MoH request to develop UHC options paper
Feb 2014 -
Request communicated to P4H CD by MoH on Wednesday, 19 February 2014,
The Ministry of Health Technical Working Group on Universal Health Coverage (TWG-UHC) has finalized the ToR for consultancy services to develop an options paper for UHC in Kenya. The consultant will synthesize the three (draft) reports developed by the national consultants ( review of the health financing functions and proposal for feasible financing options in Kenya;  Institutional and organizational arrangements for UHC in Kenya and;  Status of UHC in Kenya with respect to equity, access and service coverage) and develop feasible UHC reform options.
The lead consultant will be supported by the other P4H experts seconded by each organization to UHC-TWG. The expected time-lines and deliverable are stipulated in the TORs attached. The consultant will report to the Head, Directorate of Planning Policy and Finance (Ministry of Health), Nairobi, Kenya.
Attached please find the ToR for the options paper.
- 2014 02 19 Kenya Revised TOR UHC Reform Options paper (pdf, 216.81 KB)
Situation assessment on track despite mall attack
Oct 2013 – October 2013: Local consultants undertaking a technical assessment of the different elements required for the development of universal health coverage (UHC) have started working and the first rounds of commentary have gone as well. Some high level meetings have been postponed due to the mall attacks and are now scheduled for November. Despite this setback the UHC assessment process is still more or less on track, as is the development of strategic options. The drafting of a HF strategy is scheduled for completion by the end of the year.
P4H network continues support
Aug 2013 – August 2013: The P4H Coordination Desk (CD) receives an official Ministry of Health (MOH) request for technical support for the UHC Technical Working Group (TWG) which is tasked with developing a roadmap for UHC in Kenya. Several P4H members mobilise high level experts who will be working in coordination with a team of local consultants (see TOR). The tentative time frame for P4H support is September to December 2013.
Assessing UHC situation in Kenya
Jul 2013 – July 2013: Spurred on by a new Cabinet Secretary and team, the Ministry of Health (MOH) is energetically pursuing the universal health coverage agenda, notable developments including the formation of a Technical Working Group (TWG) which has been put together to define a comprehensive UHC strategy for the Country. The TWG is to undertake a technical assessment of the different elements of the Universal Health Coverage situation in Kenya, and to propose a set of options that the country can pursue in moving towards UHC. These outputs, to be delivered before the end of August, will form the basis of deliberations regarding the drawing up of a UHC strategy. For the sake of impartiality, and to ensure the involvement of different stakeholders, the MOH proposes using the P4H network members to provide the Technical Assisstance.
Technical working group formed
May 2013 – May 2013: Technical Working Group (TWG) of the Inter-agency Coordination Committee (ICC) on Health Financing (HF) is created and tasked with defining 5-year targets for increasing service and population coverage, and for reducing direct payments. The TGW is to work on: costing 5-year targets; elaborating efficiency and equity objectives; and drawing up targets for the different HF functions the institutional arrangements need to attain in terms of revenue generation, risk pooling and purchasing of services. The TGW is also to carry out a review of existing institutions with a view to proposing the institutional arrangements that will be necessary to attain the above-mentioned objectives. Finally, the TGW will assess different financing mechanisms in terms of the resources they can potentially generate, and define resource mobilization strategies. Deadline for these different deliverables is November 2013.
Work on health financing resumes after elections
Apr 2013 – April 2013: The Inter-agency Coordination Committee (ICC) on Health Financing (HF) meets for the first time after the elections of April 12. Discussions include the provision of free maternal health care and the abolition of user fees for basic and intermediate levels of care, as well as reform of the National Hospital Insurance Fund (NHIF). The decision is taken to form technical working groups (TWGs) covering universal health coverage (UHC), NHIF reform, and accreditation and regulation.
External Review of the Kenyan Draft Health Financing Strategy
Mar 2012 – The government of Kenya calls for health sector development partners to independently review both the content and development process of the draft strategy and to provide a road map for finalization and implementation in support of national health policies and objectives aimed at universal health coverage. The partners respond as Providing for Health (P4H) initiative and put together a team of international experts from WHO, the World Bank and GIZ not previously involved in the development of the health financing strategy to undertake a mission.
The observations include that during the protracted HFS development process which started in 1999, the Ministry of Health (MOH) and other stakeholders were unable to achieve consensus about the health financing model to be used, or how it might be implemented. Intense discussion focused on key issues such as the role of insurance and budget funding in health care financing, the feasibility of establishing a single purchaser by pooling all revenues, the use of competition between health insurers for the implementation of a basic benefits package (BBP) and the viability of a public/private mix in health financing establishing UHC by improving SHP cannot be achieved by the MOH alone. Intersectoral involvement, coordination and agreement within the Government and between the ministries of health, social welfare, labour and finance is therefore a key pre-requisite for successful reform.
The lack of an in-depth stakeholder analysis and social impact assessment was one of the main obstacles to the consultative process that underpinned the development of the HFS, making it more or less impossible to articulate and bridge the different interests between the various stakeholders.
Please read the mission report below for more details on the findings and recommendations on the way forward towards UHC.
