LECTURE 7 KEPH NHSSP II-2010.pdf - 2005\u20132010 Republic of Kenya Ministry of Health Reversing the Trends The Second NATIONAL HEALTH SECTOR Strategic

LECTURE 7 KEPH NHSSP II-2010.pdf - 2005u20132010 Republic...

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Unformatted text preview: 2005–2010 Republic of Kenya Ministry of Health Reversing the Trends The Second NATIONAL HEALTH SECTOR Strategic Plan of Kenya – NHSSP II – 2005–2010 August 2005 i NHSSP II Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes or for profit. Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – NHSSP II 2005–2010 Published by: Ministry of Health Health Sector Reform Secretariat Afya House PO Box 3469 - City Square Nairobi 00200, Kenya Email: [email protected] Edited and designed by: Margaret Crouch ii 2005–2010 Message from the Minister for Health A services outputs, and in the implementation of the health reforms and sector-wide approach initiatives. The strategic plan will also: • Improve the planning process within the Ministry, in particular by highlighting the need to improve coordination and decision making, eliminate duplication of activities, and use available resources more effectively and efficiently. • Provide a platform for dialogue and partnership with all stakeholders. • Assist the Ministry of Health in furthering the reform process. chieving the international Millennium Development Goals, as well as the targets set in Kenya’s Economic Recovery Strategy, is among the strongest commitments of the Ministry of Health as a way of realizing our national vision of providing accessible, affordable and quality health care for all Kenyans, in particular the poor. It is therefore imperative to revitalize the health sector – improve service delivery, ensure community participation, and enhance cooperation, collaboration and teamwork among the various departments within the Ministry, with the districts and provinces, and with all actors having a stake in the health sector. This Second National Health Sector Strategic Plan (NHSSP II) is a milestone for the Ministry, as it provides for the first time in our history a comprehensive output- and performance-oriented strategy that defines our aspirations and priorities for the coming five years. In addition, NHSSP II will be jointly reviewed and revised annually with all stakeholders and in this way MOH will arrive at “actionable” and operational annual plans (AOP). I believe that with this new Strategic Plan, the Ministry of Health has taken a major step towards achieving the general objectives contained in our national vision, the Kenyan Health Policy Framework and the ERS. Through NHSSP II, MOH will be able to reverse the downward trend of the past few years. The success of the Ministry in achieving this vision and in entrenching the important process of coordinated planning and implementation will depend on the commitment of its staff at central and peripheral levels and on all partners to use this tool for decision making. It will also depend on the quality of the annual review process that will provide us with feedback on our performance. I request and urge all my staff to use and learn from this strategic plan, put its suggested actions into effect in the Annual Operational Plans, and in this way contribute candidly to apply its vision, objectives and actions. N HSSP II will serve several purposes besides guiding the actions and priorities of the Ministry to improve overall sector performance. This will be made visible in the indicators of the Kenya Essential Package for Health (KEPH), in the achievements of its various support Hon. Charity K. Ngilu, MP MINISTER FOR HEALTH August 2005 iii NHSSP II Acknowledgements T The Government appreciates the financial and technical support given by the Swedish International Development Cooperation Agency (Sida), the United States Agency for International Development (USAID), the UK’s Department for International Development (DFID), the World Bank, World Health Organization and