Introduction
Background on Universal Health Coverage
Background on the demographic and socio-economic status of Kenya
Indicator | Value |
---|---|
Total population (2012) | 43.18 million |
Urban population (2011) | 24% |
Life expectancy at birth (years) (2012) | 61 |
Total fertility rates (births per woman) (2014) | 3.54 |
GNI per capita (2012) | US$ 860 |
GDP growth (2012) | 4.6% |
Unemployment rates (2008) | 40% |
Population living below the poverty line (2012) | 43.4% |
Overview of Kenya’s Health System
Disease burden
Service delivery and health outcomes
Indicators | National value | Average for low income countries | Source | |
---|---|---|---|---|
Health Service delivery | Births attended by skilled health personnel (%) (2005–2012) | 44 | 47 | WHO |
Contraceptive Prevalence (%) (2005–2012) | 46 | 38 | ||
Neonates protected at birth against neonatal tetanus (%)(2011) | 73 | 82 | ||
DPT3 Immunisation coverage among 1-year-olds (%)(2011) | 88 | 79 | ||
Density of nursing and midwifery personnel per 10 000 population | 7.9 | 14.9 | ||
Hospitals (per 10 000 population) | 1.6 | 0.9 | ||
Median availability of selected generic medicines in public sectors (%) | 37.7% | No data | ||
Health financing | Total expenditure on health as a percentage of gross domestic product (2010) | 5.4% | 5.3% | Kenya NHA and WHO |
Per capita expenditure on health expenditure on health at average exchange rate (US$) | 42.2 | 28 | ||
General government expenditure on health as a percentage of total expenditure on health | 28.8% | 38.5% | ||
Government expenditure on health as a percentage of total government expenditure | 4.6% | 9.3% | ||
Private expenditure on health as a percentage of total expenditure on health | 37% | 61.5% | ||
Out-of-pocket expenditure as % of private expenditure on Health | 76.6% | 77.7% | ||
Health status | Maternal mortality ratio (per 100 000 live births) (2010) | 360 | 410 | WHO |
Under five mortality rate (per 1,000 live births) (2011) | 73 | 63 | ||
Adult mortality rate (probability of dying between 15–60 years of age per 1000 population) (2011) | Male = 346 | Male = 288 | ||
Female = 294 | Female = 245 |
Methods
WHO/World Bank UHC monitoring framework
Goal | Achieve UHC – All people should have access to the quality, essential health services they need without enduring financial hardship |
Target | By 2030, at least 80% of the poorest 40% of the population have coverage to ensure access to essential health services |
By 2030, everyone (100%) has coverage to protect them from financial risk, so that no one is pushed into poverty or kept in poverty because of expenditure on health services | |
Health service coverage indicators | MDG-related indicators: |
1. Aggregate: A measure of MDG-related service coverage that is an aggregate of | |
2. single intervention coverage measures | |
3. Equity: A measure of MDG-related service coverage for the poorest 40% of the population | |
CCIs-related indicators: | |
1. Aggregate: A measure of CCIs-related service coverage that is an aggregate of single priority interventions to address the burden of NCDs, including mental health and injuries | |
2. Equity: A measure of CCI service coverage for the poorest 40% of the population | |
Financial risk protection indicators | Impoverishing Expenditure: |
1. Aggregate: A measure of the level of household impoverishment arising from out-of-pocket expenditures on health, equal to the ratio of the poverty gap in a world without out-of-pocket payments to the actual (larger) poverty gap. | |
Catastrophic Expenditure: | |
2. Aggregate: The fraction of households incurring catastrophic out-of-pocket health expenditures. | |
3. Equity: The fraction of households among the poorest 40% of the population incurring catastrophic out-of-pocket health expenditures. |
Literature search strategy
Search terms | Geographical | |
---|---|---|
First phase | “health sector reforms”, “universal health coverage”, “health financing” “universal access to health care” “health insurance”, “out-of- pocket expenditure”, “health care cost” “Health system reforms” | “Kenya”, “developing countr*”, “low income countr*”, |
Second phase | “health information system” “health metrics” “monitor* universal health coverage” “health indicator*” “measur* universal health coverage” “MDG monitor*” “NCD indicator*” |
Selection of articles
New developments on the WHO/World Bank UHC monitoring framework
Findings and discussion
UHC in the Kenyan context
UHC aspects | Description |
---|---|
Access to needed services | • The right to health services by all Kenyans is articulated in the constitution |
• A standard Kenya essential health package is being implemented and has included interventions for non-communicable diseases and injuries as well. | |
• The availability of health facilities and services are limited, more so for the rural population. | |
• The range and quality of health services offered are limited. | |
• Cost is a key barrier to accessing health services. | |
Financial risk protection | • Existing health financing mechanisms offer very limited financial risk protection. |
• Out of pocket expenditure is major source of health sector financing in the country. | |
• Nearly 10% of Kenyans have access to any form of health insurance. Majority of the health insurance schemes require co-payments for medicine or certain outpatient and diagnostic services thus offering limited protection. | |
• Kenyan households incur impoverishing and catastrophic health expenditure. Estimates suggest that nearly 1.5 million households are pushed below the national poverty line due to health care payments. | |
Equity | • Health sector is inequitable. The distribution and utilisation of health services favour the wealthier and urban populations in the country. |
