An Analysis of Kenya's Healthcare System: Challenges and Opportunities

This report provides a comprehensive analysis of the healthcare system in Kenya, examining its organization, financing, and resource allocation. The report begins by discussing the increasing healthcare spending in Kenya, the sources of funding including taxation, NHIF, and private insurance, and the devolution of healthcare management. It then delves into the building blocks of the health system as defined by WHO, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. The report highlights the challenges faced by the Kenyan healthcare system, such as shortages of healthcare professionals, inequitable resource allocation, and limited access to essential medicines. The report also examines the expenditures for prevention programs and public health services, the factors influencing resource allocation, and the impact of economic factors on healthcare delivery. The report concludes by emphasizing the importance of equity in resource allocation and its impact on public health service provision in Kenya, comparing the system to others like Australia.

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Introduction
This paper discusses global health systems with a particular focus on health care
system in Kenya. The study of the Kenyan health care system facilitates an
understanding of the interdependent relations between economics, health care and
public health. The perception of health and well being in Kenya is examined and the
allocation of resources in the health sector is determined. Efficiency in management
of resources in the public health sector is also examined. The first section of the paper
discusses the organization of the public health care system and the funding of the
health care (International Monetary Fund. 2007). The second section identifies and
analyzes the elements of building blocks of the health system as identified by WHO
2007.
Part 1
The health care spending in Kenya has increased rapidly over the past few years.
Between the year 2011 and 2013, Kenya`s health care spending increased by 33% to
USD2.743million. In the year 2016,Kenya spent 6.3% of its GDP on health care.
Health care financing in Kenya comes from different sources such as taxation,
National Health Insurance Fund(NHIF) and private insurance and employer schemes.
Kenya`s health care system is devolved. Management of health care finances is done
at the county level since the year 2013.Other common sources of health funding in
Kenya is Community Based Health Financing and Non-Government organizations
funding. Currently, the government spending on health care is approximately 6% of
the national GDP. This is very low compared to neighboring countries who spend an
average of 10% of their GDP on health care. Australia health care spending went
above 10% in the year 2015-16. the spending for that financial year was

$170.4bn.This shows a very huge disparity between Kenya`s health care spending and
that of Australia.
An estimated 25% of Kenyans are covered by a public, private or community based
health organization. More than 50% of the Kenyan population does not a have a
health insurance cover and they rely on the money from their pockets to pay for health
services (Willis,Reynolds& Keleher, 2012). Technology in public health care is
getting adopted at a very high rate. Health and ICT is becoming more integrated in
Kenya. The country has become a front runner in Africa in adoption of
comprehensive e-Health strategies. Kenya has a multi-billion dollar mobile money
payment system that is popularly used to pay for health care services (Guinness,
Wiseman& Wonderling, 2011). Most of Kenya`s health budget is spent on purchase
of medical equipment and building of health care facilities across the country.
In Kenya,there is a Universal health Coverage system but its yet to be well
established. Universal health care system helps in transforming lives by guarantee
access to lifesaving health services while at the same time helping to avoid poverty as
a result of expenses on health care. One of the actions that the government of Kenya
has taken to strengthen its commitment towards Universal Health Care is abolishment
of primary and maternal health service fees. Kenya is striving to achieve Universal
Health Coverage. In the year 2016, the ministry of Health of Kenya in partnership
with the World Bank and the USAID funded Health Policy Project(HPP). HPP is
working with various partners to strengthen the Universal Health Care system in
Kenya.

Part 2
The building blocks of health care according to WHO building blocks framework of
the year 2007. The building blocks of WHO helps to provide a broad based consensus
on the key indicators and effective methods and measures building health capacity.
These includes inputs, processes and output as well as effective methods of health
provision. According to WHO framework, the building blocks of health systems
include; service delivery, health workforce, health information systems, access to
essential medicines, financing and leadership/governance (Suchman, Sluyter &
Williamson, 2011).
In Kenya, the service delivery system in the country is through Public sector health
care, private sector health care as well as community based health care services. There
are also various NGO`s that offer health care services to citizens in Kenya. Most of
the people in Kenya depend on public health services. This is because public health
services are cheaper and affordable since only 20% of the population have medical
insurance cover. Public health services are devolved and are offered through the
county governments. The county governments receive finances from the national
government.
WHO framework recommends 23 doctors, nurses, and midwives per every 10,000
people for an effective health care delivery. In Kenya, there are 12 nurses and
midwives for every 10,000 people (Carrin, 2009). This is an indication that there is an
acute shortage of health services officers. There is also a huge challenge if in-
efficiency of health officers in the Kenyan Health care system. The largest shortfall in
health care professionals is mainly in the rural areas. Most of the professionals in
Kenya`s health care service delivery have average level of training and education.