the United Nations Children’s Fund – amongst others. These and all of our stakeholders have been helpful and encouraging in this attempt to chart a new course for Kenya’s health sector. his second National Health Sector Strategic Plan (NHSSP II) is the result of a long, complex process of intensive consultations, teamwork on specific assignments, detailed studies and information gathering. The process involved clients, service providers, civil society groups, the private sector, development partners and various government stakeholders. The Ministry of Health is very grateful to everyone who contributed, in one way or another, to the successful development of this Strategic Plan. Special thanks go to the members of the four MOH-led working groups that were tasked to review and suggest new approaches for the Essential Packages for Health, the financing of NHSSP II, the monitoring and evaluation framework, and the organizational structure. These building blocks were brought together and synthesized in NHSSP II. F inally, the Ministry expresses its appreciation to all the other individuals and institutions who contributed – and continue to contribute – towards improving the health of Kenyans and who joined us in our efforts to achieve the Millennium Development Goals and the objectives of the Economic Recovery Strategy. M ost important has been the concerted effort to involve all departments/divisions within MOH in order to ensure understanding and ownership of the new plan. The Health Sector Reform Secretariat spearheaded the coordination and shepherded the plan to completion. iv 2005–2010 Contents Message from the Minister for Health Acknowledgements iii iv List of Tables, Figures and Boxes List of Abbreviations vii ix Executive Summary xi Introduction – Kenya’s Health Sector Framework 1994–2010 1.1 First Health Sector Strategic Plan, NHSSP I 1999–2004 1.1.1 Findings of the External Evaluation of NHSSP I 1.1.2 Recommendations for NHSSP II 1.2 Reversing the Trends – The Second Health Sector Strategic Plan 3 Chapter 2 Health Sector Priorities 2.1 NHSSP II as Part of ERS 2003–2007 2.2 International Health Initiatives 2.3 The Design Principles That Informed NHSSP II 2.4 The NHSSP II Development Process 2.5 How the Plan Is Structured 5 5 6 7 7 7 3.4 Improve Efficiency and Effectiveness 3.4.1 Improving Value for Money 3.4.2 Improving Planning, Management and Administration 3.5 Foster Partnerships 3.5.1 Engaging in Partnerships with the Private, Not-for-Profit Sector 3.5.2 Improving Partnerships between the Private and Public Sectors 3.5.3 Improving Inter-Sector Cooperation 3.5.4 Improving Partnerships with Development Partners 3.6 Improve Financing in the Health Sector Chapter 1 1 1 1 2 13 13 13 13 13 14 14 14 14 Chapter 4 Kenya Essential Package for Health 16 4.1 KEPH Philosophy and Justification 16 4.1.1 Life-Cycle Cohorts 16 4.1.2 Levels of Care 16 4.2 KEPH Objectives and Strategies 18 4.3 KEPH Implementation 18 4.4 KEPH Outputs and Annual Targets by Life-Cycle Cohort 19 4.4.1 LIFE-CYCLE ONE: Pregnancy, Delivery and the Newborn Child 19 4.4.2 LIFE-CYCLE TWO: Early Childhood 20 4.4.3 LIFE-CYCLE THREE: Late Childhood 20 4.4.4 LIFE-CYCLE FOUR: Adolescence 21 4.4.5 LIFE-CYCLE FIVE: Adulthood / All Life-Cycle Cohorts 21 4.4.6 LIFE-CYCLE SIX: The Elderly 22 Chapter 3 Vision, Mission and Goal of NHSSP II 10 3.1 Policy Goal and Objectives: A Shift in Focus and Commitment 10 3.2 Increase Equitable Access 11 3.2.1 Increasing Geographical Access 11 3.2.1 Improving Financial Access 12 3.2.3 Addressing Socio-Cultural Barriers 12 3.3 Improve Service Quality and Responsiveness 12 3.3.1 Improving Health Worker Performance 12 3.3.2 Improving Responsiveness to Client Needs 13 Chapter 5 Systems in Support of KEPH 5.1 Interface between Services and Community 5.2 Health Planning 5.3 Financial Management v 23 24 26 26 NHSSP II 5.4 Monitoring and Evaluation 5.5 Human Resource Management and Development 5.5.1 Human Resource Management 5.5.2 Human Resource Development 5.6 Quality Assurance