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 O Hanlon Frank Feeley III Kimberly McKeon Nelson Gitonga Caytie Decker
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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 sub series 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 sub series 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, Marie Louisa 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 E mail: [email protected] Tel.: +1 (202) 458 5599
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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 Public Private 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
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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 ...... 99 Opportunity Seven: Develop Local Training Capacity in Health Management and Finance...... 99 Opportunity Eight: Support for the Policy Reform Process...... 101 Appendix 5. Case Studies ...... 104 Case Study #1: The Gold Star Network ...... 104 Case Study #2: Sustainable Healthcare Foundation/CFW Shops ...... 106 Case Study #3: Low end Insurance Product ...... 109 Appendix 6. Selected Data on Key Health Markets...... 112 1. National Health Accounts ...... 112 2. Women’s Health (Delivery, Antenatal, and Family Planning Services)...... 113 3. Treatment of Childhood Diarrhea ...... 121 4. HIV/AIDS...... 124 Appendix 7. Naivasha Workshop Report ...... 126 Antecedents ...... 126 Workshop Overview ...... 126 Addressing Misperceptions, Building Trust ...... 128 Challenges to Partnership in the Kenyan Health Sector...... 130 Closing Remarks ...... 133 Annex A: List of Naivasha Workshop participants ...... 134 Annex B: Implementation Framework for Social Health Protection Strategy...... 136 Annex C: Naivasha Declaration...... 137 Annex D: The Naivasha Workshop Recommendations—April 2009...... 139
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Appendix 8. Second PPP Workshop: Building a Roadmap for Health PPPs in Kenya (follow up to Naivasha workshop) ...... 142 1.0. Introduction Workshop Overview ...... 142 2.0. Background...... 143 3.0. Highlights from Opening Speech by Permanent Secretary, Mr. Mark Bor...... 144 4.0. Prioritization of Naivasha Workshop Recommendations...... 145 5.0. Aureus Capital ...... 154 6.0. Next Steps and Road Map ...... 155 Annex A: Agenda for June 25 and 26 Workshop at Holiday Inn, Nairobi