Kenya

Kenya has a population of roughly 40 million, a fifth of whom live on less than $1 a day. The nation is at a critical juncture for both global health and larger development issues. The country’s new constitution contains a more robust system of checks and balances to assure improved governance and fiscal accountability. These components will reduce corruption, boost business confidence, increase trade and investment, and support broad-based economic growth.

At this moment of change in Kenya’s social and political life HIV/AIDS, tuberculosis, malaria, respiratory disease, and diarrheal disease continue to present major health threats to Kenya’s people, with HIV/AIDS being the leading cause of death among Kenyans. Maternal mortality and child mortality rates are among the highest in sub-Saharan Africa. One in 19 babies will die before his/her first birthday this year. Struggling health systems are the principal obstacles for addressing Kenya’s health challenges and preventing premature mortality.

The Kenya GHI Strategy is the next step in the successful U.S. partnership with Kenya. The Strategy serves as a guide for how the U.S. will work with the Government of Kenya and other Kenyan partners to improve and save lives. The Kenya GHI Strategy builds on the success of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). The Strategy elevates efforts to strengthen health systems and improve the wellbeing of women and girls. The focus areas in Kenya’s GHI Strategy support the protection of women, infants, and children from preventable, treatable health conditions and the reduction of illness and death from neglected tropical diseases (NTDs). These areas represent opportunities for U.S. health programs in Kenya to work more collaboratively, effectively, and efficiently to attain greater value from U.S. investments. At the same time the U.S. will continue to support Kenya in achieving critical results in HIV/AIDS, tuberculosis, and malaria.

Country Leadership: National Health Plan Priorities and Challenges

Kenya’s GHI Strategy was based on Kenya’s National Health Sector Strategic Plan II, 2009-12. The Government of Kenya has provided a comprehensive output- and performance-oriented plan that defines Kenyan aspirations and priorities for the health sector over the next five years. The latest National Health Sector Strategic Plan moves from a focus on the burden of disease to placing emphasis on promotion of individual and community health. The vehicle for implementing this approach is the Government of Kenya’s Essential Package for Health which focuses on improving health outcomes through six different life stages, and outlines six critical service delivery points. These points range from rural outreach to urban hospitals. The Plan increases the role of community health workers, strengthens ownership and community oversight of the health system, and enhances the role of districts in service delivery. It also addresses financial and other barriers to care, enhances collaboration among private and public sectors, reinforces the Ministries of Health as the stewards of the health sector, and implements fast-track activities for Kenya to achieve the Millennium Development Goals.

GHI Kenya Strategy: Focus Areas

The overarching GHI country goals for Kenya are to reduce unacceptably high rates of (1) maternal, neonatal and child mortality and (2) morbidity and mortality from neglected tropical diseases. To achieve these goals, the Kenya GHI Strategy has identified three focus areas for guiding U.S. investments in Kenya: (1) strengthening health systems, (2) integrating services, and (3) increasing demand for and awareness of available services. The U.S. will work with Kenya to achieve these goals by ensuring more effective and efficient integration of health programs.

Improving Effectiveness and Efficiency through GHI Principles

The Kenya GHI Strategy outlines specific steps that will be taken to advance the GHI principles. These steps include:

• Intensifying U.S.-Kenya collaborative efforts and investments focusing on women and girls and supporting the goal of reducing maternal, neonatal and child mortality in Kenya, where progress on Millennium Development Goals 4 and 5 lags far behind other sector successes.
• Beginning an exciting new phase of development assistance in Kenya that invests in sound, country-led plans and reliably measures performance, while focusing on good governance and accountability.
• Leveraging non-U.S. health funding to achieve GHI objectives for Kenya by working with partners such as the Global Alliance for Vaccines and Immunization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Bill and Melinda Gates Foundation, and other donors.
• Boosting Kenya’s own capacity to deliver quality health services throughout the country by launching an ambitious five-year Sustainability Strategy to strengthen health systems and to achieve important health outcomes.
• Aligning the U.S. Government’s expectations of rigorous monitoring and evaluation with Kenya’s growing and impressive leadership in this field, ultimately eliminating the need for costly parallel systems.
• Ensuring that the Government of Kenya and local partners have access to credible resources for research and innovation to achieve Kenya GHI Strategy objectives.