and Standards 5.7 Commodity Supply Management 5.8 Investment and Maintenance 5.8.1 Infrastructure and Equipment 5.8.2 Transport 5.9 Communication and ICT Chapter 6 Governance of NHSSP II 6.1 Ministry of Health Responsibilities 6.1.1 Decentralization 6.1.2 Public Sector Reform and the Health Sector 6.2 MOH and Partnerships 6.2.1 Parastatal Organizations 6.2.2 Stakeholders 6.2.3 Partnership Mechanisms 6.3 Health Reforms under NHSSP II 6.3.1 The Reform Process 6.3.2 Outputs 6.3.3 Timeline for Achieving Health Reform Outputs 6.4 Sector-Wide Approach in Health (SWAp) 6.4.1 Joint Annual Planning and Review Cycle 6.4.2 Joint Monitoring of Performance 28 6.4.3 Harmonization of Funding Arrangements 49 6.4.4 Common Management Arrangements (CMA) 50 6.4.5 Timeline for Achieving SWAp Outputs 51 29 30 30 32 32 33 34 34 35 Chapter 7 Financing the Health Sector 54 7.1 Current Financing Trends, Policies and Expenditure 54 7.2 Costs of Implementing NHSSP II 55 7.3 Financing Scenarios 57 7.5 Outputs in Health Care Financing 60 36 36 37 References and Documents Consulted 61 Annexes A. Indicators of Progress in MOH–Development Partners Collaboration (Paris Declaration) 63 B. KEPH Implementation Timeframe 64 C. Governance and Management Structures in the Health Sector by Level 71 D. Methodology of Costing KEPH 72 E. Cost of KEPH by Targets 2005/06 (KSh Millions) 74 F. Sources and Types of Funding of NHSSP II 2005–2010 (Ksh Millions) 76 G. Annual Ministry of Health Expenditures (Ksh Millions) 77 H. Annual Ministry of Health Recurrent Expenditures by Sub-Vote (Ksh Millions) 78 38 39 40 41 43 44 44 45 46 46 48 49 vi 2005–2010 List of Tables, Figures and Boxes Tables A Sector performance indicators and targets, 2005–2015 1.1 Health institutions and hospital beds and cots by province, 2002/03 1.2 Registered medical personnel, 2002/03 1.3 Distribution of health facilities by type and provider, 1998 xv 3 4 6 7 3.1 Strategy shift from NHSSP I to NHSSP II 11 5.1 Governance and management structures within the health sector 6.1 Responsibilities at the different levels of the MOH 6.2 Expertise by level of service and intensity 6.3 Gains and losses in partnership arrangements 6.4 Features of parastatal organizations and their strategic plans 47 51 52 53 7.1 Cost of KEPH by intervention 2005/06 (Ksh millions) 56 7.2 Total cost of KEPH for key interventions 2005–2010 (Ksh millions) 56 7.3 Annual cost of KEPH by level of services 2005–2010 (Ksh millions) 57 7.4 Annual cost of KEPH by life cycle 2005–2010 (Ksh millions) 58 4 2.1 MDG and ERS indicators for Kenya 2.2 ERS targets for the health sector 2.3 International health initiatives adopted by Kenya 4.1 Services needed during the life cycle of an individual 4.2 KEPH indicators for pregnancy, delivery and newborn child 4.3 KEPH indicators for early childhood 4.4 KEPH indicators for late childhood 4.5 KEPH indicators for adolescence 4.6 KEPH indicators for all life-cycle cohorts 4.7 KEPH indicators for the elderly 6.5 Outputs and timeline for the implementation of health reforms 6.6 Outputs and timeline for the implementation of the SWAp 6.7 Annual planning and monitoring cycle for NHSSP II 6.8 Inputs from MOH and stakeholders in the planning cycle 8 17 Figures 19 20 20 21 21 22 A Paradigm shift focuses attention on stages in the life cycle xiii B KEPH costs by life-cycle cohort: 2005–2010 xvi C KEPH costs by facility level: 2005–2010 xvi 3.1 Proportion of children fully immunized by district, 2004 3.2 Vaccination coverage by province, 2003 (per cent) 24 37 39 40 41 vii 15 15 4.1 Levels of care in KEPH 17 5.1 Systems to support health sector performance 23 6.1 Annual NHSSP planning and monitoring cycle 48 NHSSP II 7.1 Health care financing – Scenario 1 7.2 Health care financing – Scenario 2 7.3 Relative shares of key inputs in KEPH costs, 2005–2010 58 59 59 Boxes 5.1 Outputs for the interface services and community 5.2 Outputs for support towards district health planning 5.3 Outputs for financial management systems 5.4 Outputs for monitoring and