Citizen s Engagement in Health Service Provision in Kenya

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1 Citizen s Engagement in Health Service Provision in Kenya Hon. (Prof) Peter Anyang Nyong o, EGH, MP Minister for Medical Services, Kenya Barcelona, Spain 21 st June 2010

2 Presentation Outline Introduction Policy and Legal Framework in Health Institutional Structures Health Financing and management The Referral system Pharmaceutical services Health Services Promotion Conclusion

3 Introduction Citizens participation has changed over time in line socio political changes in the country Authoritarian system in 1960s, 70s and 80s Decentralized systems since late 1980s District Focus for Rural Development (DFRD) strategy in 1983 and revised in 1995 Establishment of structures up to lowest administrative unit However, the DFRD strategy was not embedded in law

4 Levels of Citizens Participation Government structures in planning, budgeting, implementation and monitoring of programmes Private sector operations and participation Civil Society and faith based operations Direct community involvement

5 Policy and Legal Framework in Health Health Policy Framework of 1994 called for an enabling environment for stakeholder participation Reinforced by the National Health Sector Strategic Plan I ( ) and NHSSP II ( ) Further by the Economic Recovery Strategy and Kenya Vision 2030 Community Strategy in health was launched in 1996 to build capacity and reach 40% in four years A Memorandum of Understanding signed between Government and Faith Based Organizations in 2009 The MoU meant to achieve sharing of resources and collaboration in policy development

6 Institutional Framework Village Health Committee is the lowest administrative unit However, they active only community own resource persons (CORPS) are involved challenge given the low level of education in rural areas Sub-Locational and Divisional Health committees provided for but not very active Most active level has been the District Health Stakeholders Forum in planning and reviews

7 Institutional Framework Cont Devolved funds e.g. Constituency Development Funds, Local Authority Transfer Funds have enhanced citizens participation Sector Wide Approach in health is being formalized and has various structures: Health Sector Coordinating Committee Inter-agency Coordinating committees All of which involve all stakeholders All involved stakeholders have signed code of conduct

8 Distribution of Health Facilities by type and Controlling Agent, 2009 Controlling Agency Hospitals H. Centers Dispensaries Nursing Homes Clinics Total Ministry , ,004 FBOs Other Public Private ,722 2,216 Total , ,906 6,552 Non state actors control about half of the facilities

9 Estimates for staffing levels in different subsectors for registered cadres, 2007 Type of personnel No i-s 2008 MOH KNH MTRH FBO/L G Private % in Private sector Enrolled & KRNs 41,679 14,958 1, ,551 17, Doctors 5,926 1, , Clinical officers 5,478 2, , Pharmacists 2, , Pharm Techs 1, , Dentists Majority of the skilled health workers are outside public sector

10 Who Finances Healthcare in Kenya? Households bear the highest cost of care direct costs, taxes and premiums. In 2005/06, Total Health expenditure was structured as follows:

11 Financial Management Government has established other structures to enhance citizens participation: Health Sector Services Fund (HSSF) Hospital Management Services Fund (HMSF) By involving the private sector and community representatives in the management of the health facilities, with focus on finances

12 Sharing of Resources Government has been supporting Faith Based health facilities, especially the dispensaries and health centers with medical kits Hospitals under FBOs have been getting doctors, nurses and other Para-medical staff This is recognition of the role that FBOs have in health provision, especially in targeting the vulnerable and hard to reach areas

13 The referral Systems The referral system is meant to provide basic services at the community level at: Level 1: Community level; Level 2 and 3, Dispensaries and Health Centers Level 4: District Hospitals as first referral centers Level 5: Provincial Hospitals as specialized referrals Level 6: National Referral and Teaching/Research Hospitals However, weaknesses in the referral system has affected services offered at Levels 4, 5 and 6 as patients go there for basic services

14 Pharmaceutical Services Pharmaceutical services in Kenya form a major component of health service provision The first national drug policy of 1994 realized some achievements, but implementation was constrained by lack of an enabling legal and institutional framework Experience of public sector stock outs of essential medicines Counterfeit and substandard medicines in the market, unauthorized dispensing and illegal medicines outlets, and and inappropriate medicines utilization A new pharmaceutical policy under development

15 Health Services and Promotion Health promotion to the public have mainly targeted diseases that contribute most to the disease burden and mortality These are malaria (33% of morbidity; other respiratory diseases (29%) and diarrhea (13%) And HIV/AIDS that takes 17% of the total health expenditure media, education, VCT, condoms, etc Provision of free ARVs to the population over 300,000 patients involved

16 Conclusion Major efforts have been made to strengthen citizens participation results are mixed Major achievements have been in recent years devolved structures, devolved funds and structures for stakeholder participation Decentralization is necessary for citizen participation However, it is not sufficient to ensure real participation or accountability Decentralized systems can be as bureaucratic as centralized administrations but closer to people

17 Thank you for your Attention

Citizen s Engagement in Health Service Provision in Kenya

Citizen s Engagement in Health Service Provision in Kenya Hon. (Prof) Peter Anyang Nyong o, EGH, MP Minister for Medical Services, Kenya Abstract Kenya s form of governance has moved gradually from centralized