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Support to Universal Health Care

Danida is signatory to the Code of Conduct for the health sector in Kenya, as well as the Paris Declaration on Aid Effectiveness and the Accra Agenda on Action . In the spirit of the declaration, Danida is aligned with government policies and strategies and moves towards a Sector Budget Support.

The sector wide process focusing on improvement of government health service delivery support and systems, planning and budgeting, financial, procurement, and human resources management has taken root and there is a need to continue supporting the process to ensure it is entrenched and institutionalized in the health sector and becomes irreversible.

Danida supports the Kenyan health sector under our thematic programme on Health from 2017-2020 through our three development engagements:

1) Support to Universal Health Care (UHC) in the devolved system with 175 mio DKK

2) Reducing Preventable Maternal, Newborn and Child Deaths with 40 mio DKK

3) Enhancing services and advocacy on Gender-Based Violence with 10 mio DKK.

The main outputs measures of the program are:

  • Increased number of children younger than 1 year fully immunized
  • Increased number of pregnant women attending at least four Ante Natal Care visits
  • Increased number of births attended by skilled health personnel
  • Increased number of women between ages of 15-49 years currently using a modern Family Planning method.

The 47 county governments play a crucial role in Universal Health Care (UHC) delivery. The decentralisation ’Devolution’ of health services provides an outstanding window of opportunity for real change in health service delivery in Kenya. The core of the financial support is provided for operations and maintenance costs at public gazetted Level 2 and Level 3 health facilities in the 47 counties. The Program will use about 89% of the grant resources for the counties in the form of conditional grants for the operations and maintenance costs of primary health care facilities. The remaining 11% will be used to support program management and some systems strengthening through a Joint Programme Management Team (PMT), appointed from the Ministry of Health (MoH) and the Council of Governors. This PMT also manages the World Bank-funded Transforming Health Systems for Universal Care Project.

Available evidence suggests that operational funding of primary health facilities has a strong and positive effect on facility service provision as well as improving quality of care. This is achieved by providing funding specifically for areas not yet adequately covered by the central county support. After the removal of user fees at the primary health facility level, facilities lack funds to pay running cost like electricity, water, minor repairs etc. These are all instrumental in maintaining an operational facility that delivers services to the population. The support contributes to most health services provided at the primary health care level but the value of the support is most pronounced in the Reproductive, Maternal, New-born, Child and Adolescent Health services (RMNCAH) area.

Danida support to date has been appreciated by both national and county governments, because it is fully aligned to the new devolved governance system implemented in 2013. It has had a catalytic effect at two levels. Firstly, at the governance reform level it helps county governments to fulfil their constitutional mandate and deliver tangible results in one of the most important areas of devolved governance. Secondly, at the technical level, the relatively small transfer of Danish funds to these facilities has, since Danida piloted this model in 2006 and rolled it out country-wide jointly with Government of Kenya in 2010, demonstrated significant impact on peripheral health facilities, and led to improvements in quality of care, staff motivation and patient satisfaction.  The period 2014 – 2016 was to a large extent a learning period, where Danida and the World Bank engaged extensively with government to develop a comprehensive national framework for conditional grants. It served an important catalytic function to test the new established systems, improve these and show the way forward for other Development Partners wishing to strengthen the alignment of their support to national systems. Based on what was learned during the previous period, this support phase was initiated in the beginning of 2017. The first half of 2017 was used to set up the new support systems and commence financial support to the counties from July 2017.

A major design change from the previous support is further harmonisation with the World Bank in the establishment of a joint central coordination entity to facilitate implementation of the support and an improved funds flow modality.

The funds flow mechanism has been improved with the establishment of a special purpose account for health at the county level. This will ring-fence the funding for health and it is expected to improve funds flow as the counties will not be able to temporarily use the funds to cover gaps in other areas/sectors.

In the previous support, fixed sums were allocated for a set number of Government gazetted level two and three facilities. In the new phase, the counties themselves will on a needs base decide and allocate the funds to relevant health facilities. This will cater for increased ownership and capacity development. The continuous focus on level two and three facilities and operations and maintenance ensures that the support remains pro-poor. In order to secure additionality of the funding as well as long-term sustainability, a county needs to meet a minimum threshold of health expenditure (with incremental yearly increases) after the first year of support in order to be eligible for the Danida grant as well as an increasing county financing of operations and maintenance at level two & three health facilities. 

Read more about our support to Universal Health Care in the Kenya Country Programme:

Kenya Country Programme 2016-2020

Under the UHC programme, Denmark also supports the World Bank’s Multi Donor Trust Fund. Please find more information about the TF below:

RMNCAH Factsheet_October 2018

MDTF January 2019 bulletin