The JLN and Kenya
Kenya’s health sector
Since 2013, Kenya has a devolved government system, with the country divided into 47 counties, each headed by a governor. The health sector is one of its largely devolved sectors – the county governments provide health services distinctly and independently, with the central government providing policy formulation, technical guidance and health-sector regulation. Further, the Kenyan health system can be categorized into three subsystems: public sector, private sector and faith-based organizations. Of these three, the government is the main health provider with approximately 6,000 public facilities; the private sector and faith-based organizations account for nearly 4,000 facilities.
The Kenya Health Sector Strategic and Investment Plan 2014-2017 provides a blueprint for progression toward UHC. The plan outlines the health-sector objectives and the respective implementation strategies, with the objective of ensuring all Kenyans have access to equitable and quality health care.
Kenya’s evolving CCG
Kenya joined the JLN as a full member in August 2011. Up to 2015, its CCG was comprised of members from the Ministry of Health and the National Hospital Insurance Fund (NHIF). Kenya also had a representative on the JLN’s Steering Group. In December 2014, with support from the World Bank, a learning coordinator was brought on board to assist in coordinating the JLN activities in the country and support the working of the CCG. The period was characterized by a decrease in CCG activity, possibly from changes taking place both at the Ministry and within the NHIF; there also was a new chairperson appointed as the head of the Division of Health Financing at the Ministry of Health.
One of the immediate priorities for the new chairperson and other stakeholders was to expand the CCG. In the early months of the following year, the CCG was reconstituted with an expanded and more inclusive membership to represent partners and stakeholders working in the health sector in Kenya. As a result, the CCG had representatives from the Ministry of Health, NHIF, county health, private sector, faith-based organization health providers, insurance providers, donors and implementing organizations in health. It was also agreed that the JLN would be brought under the Division of Health Financing at the Ministry of Health and the leadership would be co-shared between the Ministry of Health and the NHIF, owing to their mandate in health.
With the new inclusive CCG and a dedicated learning coordinator onboard, the team has been able to execute their mandate effectively. The key to successful integration and use of JLN has been to ensure that it does not run as a parallel body, but rather, works with those with the UHC mandate in the country – with the knowledge and approval of the top leadership. This is possible because the CCG chairperson is the head of the Division of Health Financing, and the alternate is the CEO of NHIF. Additionally, the County Executive Committee Members for Health chairperson is on board.
The Kenya CCG maintains an annual calendar with quarterly face-to-face meetings and virtual meetings when the need arises. The CCG members are divided under the JLN technical initiatives based on their areas of expertise. Technical people are also co-opted from the organizations represented in the CCG. This model facilitated selection of members to participate in JLN learning collaboratives and workshops. The approach has led to better participation in the JLN activities both in-country and in the learning collaboratives, and greater cross-collaboration, allowing JLN Kenya to contribute to and implement some of the JLN tools.
Learning and progressing with the JLN
With the strengthened CCG in place, JLN Kenya has participated in several collaboratives: Health Benefits Policy; Primary Health Care Measurement for Improvement; Leveraging Resources for Efficiency; and Medical Audits. The CCG also applies WHO’s Universal UHC Tracking: First Global Monitoring Report and generates biannual reports.
Currently, the Kenya team is developing case studies for the Private Sector Engagement collaborative that will lay the foundation for the third module of the private sector engagement guide. Another team is applying the Primary Health Care Health Benefits Policy Framework in country case studies.
JLN Kenya is working with partners to find innovative ways to mark UHC Day on December 12, which also happens to be Kenya’s Independence Day. Plans are also underway to hold a stakeholder forum to disseminate JLN tools to partners to increase the awareness and application of these tools.
Overall, JLN activities in Kenya are on track and constantly working to contribute effectively to the UHC agenda in the country.
Contributed by: O.A. Omar, Project Manager – Transforming Health Systems for Universal Care Project/DANIDA UHC Program, Department of Health Sector Coordination and Intergovernmental Affairs, Ministry of Health; and Mercy Mwangangi, Head, Division of Health Financing, Ministry of Health, with support from Esther Wabuge, Kenya CCG Coordinator