Health Sector Strategic and Investment Plan (KHSSP) July 2013-June 2017: The Second Medium Term Plan for Health

Objectives

The Kenya Health Sector Strategic and Investment Plan is the health sector’s second medium-term plan, covering July 2013 to June 2017, which operationalises the Kenya Health Policy and contributes to Vision 2030. Its vision is a globally competitive, healthy and productive nation, and its mission is to build a progressive, responsive, sustainable, technologically driven, evidence-based and client-centred health system that enables the highest attainable standard of health for all Kenyans.[1][2][3]

• Achieve universal coverage of critical health services through affordable, equitable, accessible and responsive essential care.[4][3]
• Eliminate communicable conditions; halt and reverse the rising burden of non-communicable conditions; reduce violence and injuries; minimise exposure to health risks; and strengthen collaboration with health-related sectors through a Health in All Policies approach.[3][5]
• Reduce neonatal and maternal deaths by at least half, reduce time spent in ill health by at least 25%, and improve client satisfaction by at least 50%.[2][6]
• Prioritise maternal and newborn health, the Kenya Essential Package for Health, and investment across seven health-system areas.[2][3]
• Use the Kenya Essential Package for Health to integrate programmes into one rights-based package organised by population cohort, policy objective and level of care.[6][7][8]
• Improve physical access to essential services for at least 90% of the population by upgrading 40% of dispensaries to full primary-care units, operationalising model health centres, and establishing referral capacity in at least 80% of counties.[9][7]
• Provide services in congregate settings, for at-risk populations and in hard-to-reach areas, including Northern Kenya and informal settlements.[9][7][10]
• Address non-communicable conditions through health promotion, prevention, screening, rehabilitation, workplace health and safety, and palliative care. Priority conditions include mental health conditions, diabetes, cardiovascular disease, chronic obstructive airway conditions, sickle-cell disorders and cancers.[5][11][12]
• Reduce key health risks through action on tobacco, harmful alcohol use, unsafe sexual practices, addictive substances, physical inactivity, unhealthy diets, nutrition, water, sanitation, pollution, housing, education and road safety.[5][13][14]

Implementation

Implementation combines devolved national and county responsibilities, tiered service delivery, common planning and budgeting, multisectoral action, and partnership-based stewardship. The Kenya Essential Package for Health is delivered through community, primary-care, county and national levels, while annual workplans, performance reviews and a common monitoring framework link operational actions to strategic priorities.[15][16][17][18]

• Deliver community-level demand creation and non-facility interventions; use primary-care facilities as the first physical level of care; use county hospitals to complement primary care; and reserve national hospitals for highly specialised services.[15]
• Strengthen referral systems, outreach and mobile services, including services for nomadic and other hard-to-reach populations.[7][19][20]
• Improve service quality through quality-improvement policies, accreditation, service charters, client-satisfaction surveys, patient-safety measures, clinical guidelines and the national Essential Medicines List.[10][21][19]
• Strengthen the workforce through equitable deployment, recruitment, retention, training, continuing professional development, performance management and staffing norms linked to expected services.[22][23][24]
• Invest in facilities, equipment, transport, communications and information technology according to minimum norms, equitable access needs and facility workload.[25][26][27]
• Improve access to medicines and technologies through strengthened regulation, county coordination, inventory management, demand-driven pull systems, supplier accreditation, rational prescribing and dispensing, and procurement planning.[28][29][30]
• Strengthen Health Information Systems across information generation, validation, analysis, dissemination and use, drawing on facility reporting, vital registration, surveillance, surveys and research.[31][32]
• Coordinate governance through national stewardship by the Ministry responsible for Health and county stewardship by County Executive Committees, Chief Officers, County Directors for Health and County Health Management Teams.[33][34][35]
• Engage clients, state actors, non-state actors, private providers, civil society, faith-based organisations, traditional practitioners and external partners under a sector Code of Conduct and shared planning, budgeting and monitoring arrangements.[16][36][37]
• Use the Health Sector Coordinating Committee, its Steering Committee and technical groups for policy dialogue, joint planning, coordination, monitoring and follow-up of sector investments.[38][17]
• Align national and county planning and budgeting cycles through annual Planning and Review Summits, annual workplans and joint reviews that use performance findings to inform future spending plans.[39][40][41]
• Monitor progress using baseline, mid-term and end-target indicators across impact, service outcomes and health investments, including indicators for non-communicable conditions, access, quality, health risks, financing and equity.[42][43][44]