Policy framework for UHC in Kenya
Feasibility of the proposed UHC monitoring framework in Kenya
MDG-related service coverage indicators
UHC Health service coverage indicators indicator | Potential tracer indicators for aggregate MDGs-related interventions (n = 22 indicators) | Indicator available | Data source. |
---|---|---|---|
Aggregate: A measure of MDG-related service coverage that is an aggregate of single intervention coverage measures | Need satisfied for family planning | Yes | Routine facility data/KDHS. |
Skilled birth attendance | Yes | ||
DPT3 immunisation coverage | Yes | ||
Serious acute child illness coverage (Percentage of Health Facilities providing treatment as per the IMCI guidelines) | Yes | Supervision reports/Kenya service provision assessment survey | |
Household ownership of insecticide treated nets (ITNs) | Yes | Malaria Indicator survey | |
Tuberculosis treatment coverage | Yes | TB programme reports | |
Ante-retroviral treatment (ART) coverage | Yes | routine facility data (NASCOP reports) | |
PMTCT service coverage | Yes | ||
Additional coverage indicators | |||
Contraceptive use | Yes | routine facility data/KDHS | |
ANC 4+ visits | Yes | ||
Institutional deliveries | Yes | ||
Postnatal care visit within two days of childbirth (%) | Yes | ||
Measles, BCG, polio, hepatitis B, Influenza coverage among older people | No | ||
Suspected pneumonia treated with antibiotic | Yes | routine facility data/KDHS | |
Diarrhoea treated with oral rehydration salts (ORS) | Yes | ||
Coverage of exclusive breast feeding | Yes | KDHS | |
Intermittent prevention treatment (IPT) during pregnancy | Yes | Malaria programme reports/ malaria indicator survey | |
Fever treated with antimalarials | Yes | Routine facility data/Malaria indicator survey/KDHS | |
Households with indoor residual spraying (IRS). | Yes | Malaria indicator survey | |
TB case detection rate (the number of estimated new TB cases detected in a given year using the DOTS approach) expressed as a percentage of all new TB cases) | Yes | TB programme reports | |
Male circumcision rates | Yes | KAIS | |
Condom use at higher risk sex | Yes | KAIS | |
Equity: A measure of MDG-related service coverage for the poorest 40% of the population | Yes | Surveys mentioned above. |
Survey | Last conducted |
---|---|
Kenya AIDS Indicator survey (KAIS), | |
Kenya demographic health survey (KDHS), | 2008/2009 follow up of 2003 survey |
Kenya service provision assessment survey (KSPA) | 2010 survey was a follow up of 2004,1999 survey |
Kenya malaria indicator survey | 2010 follow up to 2007 |
Kenya national health accounts survey | 2009/10 follow up of 2005/06 survey |
Kenya household health expenditure and utilisation survey | 2007 follow up to 2003 survey |
Census | 2009 follow up to 1999 census |
CCI related service coverage indicators
UHC Health service coverage indicators | Potential tracer indicators for the aggregate CCIs-related service coverage measures (n = 27 indicators) | Indicator available | Data sources |
---|---|---|---|
Aggregate: A measure of CCIs-related service coverage that is an aggregate of single priority interventions to address the burden of NCDs, including mental health and injuries | Percentage with hypertension diagnosed and receiving treatment | No | |
Probability of dying between the exact ages of 30 and 70 from any of cardiovascular disease cancer diabetes or chronic respiratory disease | No | ||
Age-standardised prevalence of diabetes (based on HbA1c levels), hypertension, cardiovascular disease and chronic respiratory disease | No | ||
Age-standardised mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ | No | ||
Prevalence of persons aged 18+) consuming less than five total servings (400g) of fruit and vegetable per day | No | ||
Fraction of calories from added saturated fats and sugars | No | ||
Hepatitis B vaccination coverage | No | ||
Percentage of the population that is overweight and obese | Not Yet | a survey proposed | |
Prevalence of insufficient physical activity | No | ||
Human papilloma virus (HPV) vaccination coverage | No | ||
Percentage of women with cervical cancer screening | Yes | routine facility data | |
Arthritis treatment coverage | No | ||
Spectacle coverage | No | ||
Dental coverage | No | ||
Road traffic deaths per 100,000 | Yes | Vital registration and Traffic department records. | |
Harmful use (consumption) of alcohol | No | ||
Current use of any tobacco product | Yes | NACADA | |
Smoking cession rates | No | ||
Additional indicators | |||
Angina treatment coverage | No | ||
Cardiovascular diseases preventive drug therapy for high risk groups | No | ||
Diabetes treatment coverage | No | ||
Coverage of pain relief | No | ||
Asthma/COPD treatment coverage | No | ||
Depression treatment coverage | No | ||
Cataract surgery coverage | No | ||
Coverage with rapid emergency response | No | ||
Equity: A measure of CCI service coverage for the poorest 40% of the population | No |
Financial risk protection indicators
Financial risk protection coverage indicators | Indicator available | Data source |
---|---|---|
Aggregate: a measure of the level of household impoverishment arising from out of pocket expenditures on health, equal to the ratio of the poverty gap in a world without out of pocket payments to the actual poverty gap | yes | Kenya household health expenditure and utilisation survey |
Aggregate: the fraction of households incurring catastrophic out of pocket health expenditures | yes | Conducted every 5 years last survey was conducted in the year 2013 |
Equity: The fraction of households among the poorest 40% incurring catastrophic out-of-pocket health expenditures. | yes |