GHI in Action: Getting Bednets to Women and Children At Risk of Malaria

Insecticide Treated Nets (ITNs) have been shown to reduce malaria deaths in children under five years of age by about 20 percent and malarial illness among children under five and pregnant women by up to 50 percent. The Government of Kenya aims to achieve universal coverage with ITNs by providing one net for every two people at risk of malaria.

USG-Kenya partnership support

On March 9, 2011, Kenya launched the free distribution of nearly 11 million LLINs, which will benefit 22 million people at risk of malaria living in various parts of the country. Under the Global Health Initiative, the USG-Kenya partnership is investing in the country’s universal ITN coverage plan, which includes the mass distribution campaign.

While supporting the mass distribution campaign, USG in Kenya is addressing the additional GHI principles by:

• Supporting ITN distribution channels that achieve and sustain high and equitable coverage among women and children who are among the groups most vulnerable to malaria – USG is providing 2.7 million LLINs to the 2011 mass distribution campaign and has been providing more than 50% of LLINs needed annually for routine distribution through maternal and child health clinics, HIV/AIDS comprehensive care clinics and community based approaches.
• Maximizing USG contribution to the campaign through a coordinated effort by the different USG agencies through the President's Malaria Initiative. The campaign is being implemented in provinces where all USG agencies are working allowing for a whole-of-government approach. The 2.7 million USG contributed LLINs for the campaign are being procured and distributed by USAID while Peace Corp Volunteers are providing logistics and social mobilization support in selected districts, and CDC will assist the Government of Kenya in evaluating ITN retention, use and achievement of universal coverage at the end of the campaign. Although not directly involved in this malaria prevention campaign, the US Department of Defense continues to provide downstream critical support for malaria treatment by strengthening national and district capacity for malaria diagnosis.
• Building capacity of the Government of Kenya to effectively carry out future mass ITN distribution campaigns with minimal or no donor support – In support of Kenya’s plan to conduct a mass distribution campaign once every three years, USG agencies (CDC and USAID and their implementing partners) have developed tool kits and provided capacity building to national and district level officers to plan and implement logistics, communication, social mobilization, monitoring and evaluation through existing health systems. In addition, capacity has been built by USG partners for the use of Personal Digital Assistants (PDAs) with GIS mapping for the post-campaign evaluation.
• Tracking net delivery, ownership and use to enable improved impact of the intervention – USG Kenya partners have supported the Government of Kenya develop, print and administer tools as well as analyze data collected to monitor logistic arrangements, human resource performance, social mobilization efforts etc. during the campaign. In addition, support has been provided for the conduction of national household surveys to measure increases in ITN coverage and use among target groups.
• Supporting operational research and innovation – Kenya is receiving technical support from USG Kenya partners for monitoring physical and insecticide longevity of LLINs in the households to enable the Government know when distributed nets may no longer be effective and must be replaced. In addition, USG is supporting operational research to test the feasibility of recycling old and ineffective nets to aid with their disposal.

It is anticipated that due to increased USG efficiency under the Global Health Initiative, committed funding of approximately USD $20 million to Kenya’s mass ITN distribution campaign will help save millions of lives.

GHI: What Others Are Saying

“Meaningful work is being done in developing a new and more cohesive model of integrating U.S. government health programs and in prioritizing key approaches that could have significant public health impacts, but have been neglected in the past...Programs now focus more on improving integration, examining unit cost efficiencies, capturing impacts, collaborating with other donors, and leveraging higher commitments from the Kenyan government. These are all welcome and constructive changes that strengthen U.S. approaches to health and have broad applicability beyond Kenya.”

CSIS Report “On the Ground with the Global Health Initiative” March 2011

• News Release
• Kenya GHI Strategy
• GHI in Action: Kenya