Monitoring & Evaluation

The monitoring and evaluation framework combines indicator-based performance management, routine information systems, periodic reviews and multi-level accountability. It uses 2012 or 2013 baselines, 2015 mid-term milestones and 2017 end targets across health impact, service outcomes, investment outputs and inputs.[42][43][44]

• Monitor non-communicable conditions through adult body mass index, cervical cancer screening, mental health outpatient presentations, high blood pressure outpatient cases and cancer admissions.[45][46]
• Track wider health outcomes and service performance through mortality, disability, service inequality, client satisfaction, access, quality, maternal and child health, injuries, health risks and collaboration with health-related sectors.[42][47][43][44]
• Use routine facility reporting, vital registration, disease surveillance, surveys and research as information sources for planning, management and decision-making.[48][31]
• Strengthen data generation, validation, analysis, dissemination and use through a common data architecture, electronic systems, Health Observatory functions, data audits and links between county and national information systems.[48][31][32][49]
• Assess information-system performance through timely and accurate District Health Information Software 2 reporting, facility-register coverage, electronic medical-record coordination, data-quality audits, vital-events reporting and Integrated Disease Surveillance and Response capacity.[50]
• Apply quality and service-delivery indicators covering facility proximity, emergency obstetric care, immunisation, tuberculosis cure, malaria case fatality, maternal or death audits, referral completion, workforce capacity, infrastructure, equipment and essential-medicine stock-outs.[51][52][21][53]
• Conduct annual System of Health Accounts, benefit-incidence analysis, expenditure tracking and reviews, household expenditure surveys, value-for-money assessments and sector-wide efficiency assessments to monitor health-financing performance.[54][55]
• Require annual work plans and reports, quarterly performance reviews, county and national annual health reviews, and publication of an annual State of Health in Kenya report.[33][56][57]
• Use the Joint Annual Review, quarterly monitoring reviews and technical assessments to assess previous-year performance and inform subsequent planning and budgeting.[41]
• Conduct a mid-term review at the strategic plan midpoint, also serving as the Millennium Development Goals evaluation in 2015, and an end-term review against planned results.[41]
• Strengthen accountability through the Sector Code of Conduct, Health Sector Coordinating Committee, technical groups, county and sub-county management teams, community forums, recommendation-tracking plans, public reporting and annual partnership monitoring.[9][58][59][38][56][57]

Reporting arrangements are comparatively detailed in the review framework, but several extracts do not specify a consolidated evaluation methodology, surveillance governance, complete indicator set or sanctions for non-performance.[42][60][43][56][57]

Costing & Financing

The financing approach seeks universal access to the Kenya Essential Package for Health while reducing direct payments, improving resource adequacy, equity and efficiency, and coordinating public and non-public resources through a common budgeting framework.[61][62][16][40]

• Mobilise resources through taxation, user payments, bilateral, multilateral and philanthropic support, social or private health insurance, direct purchasing, direct provision and contracting of care.[61][33]
• Develop a Health Financing and Social Protection Strategy covering funding sources, institutional arrangements, functions and quantified objectives, supported by costing for financing decisions and annual System of Health Accounts reporting.[62][54]
• Reduce financial barriers through social health insurance, community-based pre-financing, health-care subsidies, a revised cost-sharing strategy and output-based financing, particularly in hard-to-reach areas.[9][7][63][55]
• Apply resource-allocation criteria that address equity, gender, participation, people-centredness, efficiency, social accountability and multisectoral priorities.[39][40]
• Address resource gaps in essential medicines and medical supplies, infrastructure maintenance, health-worker recruitment and training, and information-system development.[64][20][22][24]
• Monitor technical and allocative efficiency, expenditure reaching end users, off-budget resources and out-of-pocket payments.[2][52]
• Use annual work plans and joint reviews to align available budgets, sector priorities, spending plans and performance findings across national and county levels.[17][18][41]
• Seek to meet the Abuja Declaration commitment to allocate 15% of government expenditure to health, although reported government expenditure remained below this target in 2009/10.[65][61]

Reported total health expenditure was approximately 5.4% of gross domestic product and US dollars 42.2 per capita in 2009/10.[61]The extracts identify financing constraints, including incomplete information on donor and private spending, lack of a strategic resource-mobilisation approach and absent costing information, but do not provide a consolidated strategy budget, quantified funding gap or economic assumptions.[62][55]