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Health Sector PERFORMANCE Report July 2008–June 2009 (Annual Operational Plan 4)

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Republic of Kenya Reversing the trends The Second NATIONAL HEALTH SECTOR Strategic Plan Health Sector PERFORMANCE Report July 2008–June 2009 (Annual Operational Plan 4) Health Sector Reform Secretariat June 2010 Performance Report Republic of Kenya Reversing the trends The Second NATIONAL HEALTH SECTOR Strategic Plan of Kenya Health Sector PERFORMANCE Report July 2008–June 2009 (Annual Operational Plan 4) Ministry of Public Health Ministry of Medical and Sanitation Services Afya House Afya House PO Box 30016 – GPO PO Box 30016 – GPO Nairobi 00100, Kenya Nairobi 00100, Kenya Email: [email protected] Email: [email protected] Website: www.health.go.ke Website: www.medical.go.ke June 2010 i NHSSP II / AOP 4 – 2008/09 Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes or for profit. Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – HEALTH SECTOR PERFORMANCE REPORT JULY 2008–JUNE 2009 (Annual Operational Plan 4) Published by: Ministry of Health Technical Planning and Monitoring/Coordination Departments Afya House PO Box 3469 - City Square Nairobi 00200, Kenya Email: [email protected] ii Performance Report Contents List of Tables v 2.3.5 Distribution of Achievements by List of Figures vii Poverty Levels 21 List of Abbreviations viii 2.4 Client Perceptions of Sector Performance 21 Foreword xi 2.4.1 Methodology Employed 22 Executive Summary xiii 2.4.2 General Emerging Issues with Client Satisfaction 23 1 Introduction and Background 1 2.4.3 Client Satisfaction Index 25 1.1 Recap of Sector Strategic Direction and Past 2.4.4 Emerging Issues with Employee Review Recommendations 1 Satisfaction 26 1.1.1 Recap of NHSSP II 1 2.5.5 Areas for Improvement 27 1.1.2 Recap of Sector Investment Priorities 2 2.5 Implications of Performance for Sector 1.1.3 Priorities in the Joint Programme of Targets 28 Work and Funding 2 2.5.1 Implications for NHSSP II Targets 28 1.1.4 Priorities from the Midterm Review 2 2.5.2 Implications for Equity Goals 29 1.1.5 Priorities for the Government 2 2.5.3 Implications for International 1.2 Objectives of AOP 4 4 Commitments 29 1.3 Methodology for Developing the AOP 4 Report 5 3 Analysis of Management Support to 1.3.1 Conceptual Framework 5 Service Delivery 32 1.3.2 Key Challenges 7 3.1 Management Support from Provinces 32 1.4 Presentation of the AOP 4 Results 7 3.1.1 Central Province 32 3.1.2 Coast Province 33 2 Analysis of Service Delivery Achievements 9 3.1.3 Eastern Province 34 2.1 Current Status of Health in Kenya 9 3.1.4 North Eastern Province 35 2.2 Level of Achievement of Sector Targets 10 3.1.5 Rift Valley Province 35 2.2.1 Overall Level of Achievement in Service 3.1.6 Nyanza Province 36 Delivery 10 3.1.8 Western Province 37 2.2.2 Overall Achievement by Province 10 3.2 Management Support from Medical Services 2.2.3 Overall Achievement by Level of Care 16 Technical Support 38 2.2.4 Overall Achievement by Ownership 17 3.2.1 Clinical Services 38 2.2.5 Trends in Achievement, AOP 1–AOP 4 17 3.2.2 Surgical and Rehabilitative Services 39 2.3 Equity in Distribution of Achievement of 3.2.3 Nursing Services 39 Sector Targets 18 3.2.4 Pharmaceutical Services 40 2.3.1 Distribution of Achievements by Urban/ 3.2.5 Diagnostic and Forensic Services 40 Non-Urban Regions 18 3.2.6 Technical Planning and Coordination 41 2.3.2 Distribution of Achievements by Arid/ 3.2.7 Technical Administration 41 Non-Arid Regions 18 3.2.8 Standards and Regulatory Services 41 2.3.3 Distribution of Achievements by Gender 19 3.3 Management Support from Public Health 2.3.4 Distribution of Achievements by and Sanitation Technical Support 41 Literacy Levels 20 iii NHSSP II / AOP 4 – 2008/09 3.3.1 Disease Prevention and Control 4.7 Commodities and Supplies 62 Services 42 4.7.1 Levels and Distribution of AOP 4 3.3.2 Family Health Services 43 Investments 62 3.3.3 Health Promotion 43 4.7.2 Trends in Investments in NHSSP II 63 3.3.4 Primary Health Service 44 4.7.3 Impact of AOP 4 Investments 63 3.3.5 Disaster Preparedness 44 4.8 Operations and Maintenance 63 3.3.6 International Health Relations 44 3.3.7 Environmental Health and Sanitation 45 5 Analysis of Sector Partnership 3.3.8 National Public Laboratory Service 46 Achievements 65 3.4 Management Support from Parastatals 46 5.1 Governance and Partnership Achievements 65 3.4.1 Kenyatta National Hospital 46 5.1.1 Status of Planned Outputs 65 3.4.2 Radiation Protection Board 47 5.1.2 Challenges in Delivery of Planned 3.4.3 Kenya Medical Supply Agency 47 Outputs 68 3.4.4 National Hospital Insurance Fund 48 5.2 Status of the Health Partnership 68 3.4.5 Kenya Medical Research Institute 48 5.2.1 Performance against Country 3.4.6 Kenya Medical