The health system in Kenya is facing enormous challenges. The health related Millennium Development Goals on child and maternal health have stagnated or declined. The maternal mortality rate is 488/100.000 of live births (Germany: 7/100.000 ). For the majority of the poor population (47% live below the poverty line with less than $1.25 per day), health services remain unaffordable. Health facilities are poorly equipped and medical supplies are not available country-wide, which significantly affects the quality of health services.
Medical expenses, particularly for inpatient health care, are a risk towards financial ruin for the poor and thus majority of the Kenyan population - despite free basic health services. Only about 20% of the population has a health assurance cover. Therefore, there is an urgent need to create a sound and financially sustainable social health insurance system, which covers the poor and the informal sector.
Objective and Approach of German Development Cooperation
Within the framework of “health care” as a prioroty area, the German Development Cooperation concentrates on health financing. The aim is to enable poor and vulnerable groups to have improved access to quality basic health services by covering financial risks. To achieve this, the German Development Cooperation will also support reforms in terms of regulation, accreditation of healthcare providers and quality management.
Examples: What has been achieved?
Under a voucher program which covers the areas of maternity support, family planning & treatment to victims of gender violence, about 300,000 poor women have received health services. 250,000 births were attended to by medical staff in accredited health centres and hospitals. More than 260,000 women received family planning services in these institutions. The approach of the voucher program (e.g. billing of medical services, accreditation system) and the experiences with quality management are used to establish and improve the health insurance system that will cover the poor and the informal sector.
Through the family planning programs and the support of a group of small private hospital clinics (clinical social franchising) for reproductive health services, more than 600,000 women received counselling in terms of family planning and access to modern contraceptive methods.
Policy advisory services, capacity development and implementation support contributed to important developments in the health sector; including:
Introduction of economically assessed approaches for waiver of user fees and establishment of a Health Economics Unit, specialized on the costing of health services, at the University of Nairobi
Country-wide introduction of the Kenya Quality Model for Health (KQMH) for quality management in hospitals and health centers
Development and wide application of an effective course programme for health and health management professionals using a mentoring approach ; now part of the curriculum at the Kenyan School of Government
Creation of platforms to facilitate participation of non-state actors - NGOs, faith-based health care institutions and private service providers - in the development of the health system
Introduction of a standard protocol for the medical and forensic procedures in cases of gender-based violence (GBV); establishment of centers for care and counselling of affected women and young people
In reaction to the severe drought that hit Kenya in 2011, emergency relief in the drought affected areas could be provided together with international and local stakeholders to address health and nutrition related needs arising from the emergency situation.
As part of the fight against polio and in response to the recent outbreak in May 2013 on the Somali-Kenyan border, an additional funding of 5 million Euros was provided in 2013. As part of the Kenyan vaccination campaign, which is expected to reach a total of 8.4 million children under the age of five, the vaccinations and the mobilization of stakeholders received financial support.