The commitment of the government of Kenya to RMNCAH has generated improvements in most RMNCAH indicators since 2008: skilled birth attendance increased from 44 percent to 62 percent and under-five mortality dropped from 74 to 52 per 1,000 live births in 2014. Despite such progress, economic and geographic disparities persist and challenges in health service delivery remain—for instance, in Turkana County, only 22.8 percent of women delivered with a skilled provider compared to 89 percent in Nairobi (KDHS, 2014).
The government of Kenya is driving an inclusive coordination platform, involving a wide array of stakeholders including national and county governments, faith-based and civil society organizations, professional associations, the private sector (for-profit and not-for-profit), development partners and financiers for the development of the investment case and the health financing strategy.
Building on an extensive consultative process with national and county governments, civil society, faith-based organizations, the private sector, professional associations, and development partners and financiers, the government of Kenya has developed a national RMNCAH Investment Framework to enhance resources and align all stakeholders around prioritized investments that generate results.
The national RMNCAH Investment Framework proposes innovative supply-side performance incentives to address health system bottlenecks pertaining to human resources for health, health commodity management and quality Health Management Information Systems. It also proposes vouchers and conditional cash transfers to overcome socio-cultural, geographic, and economic barriers to health service utilization, and emphasizes multisectoral interventions, including interventions aimed at strengthening the civil registration and vital statistics systems and improve birth and death registration. To address equity and increase coverage, the RMNCAH Investment Framework prioritizes investments in 20 counties selected on the basis of low coverage rates for RMNCAH services, large underserved populations and marginalization. The RMNCAH Investment Framework will be fully aligned with the Kenyan devolved health system so as to guide the development of county annual work plans focused on evidence-based, prioritized, and locally-relevant solutions.
Several partners, including the Department for International Development (DFID), the Japanese International Cooperation Agency (JICA), the United Nations Children’s Fund (UNICEF), the U.S. Agency for International Development (USAID), and the World Bank, are providing technical assistance to facilitate GFF processes. This includes supporting counties in the development of their costed work plans.
The governments of Denmark, Japan, the United Kingdom, and the United States committed complementary resources for the implementation of the national RMNCAH Investment Framework, in addition to the World Bank with financing from both the International Development Association (IDA) and the GFF Trust Fund.
Health financing strategy
The government of Kenya is also engaged in developing a health financing strategy to ensure sustainable financing for achieving these results by 2030. The Kenyan health financing strategy is in its early stages with stakeholder consultations planned in the near future. Initial thinking brings the strengthening of domestic resource mobilization to the fore—including harnessing the potential of the informal sector—possibly reducing pooling fragmentation and developing strategic purchasing arrangements. Complementing the Kenyan national RMNCAH Investment Framework, the health financing strategy will specifically seek to ensure resource adequacy for efficient and equitable access to affordable essential health care for all Kenyans.