evaluation systems 25 27 28 5.5 Outputs for human resource management 5.6 Outputs for human resource development 5.7 Outputs for quality assurance and standards 5.8 Outputs for commodity supply management 5.9 Outputs for investment and maintenance systems 5.10Outputs for maintenance of transport 5.11 Outputs for communication systems and ICT 7.1 Outputs for health care financing 29 viii 31 31 32 33 34 35 35 60 2005–2010 List of Abbreviations AIA Appropriation in aid AIDS Acquired immune deficiency syndrome ANC Antenatal care AOP Annual operational plan ART Anti-retroviral therapy BEOC Basic emergency obstetric care BMC Budget Management Centre CBO Community-based organization CBS Central Bureau of Statistics CEDAW Convention on the Elimination of All Forms of Discrimination against Women CEOC Comprehensive emergency obstetric care CMA Common management arrangements CORPs Community owned resource persons CPR Contraceptive prevalence rate CRC Convention on the Rights of the Child CSO Civil society organization DAC Development Assistance Committee (OECD) DHMB District Health Management Board DHMT District Health Management Team DHP District health plan DHSF District Health Stakeholder Forum DMO District Medical Officer of Health (Head of the DHMT) DMS Director of Medical Services DOTS Directly observed treatment short course (for TB) EBF Exclusive breast feeding (6 months) EPI Expanded Programme of Immunization ERS Economic Recovery Strategy ERSWEC Economic Recovery Strategy for Wealth and Employment Creation (being the Kenyan equivalent of the PRSP; generally referred to simply as ERS) FBO Faith-based organization FMS Financial management system FP Family planning GAVI Global AIDS Vaccine Initiative GDP Gross domestic product GFATM Global Fund to Combat AIDS, TB and Malaria GIC Global Initiatives Committee (part of JICC) GOK Government of Kenya HBC Home-based care HC Health centre HF Health facility (= all facilities at levels 2 and 3) HHOOP Household out-of-pocket expenditure HIPC Highly indebted poor country HIV Human immune-deficiency virus HMIS Health management information system HODs Heads of departments HR Human resources HRD Human resource development HRM Human resource management HS Health Secretary HSRS Health Sector Reform Secretariat IAVI International AIDS Vaccine Initiative ICC Interagency Coordinating Committee ICT Information and communication technology IMCI Integrated management of childhood illnesses IMF International Monetary Fund IMR Infant mortality rate (the number of infant deaths per 1,000 live births) IOP Interim operational plan (MOH) IPT Intermittent prophylactic treatment (for malaria) IT Information technology ITN Insecticide treated (bed) net IVM Integrated vector management JAR Joint Annual Review (part of SWAp) JICC Joint Interagency Coordinating Committee KDHS Kenya Demographic and Health Survey KEMRI Kenya Medical Research Institute KEMSA Kenya Medical Supply Agency KEPH Kenya Essential Package for Health KEPI Kenya Expanded Programme on Immunization KHPF Kenya Health Policy Framework KMA Kenya Medical Association KMTC Kenya Medical Training College KNH Kenyatta National Hospital KQM Kenya quality model Ksh Kenya shilling LLITN Long lasting insecticide treated (bed) net ix NHSSP II MAP MDGs M&E MMR Multi-sector AIDS Programme (World Bank) Millennium Development Goals Monitoring and evaluation Maternal mortality ratio (the number of maternal deaths per 100,000 live births) MOEST Ministry of Education, Science and Technology MOF Ministry of Finance MOH Ministry of Health MOU Memorandum of understanding MPND Ministry of Planning and National Development MTEF Medium-term expenditure framework MTRH Moi Teaching and Referral Hospital MTR Midterm review (of NHSSP II) MTTP Medium-term procurement plan NA Not available NC/pp New consultations per person NCAPD National Coordinating Agency for Population and Development (formerly National Council for Population and Development – part of MPND) NDP National Drug Policy NEPAD New Partnership