DOMESTIC RESOURCE MOBILIZATION FOR HEALTH: NATIONAL HEALTH FINANCING DIALOGUE FOR IMPLEMENTATION OF THE HEALTH SECTOR DOMESTIC FINANCING SUSTAINABILITY PLAN
The National AIDS Control Council (NACC) together with Global Fund – Kenya Coordinating Mechanism (GF-KCM) held a Policy Dialogue meeting early October 2018 in Crown Plaza Hotel, Nairobi to deliberate on the need for Domestic Resource Mobilization for Health geared towards building a Health Sector Domestic Financing Sustainability Plan.
The Government of Kenya has been heavily reliant on donor funding for Health programs for over ten years. For example, external financing towards HIV accounted for 73% of resources, 37% of TB spending and 12% of malaria spending in 2015. External funding from the US Government and from the Global Fund are expected to be substantial between 2018 – 2020 for the three diseases with external funding being roughly 1.2 times the Ministry of Health’s budget.
There are many challenges confronting the health sector in the area of financing and that is the reason the policy dialogue has become even more critical in light of escalated costs related to the provision of health services, the unpredictability of resource flows and the significant changes in the way external assistance is being financed and distributed in the health sector.
The National Health Financing Dialogue highlighted more critical issues in health care service delivery with a focus on efficiency and value for money as well as strengthening the country’s need for a the sustainable health financing mechanism. This is coming at a time when His Excellency the President of the Republic of Kenya has set a target of attaining 100% Universal Health Coverage(UHC) over the next five years. This is in keeping with every Kenya’s right to quality and affordable health care, including reproductive and emergency health services as enshrined in the Constitution. In addition, the recently enacted Health Act 2017 mandates the Government of Kenya to ensure progressive financial access to UHC.
There is a clear recognition and increasing conversation about the need to diversify and expand the sources of domestic funding to ensure sustainable financing of the health sector and reduce dependence on development partners. In 2014, the Kenyan economy was rebased and reclassified as a Lower Middle Income Country. The rebasing of the Kenyan economy means that Kenya should significantly increase resources for health from domestic sources, procure essential health related commodities at market prices and will no longer be eligible for World Bank IDA concessional loans.
Notably, domestic funding for the HIV, TB and malaria programs have been progressively increasing. The government is strongly committed to increasing its contribution to the health sector including the three disease programs over the 2018-2021 implementation phase as well. The increasing focus on universal health coverage through improved domestic financing for health is articulated through the ‘Second Medium Term Plan of Kenya, Vision 2030’, ‘Kenya Health Policy, 2014–2030’, and ‘Kenya Health Sector Strategic And Investment Plan (KHSSP) July 2014 – June 2018’. It is also worth noting that the Kenya 2030 vision provides for increase of the Government expenditure on health from 8% in 2016 to 12% by 2017/18. This was expected to greatly narrow the funding gaps.
Kenya’s disease responses face three key long-term transition challenges. The first is replacing donor funding, a second is closing the resource gap even when external resources are available in the health sector and a third is ensuring the efficient delivery of health services. To address these challenges and ensure that disease responses are financed, the following key recommendations were proposed:
- Integrating sustainability and transition issues into routine health financing discussions between the Ministry of Health and the National Treasury official at the national and county levels.
- Specifying the national and county roles with respect to program activities that will be transitioned the short, medium and long term.
- Ensuring efficiency is a central focus in the sustainability and transition planning for the three diseases.
- Ensuring the health financing functions are aligned with public financial management and analysed at the program level.
- Ensure all government stakeholders adopt ‘urgent incrementalism’ in ensuring step-wise annual progress on which aspects of programs will be transitioned to the government of Kenya for funding. A forecast could be developed for a 10 year period.
This Policy dialogue interrogated these recommendations further with the aim of developing and finalizing a road map for implementation of the country’s domestic financing sustainability plan for health. The discussions focused on increasing domestic financing for health and reflected on the advocacy plan for the same. This will help in forming consensus on government health financing priorities and next steps to ensuring robust funding is available to meet not only the programmatic gaps for the AIDS, TB and Malaria programs but the entire health sector programmes.
The deliberations also pointed at the need to provide a platform for which the key Kenya stakeholders including government, civil society, NGOs as well as partners to discuss and showcase mechanisms to increase domestic resources for health in the effort to achieve Kenya’s goals towards universal health coverage and also develop the Transition roadmap for implementation of the country’s domestic financing sustainability plan for health.
The dialogue successfully brought key stakeholders of public sector financing and health financing, the Ministries of Health, Finance and Planning, Members of Parliament, civil society partners, development and other technical partners.
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