 2 nd -4 th 2007, Madagascar. Presented By: Ruth Charo October 2007

2 Background NHSSP II set a priority to develop a Health Sector Wide approach. Stakeholders met in October 2005 and agreed to develop a JPWF and a SWAp strategy. A joint appraisal mission held in April-May 2006 provided constructive suggestions on the SWAp. Suggestions included JPWF and AOP.

3 Trends in Selected Health Indicators

4 Inequities in Health Selected Indicators Nairobi Central Coast Eastern Nyanza Rift Valley Western North Eastern Fertility rate (total births per woman) Population with no education Use of modern contraceptives Infant mortality (per ,000 live births) Under five Mortality Women who received no ANC care Births attended by Health Personnel Full Child Vaccination coverage

5 Inequities in Health Table 2 Number of Beds by Facility Type and Province Province PGH District hosp Health Centre Dispensary Total % beds Bed Per Population Bed per 100,000 population Rift Valley 453 2,796 1, , , Eastern 353 2, , , Nyanza 397 1, , , Central 396 1, , , Western , Coast 359 1, , , Nairobi , North Eastern , Total 2,650 12,381 3, , , % Beds North Eastern, R/valley and Western below national average 62.8% of beds in hospitals( serving 30% of population)

6 Process for Development of NHSSP II Government Ministries Finance, Agriculture, Water, Education, Gender, etc Community and civil society groups Private Sector Non-Governmental Organisations, Faith- Based Organisations, and Private health practitioners Development partners who support the health sector

7 Framework for Kenya Health Essentail Package (KEPH) : Support systems Servic e Deliver y Health sector performanc e Healt h outcome s 1. Interface between Services and Community 2. District Health Planning Quality and responsivenes s to demand 3. Financial Managemen t 4. Monitoring and Evaluation 5. Resource Human s 6. Standards and 6.pp Assuranc Quality t e 7. Commodity supply (pharmaceutical 7pp 7.pp / s 8. Maintenance t equipment) (infrastructure, equipment 8.pp transport, t ) 9. Communication systems / ICT K E P H Equitable acces s Efficiency and effectivenes s IMPROVED HEALTH of the POPULATION * adapted from Chen and Evans (2004)

8 JPWF: Areas of Work and Background Documents Areas of Work Background documents Outputs S/Delivery plan SERVICE DELIVERY Community strategy Referral strategy Norms and standards JOINT PROGRAM OF WORK AND FUNDING HUMAN RESOURCES INFRASTRU CTURE HRH plan (HRM and HRD) Infra improvement plan A O P / /10 A O P 3 A O P 4 A O P 5 FINANCIAL MGT PFM improvement plan PROCURME NT Proc. improvement plan Bottom up plans PLANNING, M & E PM & E framework

9 What is the JPWF It is a planning and programming tool to: Guide the activities and investment decisions in implementation of KHSWAp Outlines priority health activities, strategies and resource implications of the four years. Provides cost estimates of the various activities. Provides projections of possible resource availability based on planned sector resources outlined in MTEF and other sources. Help support the process of alignment and harmonization process.

10 Priorities of JPWF To address equity through expansion of access of basic services with focus at community level. Enhance health gains through cost effective interventions (eps. L 2-4). Enhance efficiency i and budget effectiveness by facilitating availability of funds at point of use (operational & effective PFM system, operational PME and RBM procedures) and Strengthen sector stewardship and partnerships with all stakeholders: clarity of roles, joint planning, funding & monitoring arrangements, common management arrangements.

11 JPWF: Service Delivery Areas of Focus: Community Services District Services Secondary and Tertiary Services Referral System

12 JPWG: Systems Inputs Areas of Focus: Human Resources Infrastructure Commodities

13 JPWF: Systems Support Areas of Focus: Public Financial Management Procurement Performance M&E

14 JPWF:Governance Areas of Focus: Stewardship Governance Partnership

15 Partnership The NHSSP II and JPWF recognizes the need for PPP. The private health sector in Kenya commands about 52% of the national health infrastructure. CSOs involved in CoC, DHSFs, AOPs, HSCC, JICC, MTEF, JRM and various MOH Task Forces and ICCs.

16 Planning and Monitoring Cycle Planning and monitoring cycle February - April District Annual Plans Provincial Support Plans Hospital Plans Department/Division Plans Parastatal Plans Resources, (GoK, Partners) MTEF May Health Review Summit January MoH Annual Report JRM Report Information Collection & Use Health Planning Summit (AOP) November Implementation External Joint Review Missions (DP + MOH) Internal review October September

17 Possible Financing Mechanisms Funding Mechanisms for the Health Sector Development Partners (DP) GOK / Ministry of Finance (MOF) Option A: Direct Project Funding < HSCC, SCs > Option B: Pooled Funding for specific areas (Com. Bank Acc. with fund agent or DP/MoH) Option C (budget support with/without earmarking): Common Fund in MoH Development Account HSCC (MOH-DP) Fund Management Committee -On-going projects addressing MOH priorities (align with planning of JPWF and AOP) -Tech Assistance (under an aligned and harmonised planning mechanism (AOP & business plans) Non-public Sector Fund Commodities Procurement Fund Emergency Hiring Program Service Delivery Fund Health Equity Fund (demand side interventions) IEC-Fund (RHD/GTZ) Technical Assistance Pool Service Delivery (O&M) -O&M (HFF) -CB-KEPH -National Programmes -Training -Tech Assist HRH (PE) -HRH (PE) Commodities Supply - through KEMSA for: EMMS - through MoH: services, equip, transport, infrastructure Systems Support & Governance Policy, Planning, M&E, FMS, RBM, Equity, Annual Reviews, Mgmt Cap Bldg, TA Harmonisation & alignment of funding mechanisms over time

18 GDC: Pre-sector reform service provision Source: (Synthesis Report - Forum on Alignment Challenges in Programme- Based Approaches - Enhancing implementation effectiveness of Programme-Based Approaches through programme and stakeholde r alignment; 17 to 19 November 2003, Berlin; 30 April 2004; GTZ Eschborn, Germany)

19 GDC: Post-sectorsector reform service provision Source: upload/pdfs/swap/swap376.pdf Source: (Synthesis Report - Forum on Alignment Challenges in Programme- Based Approaches - Enhancing implementation effectiveness of Programme-Based Approaches through programme and stakeholde r alignment; 17 to 19 November 2003, Berlin; 30 April 2004; GTZ Eschborn, Germany)

20 THANK YOU!