for Africa’s Development NGO Non-government organization NHIF National Health Insurance Fund NHSSP National Health Sector Strategic Plan NS Not stated NSHIF National Social Health Insurance Fund OAU Organization of African Unity OECD Organization for Economic Cooperation and Development O&M Operations and maintenance ORS Oral rehydration salt (or solution) PEPFAR President’s Emergency Plan for AIDS Relief (= Bush Initiative) PER Public expenditure review (for health) PHC Primary health care PHO Public Health Officer PHT Public Health Technician PLWHA Person/people living with HIV/AIDS PMO Provincial Medical Office (Officer) PMTCT Prevention of mother-to-child transmission (of HIV) PNC Postnatal care PPB Pharmacy and Poisons Board PRSP Poverty reduction strategy paper PS Permanent Secretary QA Quality assurance RH Reproductive health RHF Rural health facilities (levels 2 and 3) STI Sexually transmitted infections SWAp Sector-wide approach (for health) TB Tuberculosis TBA Traditional birth attendant TOR Terms of reference TT2 Tetanus toxoid vaccination (2 doses) UFMR Under-five mortality rate UN United Nations UNDP United Nations Development Programme US$ United States dollars VCT Voluntary counselling and testing VHC Village health committee WB World Bank WHO World Health Organization WRA Women of reproductive age (15–49 yrs) x 2005–2010 Executive Summary T his second National Health Sector Strategic Plan 2005–2010 (NHSSP II) intends to reverse the decline in the health status of Kenyans. The vision of the sector is of an efficient, high quality health care system that is accessible, equitable and affordable for every Kenyan household. The mission is to promote and participate in the provision of integrated and high quality curative, preventive, promotive and rehabilitative health care services for all Kenyans. The plan is further designed to contribute to the accomplishment of Kenya’s Economic Recovery Strategy and the achievement of the Millennium Development Goals. Besides a whole new approach to service delivery, NHSSP II lays out a series of supporting measures ranging from community involvement, human resources and financial management, to monitoring and evaluation, infrastructure, and institutional reforms. The indicators, targets and outputs of NHSSP II will be used as the basis for the development of annual operational plans (AOPs) and internal and external annual performance reviews. Goal, Objectives and Principles principles that guided the development of this second strategic plan. First, service delivery will place human capital development and the human rights approach squarely at the core of its interventions. Moreover, NHSSP II shifts the emphasis from the burden of disease to the promotion of individual and community health. It does this by introducing the Kenya Essential Package for Health (KEPH), which focuses on the health needs of individuals through the six stages of the human life cycle. Finally, the strategy emphasizes strong community involvement in health care. R educing inequalities in health care and reversing the downward trend in health related impact and outcome indicators are the twin goals of NHSSP II. Six separate but interlinked policy objectives aim towards the realization of this goal: • Increase equitable access to health services. • Improve the quality and responsiveness of services in the sector. • Improve the efficiency and effectiveness of service delivery. • Enhance the regulatory capacity of the Ministry of Health. • Foster partnerships in improving health and delivering services. • Improve the financing of the health sector. The Kenya Essential Package for Health T he Kenya Essential Package for Health (KEPH) integrates all health programmes into a single package focused on improving health at different stages of the human life cycle. It requires a shift in the prevailing paradigm, which is focused on service delivery. NHSSP II therefore adopts a broader app...
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