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Private Health Sector Assessment in Kenya WORLD BANK WORKING PAPER NO. 193 Private Health Sector Assessment in Kenya THE WORLD BANK WORLD BANK WORKING PAPER NO. 193 Private Health Sector Assessment in Kenya Jeff Barnes Barbara OHanlon Frank Feeley III Kimberly McKeon Nelson Gitonga Caytie Decker Copyright © 2010 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First Printing: April 2010 Printed on recycled paper 1234 13121110 World Bank Working Papers are published to communicate the results of the Bank’s work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. Some sources cited in this paper may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed herein are those of the author(s) and do not necessarily reflect the views of the International Bank for Reconstruction and Development/The World Bank and its affiliated organizations, or those of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank of the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable law. The International Bank for Reconstruction and Development/The World Bank encourages dissemination of its work and will normally grant permission promptly to reproduce portions of the work. For permission to photocopy or reprint any part of this work, please send a request with complete information to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA, Tel: 978 750 8400, Fax: 978 750 4470, www.copyright.com. All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA, Fax: 202 522 2422, email: [email protected]. ISBN: 978 0 8213 8359 9 eISBN: 978 0 8213 8363 6 ISSN: 1726 5878 DOI: 10.1596/978 0 8213 8359 9 Library of Congress Cataloging in Publication Data has been requested. Investment Climate in Health Series his subseries of the World Bank Working Papers is produced by the Investment TClimate Department of the World Bank Group. It is a vehicle for publishing new material on the World Bank Group’s work in the health sector, for disseminating high quality analytical work, and for consolidating previous informal publications after peer review and standard quality control. The subseries focuses on publications that expand knowledge of government policies and the operating environment and suggest ways of better engaging the private health sector in treating illnesses among the poor and other vulnerable populations. Best practice examples of both global and regional relevance are presented through thematic reviews, analytical work, and case studies. The editor in chief of the series is Alexander S. Preker. Other members of the Editorial Committee are Peter Berman, MarieLouisa Escobar, Scott Featherston, April L. Harding, Gerard M. La Forgia, Benjamin Loevinsohn, Tonia Marek, Dominic Montagu, Ok Pannenborg, Khama O. Rogo, Onno P. Schellekens. For further information contact: Therese Fergo Email: [email protected] Tel.: +1 (202) 4585599 iii Contents Acknowledgments .................................................................................................................... x Acronyms and Abbreviations ................................................................................................xi Executive Summary................................................................................................................xiv Key Findings.....................................................................................................................xiv Recommendations ..........................................................................................................xvii Areas for Future Study....................................................................................................xix 1. Introduction and Background............................................................................................. 1 Introduction......................................................................................................................... 1 2. Methodology .......................................................................................................................... 4 3. Assessment Findings and Issues ........................................................................................ 6 Private Sector Size and Structure...................................................................................... 6 Kenyan Burden of Disease and the Private Health Markets....................................... 11 Ensuring Delivery of Quality Services in the Private Health Sector.......................... 23 Health Financing and Insurance..................................................................................... 29 The Business Environment for the Private Health Sector ........................................... 39 Private Sector Supply Chain............................................................................................ 46 Policy Reform Environment ............................................................................................ 52 4. Recommendations............................................................................................................... 63 Stewardship and Governance of the Private Health Sector ........................................ 63 Health Financing and Social Health Insurance............................................................. 64 Delivering Quality Services in the Private Health Sector............................................ 66 Delivering Quality Drugs through the Private Supply Chain.................................... 72 Bridging the Knowledge Gaps to Stimulate Investment and Inform PublicPrivate Policy Dialogue.......................................................................................................... 74 5. Conclusions .......................................................................................................................... 76 Estimating the Impacts..................................................................................................... 76 Other Market Opportunities ........................................................................................... 78 Appendixes............................................................................................................................... 79 Appendix 1. Scope of Work................................................................................................... 79 Background........................................................................................................................ 79 Objectives........................................................................................................................... 80 Statement of Work ............................................................................................................ 80 Suggested Methodology .................................................................................................. 83 Deliverables ....................................................................................................................... 84 Duration, Timing and Schedule...................................................................................... 85 v vi Contents Appendix 2. Stakeholders Interviewed............................................................................... 86 Appendix 3. Focus Group Discussion Analysis=................................................................. 89 Understanding the Private Health Sector in Kenya: An Analysis of Focus Group Discussions with Private Health Providers ........................................................... 89 Contributions of Private Providers to Public Health ................................................... 89 Constraints Preventing Private Providers from Providing More Services ............... 90 Potential Strategies for Improving the Health Care Provided by the Private Sector91 Appendix 4. Donor Investment Opportunities.................................................................. 93 Opportunity One: Creating a Legal Structure for Innovation and Security in Health Insurance .................................................................................................................... 93 Opportunity Two: An Integrated Licensing and Enforcement Structure for Health Facilities ...................................................................................................................... 94 Opportunity Three: Linking Gold Star, Insurance, and Affordable ART Supply.... 95 Opportunity Four: Accreditation and Quality Assurance for Laboratories ............. 96 Opportunity Five: Rural Retail Drug Network............................................................. 97 Opportunity Six: Expand Access to Finance ................................................................
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