- Kenyan mission report (pdf, 1.28Mb)
Update on health financing issues in Kenya
Nov 2011 – After completing the drafting of the Health Financing Strategy in early 2011, discussions at national level and in the National Social and Economic Forum focused on the organizational landscape of future health care financing. Several recent developments may influence the final form of the strategy and the way it is implemented, including, notably, an up to three-fold increase in the membership contribution to the National Hospital Insurance Fund (NHIF), which is being assessed in court after several national stakeholders, including the Labour Unions, lodged an appeal. Second, the International Finance Corporation funded an organizational review of the NHIF, conducted by Deloitte. The review has been welcomed by government and development partners, while the comprehensive list of recommendations provides valuable guidance for improving the NHIF. A copy of the report is available for download below. Third, a possible insurance scheme for civil servants is being debated, a project that has largely been developed outside the Ministry of Health, and separate from the health financing strategy process. Issues regarding equity and sustainability and how the scheme would relate to the national health financing strategy will require further discussion. Finally, the piloting of outpatient benefits by the NHIF: one of the questions concerns how this could be harmonised with the GIZ-DFID-funded Health for All Kenyans by Innovation (HAKI) project which has received substantial additional funding by World Bank and KfW. The NHIF appears to see HAKI as a learning opportunity on how to provide pro-poor-oriented social insurance including outpatient schemes.
- Strategic Review of NHIF – Final Report (pdf, 3.32Mb)
P4H and the health financing inter-agency committee
Oct 2010 – P4H partners are now represented and active in the health financing inter-agency committee (ICC), formerly known as the Health Financing Task Group, which is working on the health financing agenda and particularly on the implementation of the health care financing policy and strategy (HCFS). As part of the strategy process, Germany (GTZ) with co-funding from DFID is implementing a first pilot phase, testing the provision of social health protection through social health insurance in one district and the waiving of user fees in another. Further, in response to the request of the Government of Kenya on “Developing an integrated social protection policy for Kenya”, ILO is providing policy advice based on an assessment of the current social protection scheme for both formal and informal economy workers and their families. To address the key obstacles to achieving universal coverage and providing access to essential health benefits as identified in the report, ILO suggests an integrated strategic approach, focusing on: affordability at national and household level; accountability and sustainability; maximizing fiscal space; increasing capacity for implementation; the monitoring of reforms to increase coverage and expand benefit packages; redefining the roles of existing provider schemes; and improving social dialogue.
The coordinated efforts in Kenya have led to the development of a bill by the Ministry of Finance, based on the health financing strategy and with due consideration of: the recommendations made by the National Social and Economic Council; a concept note for establishing a Health Benefit Authority Board, as foreseen by the HCFS; the recruitment of a healthcare financing strategy project team; and the identification of suitable pilot districts.
NESC accepting the draft health financing strategy
Apr 2010 – The draft healthcare financing strategy has been accepted by the National Economic and Social Council (NESC: national advisory agency for policy analysis and development – see website); both Ministries of Health are in the process of developing proposals for the Cabinet in line with NESC recommendations; and an Inter-agency Coordinating Committee (ICC) on health-care financing has been formed.
There has also been an intensive communications push, including public lectures and forums, and a consensus-building campaign bringing all social health protection stakeholders together. Furthermore, substantial “pro-poor” analytical work has been undertaken and disseminated.
The joint strategic process has formed a sound basis for linking various work streams and support interventions. Notable examples include:
- The German Health Programme (through GTZ) and UK/DFID are jointly piloting the introduction of the Healthcare Financing Strategy on increasing access to the poor, and the next phase of the voucher programme (KfW) will be fully integrated into the strategy.
- Social Protection schemes under the Ministry of Gender, Children and Social Development have been linked to the Healthcare Financing Strategy through moderating consultations between donors, MoGCSD, MOHs and NHIF, notably by procuring NHIF memberships for cash transfer beneficiaries.
- Significant support to Social Health Protection reforms have been included in the new WB programme.
- The upcoming ILO mission to Kenya (29 June to 2 July) is being coordinated with the Kenyan HF Strategy team and process.
Relevant external Blog:
Making progress on a Health Financing Strategy
Dec 2009 – P4H network partners have funded a 3-month assignment supporting the government in finalising and disseminating the Kenya Health Care Financing Strategy. This strategy is the result of a consultative process initiated by the MOH back in 2007, and has now been finalised and disseminated to a number of stakeholders, including the Prime Minister’s Office and the Ministry of Finance, health-care service providers, including private sector, development partners and researchers.
Processes that have been supported/facilitated by P4H:
- The dissemination and discussion of the financing strategy.
- Detailing the initial phases of the implementation of the strategy, including testing ways to extend coverage to the poor and reviewing the institutional setup in preparation for future changes. Consequently, the issue of how to finance healthcare in the future has moved up the national agenda.
- Involvement of diverse stakeholders in the discussion, from government to development partners, and the National Hospital Insurance Fund to the private sector. The focus is on improving coverage, especially of the poor, through existing mechanisms, while continuing the discussion about how to achieve universal coverage.
Since November 2009, the National Economic and Social Council (NESC) has taken up the issues outlined in the Healthcare Financing Strategy. The NESC is chaired by the President of Kenya and recommends policies to the Cabinet.
Ministerial Study Tour to Paris, Berlin and London
Jan 2009 – France, Germany, the UK and the World Bank, together with the government of Kenya organised a ministerial study tour on health financing to Paris, Berlin and London from 21 – 31 January 2009. Under the umbrella of P4H, the study tour aimed at:
- llustrating how different systems in the UK, France and Germany have evolved over time; the close links between health financing and long-term health systems development; the range of options that are available in terms of health financing mechanisms that can co-exist in the system;
- Getting a better understanding of governance options for the management of social protection schemes; the role of government, community – based, private and public insurances and health care providers;
- Demonstrating workable options for the successful participation of non-public health-care providers in producing health care for the entire population covered by social protection schemes;
- Illustrating how systems ensure participation of users in planning, implementation and accountability for equity and efficiency.