Assessment of Cross-Programmatic Efficiencies in Kenya’s Health System at World Health Organization

Background

Kenya is committed to accelerating progress towards Universal Health Coverage (UHC) as a key component of the governments’ “Big Four Agenda”. However, meaningful progress towards UHC will be made if fiscal space is expanded so as to ensure that all those who need health care access it without incurring a financial burden. This will require action not just on raising the resources but also improvements in the organization and use of those funds.

While Kenya remains one of the fastest-growing economies in Sub-Saharan Africa having transitioned into a lower-middle-income country in 2014, this growth has not been matched with an increase in public health spending per person and out-of-pocket payments remain dominant compromising progress towards UHC.

Greater consideration for efficiency is even more important given that Kenya is set to transition from donor funding for critical programs such as HIV/AIDS, TB, and immunizations. These program areas were frequently implemented as vertical programs. While this approach rapidly expanded access to needed services, there are challenges in ensuring sustainable UHC. Initial experience with funding cuts from development partners indicates a need to strengthen the preparedness for the transition.

In light of this challenge, one of the immediate remedies to ensure sustainable financing on the path to UHC is to increase efficiency. Achieving this requires identifying areas of inefficiency in the system and think of ways to promote efficiency gains with a focus on domestic sources. It is important to note that whereas additional funds will definitely be required specifically to fill the gap left by donors, there is potential to reduce this resource gap by restructuring the delivery of services in a way that eliminates unnecessary duplication, redundancies and other sources of inefficiency and puts the health system on a more sustainable trajectory.

Kenya’s commitment to UHC provides an opportunity to address development partner transition from UHC perspective by; building consensus that what is to be sustained is increased effective coverage of priority health interventions; that sustainability requires acting not just on the revenue but also expenditure issues; and that such actions must be done system-wide as opposed to specific programs. UHC thus provides a system-wide unit of analysis needed to address transition.

This analysis aims to assess programmatic arrangements in the Kenyan health system to identify potential sources for efficiency gains and how these could be leveraged on the path to UHC.

Purpose

To identify the existing overlaps, redundancies, duplications, and misalignments across the health system that need to be addressed so as to make the health system more efficient and sustainable.

Specific Objectives

• To assess programmatic arrangements at the national ministry of health (and between the national and county levels) and examine how to function assignment across programs and agencies influences the efficiency of the Kenyan health system
• To identify inefficiencies created by overlapping, duplicating or misaligning health system functions across vertical programs
• To find out the implications of these inefficiencies on overall system performance and the ability to achieve and sustain overall health system objectives
• To identify opportunities that are available to address these inefficiencies at national, and county level,

Approach

The selected consultant will undertake the assessment using the system-wide approach to analyzing efficiency across health programs that have been developed by WHO. This approach uses applied health systems analysis to unpack health programs by their functional parts as a way of identifying the critical areas of inefficiency that can be addressed through targeted reforms. An indicative analytical roadmap will be discussed with the selected consultant and refined further at inception to meet the study objectives.

Process of work

A national consultant will work closely with the Ministry of Health, WHO country office. The nature of work will require wide engagement with the various people involved in the management of the various programs and agencies. This work will be linked with the ongoing work on health sector transition and will specifically work with the health financing workstream on the transition task force. The recommendations will be able to feed into the transition plan roadmap.

The consultant shall work in collaboration with the MOH team and carry out the following specific functions

• Carry out a desk review of existing literature/documents including policies; strategies; previous assessment reports and publications among others
• Facilitate the development of the assessment tools with MOH and stakeholders
• Develop consultative materials including presentations for the various stakeholders’ engagements
• Facilitate consultative meetings with the various stakeholders
• Develop the draft assessment report and the final report with inputs from stakeholders
• Tease out succinct recommendations to inform/ to be incorporated to the transition plan

Deliverables

The selected consultant will be expected to provide the following deliverables;

• An inception report indicating an understanding of the TORs and proposed methodology for the assessment
• A draft report and PowerPoint presentation to be presented at a workshop with stakeholders to validate preliminary findings and generate consensus
• Based on the stakeholder workshop, develop targeted and actionable policy options to address the sources of the identified cross-programmatic inefficiencies
• A final report with the recommended health system-related reforms actions and interventions to address the identified inefficiencies

Timelines

The expected level of effort is 60 days over a 3-month period starting June 2020 up to end of September 2020

Qualifications

This assignment requires an individual consultant with the following qualifications

• A Ph.D. or Masters with at least 10 years’ relevant experience in health economics, health financing, health systems
• ·Experience supporting health system reform processes to move towards sustainable Universal Health Coverage in Kenya and other countries
• ·Experience in undertaking analyses aimed at improving health system efficiency in Keny
• ·A good understanding of health sector devolution.
• ·Experience working with WHO or any other international organization in a similar or higher capacity will be an added advantage.
• ·Demonstrated analytical and writing skills
• · Team player with good interpersonal, communication, report writing, analytical, and presentation skills are required.
• · Fluent (Read - Write - Speak) in English