Training Institute 48 Ownership 70 3.4.7 Moi Teaching and Referral Hospital 48 5.2.2 Performance against Sector Alignment 70 3.5 Cross-Cutting Support Systems 48 5.2.3 Performance against Sector 3.5.1 Accounts 48 Harmonization 71 5.2.4 Performance against Managing for 4 Analysis of Sector Investments 49 Results 72 4.1 Financing for AOP 4 49 5.2.5 Performance against Mutual 4.2 AOP 4 Expenditure Review 50 Accountability 72 4.2.1 MTEF Expenditure 50 5.3 Partnership Indicator Dashboard and Way 4.2.2 Donor Expenditure 51 Forward 72 4.2.3 Out of Pocket Expenditure 51 4.2.4 Overall Expenditure 51 6 Overall Sector Performance 74 4.3 AOP 4 Expenditure Tracking 51 6.1 Performance in Level and Distribution of 4.3.1 Flow of Funds from Ministry of Finance Health Services 74 to MOH HQ 52 6.1.1 Level of Health Services Achieved 75 4.3.2 Flow of Funds from MOH to Provincial 6.1.2 Distribution of Health Services 77 General Hospitals 53 6.2 Performance in Level and Distribution of 4.3.3 Flow of Funds from MOH HQ to Hospital Services 77 District Hospitals 54 6.3 Overall Recommendations 79 4.3.4 Flows from MOH to Rural Health 6.3.1 Reporting for Performance Monitoring79 Services 54 6.3.2 Service Delivery Performance 79 4.3.5 Use of Cost-Sharing Revenues 55 6.3.3 Management Support Performance 81 4.4 Investment Trends, AOP 1 – AOP 4 56 6.3.4 Sector Investments 81 4.5 Human Resources for Health Investments 57 6.3.4 Partnership 81 4.5.1 Levels and Distribution of Investments in AOP 4 57 Annex A: District Performance 82 4.5.2 Trends in Investments in NHSSP II 58 Annex B: Hospital Performance 104 4.5.3 Impact of AOP 4 Investments 59 4.6 Physical Infrastructure Investments 59 4.6.1 Levels and Distribution of Investments in AOP 4 60 4.6.2 Trends in Investments in NHSSP II 61 4.6.3 Impact of AOP 4 Investments 61 iv Performance Report List of Tables 1.1: Midterm recommendations from the MTR 3 4.4: AOP 4 AIEs for provincial general 1.2: Strategic thrusts from the respective hospitals O&M expenses v/s budget ministry strategic plans 4 allocations 53 1.3: AOP 4 report structure 8 4.5: Comparison of DAB estimates and actual spending based on AIEs 53 2.1: Reporting rates of districts per province 10 4.6: Number of days from raising AIE to receipt 2.2: Sector achievement and performance in by PGH by quarter 53 AOP 4 11 4.7: AIEs for district hospital O&M expenses 2.3: Achievements, by province during AOP 4 13 in FY 2008/09 54 2.4: AOP 4 achievements against sector 4.8: AIEs for selected DMOHs under R11 113 indicators, by level of care 16 335, FY 2008/09 (Ksh) 55 2.5: National trends in selected indicators, by 4.9: Reported cost-sharing revenues for RHF urbanization 18 for FY 2008/09 (Ksh) 56 2.6: National trends in selected indicators, by 4.10: Expenditure from cost-sharing revenues, level of aridity 19 by broad category, FY 2008/09 56 2.7: National trends in selected indicators, by 4.11: Trends in expenditures, AOP 1 – AOP 4 57 gender empowerment 19 4.12: New staff recruitments, AOP 4 57 2.8: National trends in selected indicators, by 4.13: Distribution of staff, by duty station location 58 literacy 20 4.14: Trends in public health worker cadres, 2.9: National trends in selected indicators, by AOP 1 – AOP 4 58 poverty level 21 4.15: Facilities by ownership, in each province 60 2.10: Areas analysed 22 4.16: Numbers of facilities, at beginning, and 2.11: Research methodology 22 end of AOP 4 60 2.12: Number and types of interviews 22 4.17: Total value of pharmaceutical com- 2.13: Contact point categorization 23 modities, by province 62 2.14: Proposals on government and community 4.18: Commodity values for key programme initiatives 25 areas, AOP 2 – AOP 4 63 2.15: Disaggregation of the customer/patient 4.19: Resource allocation criteria for Kenyan satisfaction index by level of care 26 health facilities 63 2.16: Customer/patient service expectations 26 4.20: Allocations for O&M, by province 64 2.17: Satisfaction levels against expectation levels 27 5.1: AOP 4 progress against planned outputs 66 2.18: Outputs of level 1 services 30 5.2: Summary of progress, issues and recom- mendations on strengthening the Kenya 4.1: MTEF budget, and expenditure in AOP 4 partnership 68 (Ksh billion ) 50 5.3: Kenya health partnership indicator 4.2: Reported donor expenditures, AOP 4 (Ksh) 51 dashboard, AOP 4 73 4.3: Health sector budget and actual expen- ditures AOP 2 – AOP 4 (Ksh million) 53 6.1: Health Services Index 75 v NHSSP II / AOP 4 – 2008/09 6.2: AOP 4 average provincial achievements, A3: Nyanza Province AOP 4 performance by by health service indicator variable district 88 (percentage) 76 A4: North Eastern Province AOP 4 perform- 6.3: Provincial ranking, by type of services 77 ance by district 91 6.4: Provincial summary of AOP 4 hospital
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