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• Kenya adopted a new constitution back in 2010 which
marked birth to devolution.
• Like many other countries such as Singapore and
Ethiopia where devolution had worked pretty well in
aiding development, Kenyans invested much hope in
devolution as the vehicle to development especially in
the health sector where indicators were disturbing.
• However, decentralization began after the 2013
elections and devolution kicked off, the health sector
has been in a way beset my a bulk of challenges
especially in health financing that have hindered
improvement of numerous health care indicators.
• There has been promising improvements in majority of the counties across
majority of health system strengthening pillars but a whole lot still has to be done.
• Health Sector Development Partner Forum (HSDPF) think-tank based at the
Catholic University of Eastern Africa in Kenya, in which I was a co-convener, hosted
a WHO endorsed knowledge sharing platform that brought together all key
stakeholders in health with especial focus to counties. The theme of the forum
being “Sustainable Healthcare partnerships in the Devolved Setup” allowed the
county executive committee members for health to highlight the key challenges
faced in their respective counties. The main challenges highlighted to be hindering
attainment of Universal Healthcare Coverage (UHC) that stemmed from the forum
i. Health financing, financing of healthcare activities .
ii. Human resources in health.
Therefore, there is a great need for different stakeholders in health to find innovative
and efficient of ways to address these needs which pose a great threat to
achievement of UHC and SDG 3
Situation in Kenya
Health in Kenya has been greatly beset by the aforementioned shortcomings.
Majority of counties are spending about 30% of their budget compared to the
previous 6% that was spent by the national government to finance health and this
may a pose a great threat to other development areas. Considering that health is
dependent on various social determinant factors, a lot need to be done to fully
finance the health activities as well as the determinants.
Mismanagement of fund is also common in majority of counties where funds are
invested into projects that do not have a clear goal or work structure. This leads to
loss of funds that could have brought the difference if well managed.
From Human Resources for Health perspective, WHO Global Atlas of Health Workforce
identified Kenya as having a critical shortage of healthcare workforce since
independence. With the shortage, strikes by health professional has been in rise
due to what they term as dissatisfaction and poor payments. Therefore the
paradox is, who will be responsible to halt this commotion?
In terms of ODA for Kenya , the health sector allocations has averaged 24.1% of the in
the last five years $3077.38 M received yearly. This is quite a significant amount if
well utilised could be the turning point to a better health.
• Its time for Kenya, the developing world as well as the world in general to rethink on strategies of
financing the health sector. The following are some of the solution I propose Kenya to adopt to
overcome the menace in health
Effective use of ODA funds to mobilise funds.
Considering that Kenya has been receiving a fair share of ODA allocation, its time for healthcare
stakeholders to utilise the money allocated for health to improve the health situation in the
country. As explained in Paying for Development: Domestic Resource Mobilization ODA
allocation is expected to decrease in the near future and this will greatly apply to Kenya having
attained a Lower middle income country. As explained by Ngozi Okonjo the impact of ODA
should go beyond actual financing. ODA should be used effectively as catalytic source of finance
by leveraging the millions and billions dollars in private sector.
This is well replicable in health sector where the ODA allocation can be used to leverage for other
resources especially from the private sector. The only challenge in this is that there is
inadequacy in capacity among the medics on how to use the ODA to leverage for more
finances. Its therefore important for invent programs that are geared towards building capacity
among health workers on how to efficiently use the ODA available in mobilising for adequate
• One of the way to go if Kenya and other developing countries are willing to
attain SDG 3 is to advocate for partnerships. There is a lot of funds that are
untapped. Blended capital is needed in the health sector as need in other
sectors. This can done by creation of enabling environment in Kenya by
the public sector to entice the private sector to participate in financing for
health. ODA allocated for health should also be used mainly to mitigate
risks and create an enabling environment as well that will help providing
adequate finances for health.
• In summary there is need for Kenya to invest efforts in Domestic resource
mobilisation which is the path every country should follow in pursuit to
success as quoted in “Why domestic revenue mobilization belongs on the
• To attain this, there is need for capacity building on how resources can be
mobilised locally in quest to eradicate the old way of using fund especially
the ODA funds. Below is a logical frame work that looks to summarize
what ODA can achieve for Kenya in the health sector.
Output-outcome-impact logic overview
Inputs Activities Outputs
of project activities
Private public partnerships
Improved health services
Universal Health Coverage
and SDG 3