The health information systems are being adopted in Kenya at a very fast rate. This is
despite the fact that most of the public health care facilities in Kenya depend on
manual systems of keeping information. Most hospitals in Kenya are adopting health
information systems that help the facilities to manage patient data and hence improve
health care delivery.
Financing for Kenya`s Health Care services is mainly through personal payments.
20% of the Kenyan population have medical insurance cover whereas the remaining
80% depend on NGO`s, Community Health Care or they pay for medical services
using their merger savings (Volberding, 2008). The major Medical Insurance provider
is the National Hospital Insurance Fund (NHIF) which offers medical cover to public
service workers and people who are not formally employed.
Access to essential medicines is not adequate in Kenya. Patients struggle to get
medication in most public health care facilities. This is because of issues related to
mismanagement of finances in Health care and embezzlement of funds. Malaria, TB,
HIV/AIDS and other major important drugs are not easily accessible in public health
care facilities (World& WHO, 2008). The low accessibility to of key medicines and
drugs shows that there is a lot that needs to be done to improve public health services
delivery.
Governance and leadership is a very important aspect of the health delivery
framework. Governance /leadership involve the structures and the systems that are in
place to give guidance and leadership to staff working in the health service sector.
The leadership of the health care service in Kenya is headed by the cabinet secretary
of Health Services. The permanent secretary in charge of health services delivery.
There are also county directors of medical services who oversee the delivery of high

quality health services medical services to patients (Killoran & Kelly, 2010). The
county directors of health services are in charge of medical staff and they supervise
their work and determine their remuneration and allowances.
The sub-county hospital management board is the board (SD-HMB) board that
oversees the management of all health facilities at the sub-county. The Healthy Center
management committee (HCMC) is the lowest body of management in provision of
medical services in Kenya. Various medical practitioners and businesses are
encouraged to hold leadership positions in the health service sector and hence
contribute to enormous improvement of the sector.
Part 3
Expenditures for prevention programs and public health services in Kenya are
estimated based on a variety of factors. These factors vary from time to time
depending on the prevailing public health conditions (Beatty & Institute of Medicine
U.S, 2012). There are medical professions who are specialized in public health
financing. One of the parameters that guides in the allocation of resources for
prevention programs is the probability of contracting a diseases and the danger that
the disease poses to public health. Diseases or public health issues that are of high risk
level to the general public are given higher priority when it comes to budgeting.
Another factor is the health needs of a particular society or county. Different counties
in Kenya have different health needs. Since the counties are in charge of preparing
their own budget, they are expected to access the most urgent health needs and then
address them adequately in their public health budgets.

Resource allocation refers to the methods/formula used in allocating the available
scarce resources to various sectors of the public health care system. In any country, it
is very important that public health expenditure reflects equitable resource allocation
in Health care. The government of Kenya has out various measures to ensure that
there is equity in allocation of public health resources. One of these moves is
procuring cancer dialysis machines for every county in partnership with major donors
in the public health sector (Oxford Textbook Of Global Public Health, 2017).
Equitable resource allocation in public health promotes improved health standards.
Economic factors can greatly hinder delivery of health programs in Kenya. Given that
majority of the citizens are poor, they cannot afford to pay for health care. There are
also poor bad infrastructural projects such as roads which hider access to some areas
where people require emergency medical services and this greatly hinders health
provision.
Economic levers are very important in improving public health service delivery.
Economic levers such as savings incentives can encourage citizens to save for health
care. These savings can be used in future to cater for health care bills. Encouraging
innovation in an economy can result to important technological innovations that can
help to solve health care problems facing Kenya (Barnes & World Bank, 2010).
Economic levers also help to encourage investment in health care sector. These
investments largely contribute to improvement of health service provision and hence
help in improving health care.
The relationship between equity and resource allocation has a very huge impact on
public health service provision in Kenya. Equity in resource allocation refers to fair
and equitable allocation of human, financial, and physical resources in the public

health care. In Kenya, there is a lot of inequity in allocation of resources in public
health. The rural areas are mostly discriminated against in both allocations of health
staff as well as financial resources (Boslaugh, 2013). These discrepancies have led to
a very huge gap between health provision in rural areas and urban areas. These deficit
needs to be addressed urgently.
Conclusion
This report discusses the public health service sector in Kenya. Allocation of
resources in health care in the country is evaluated and compared to other countries
such as Australia. The paper also investigates the health care systems and the
relationship between resource allocation and provision of public health programs in
Kenya.
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