Kenya

Last Updated: February 9, 2012

Senior Program Officer:

Diana Kizza, MSc

Program Activities
Health Sector Architecture
Health Financing
Budgeting
Budget Flows and Reporting
Budget Performance
Parliamentary Notes
Immunization Performance Indicators
Disease Burden
Useful Links

Program Activities:

October 2008 and January 2009: Director Mike McQuestion and Program Officer Diana Kizza held introductory meetings with Kenyan immunization stakeholders including Ministry of Health, World Bank, UNICEF and WHO.
April 2009: Ms. Kizza addressed the Kenya Pediatric Association 2009 Annual Scientific Conference, in Nairobi.
September 2009: Director Mike McQuestion and Program Officer Diana Kizza met with Ministry of Health, parliamentarians, UNICEF and World Bank counterparts in Nairobi to propose a series of parliamentary briefings on immunization financing.
September 2010: Diana Kizza and two members of the Kenyan Pediatric Society and six MPs from the Health Committee participated in Kenya's first parliamentary briefing on sustainable immunization financing.
February 2011: Director Mike McQuestion and Program Officer Diana Kizza met with Ministry of Health and parliamentary counterparts to plan a second parliamentary briefing on immunization financing.
March 2011: Second parliamentary briefing on sustainable immunization financing.
July 2011: Director Mike McQuestion and Program Officer Helene Mambu-Ma-Disu conferred with Ministry of Health, parliamentary and Kenyan Pediatric Society colleagues in Nairobi.
February 2012: McQuestion and Kizza attend a third parliamentary briefing in Nairobi.

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Health Sector Architecture:

In 2008, the political situation led to new governance structures in Kenya. The Ministry of Health and Sanitation was split into two: The Ministry of Medical Services and the Ministry of Public Health and Sanitation. A Health Sector Coordinating Committee is alternately chaired by the permanent secretaries of the MoMS and MoPHS.
The National Health Sector Strategic Plan II (2005-2012) defines six levels of health care. Level 1 is the community. On Level 2 are dispensaries. On Level 3 are health centres. Levels 4-6 are hospitals. The health sector is developing a decentralized governance structure. It includes provincial and district stakeholders fora and health facility and community health committees. Among other functions, the provincial and district fora will monitor, supervise and evaluate health program performance.
In 2010, the Health Sector Services Fund began disbursing recurrent cost funds directly to Level 1,2 and 3 health facilities. The funds and managed by Health Facility Management Committees and support delivery of the Kenyan Essential Package for Health, which includes immunization. Provincial and district health management teams provide oversight and district-level accountants report how the funds are used.
National and external health partner efforts are aligned through the Joint Program of Work and Funding (2006-2010). A health sector SWAp is implemented according to a multisectoral Code of Conduct. The MoF External Resources Department coordinates all external aid. Line ministries negotiate aid programs with its approval.
Percent of children fully immunized in one of eight start-up indicators for a proposed MoH Performance-based Monitoring and Evaluation System. Provinces are to report quarterly to the Health Management Information Division of MoPHS. Read more here.
International Health Partnership: Kenya is a fully-inaugurated IHP+ country; it is currently working towards completing a compact. Read more here.
The Kenyan Expanded Program on Immunization is located in the Immunization Division, Department of Family Health, MoPHS.
Specific targets for immunization and other health priority programs are set out in the National Health Sector Strategic Plan (2005-2012). Annual plans prepared by Level 2 and 3 facilities are consolidated into district (n=148) and provincial (n=8) plans. Vaccine coverage is one of the core health sector indicators.
External partners and the government jointly oversee the Kenyan Expanded Programme on Immunization through an Inter-agency Coordinating Committee.

Sources: Ministry of Medical Services (2008). Strategic Plan 2008-2012. Ministry of Public Health and Sanitation (2008). Strategic Plan 2008-2012.

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Health Financing:

In 2007, Kenyans spent US$72 per capita on health. Health accounted for 8% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
In 2007/08 the Government of Kenya spent around US$342.9m on health (US$10 per capita). In 2008/09, the government allocated about US$443.9m to the health sector. Of this, the MoPHS was to receive US$102.5m. This is expected to increase to US$345.5m in 2011/12. Cost-sharing (user fees at health facility level) annually contributes about US$21.7m to these figures. (Sources: MoPHS Strategic Plan 2008-2011, Annual Health Sector Statistics Report 2008.)
In 2008, Kenya received US$99.3m in Official Development Assistance for health, down from US$108.6m in 2007. (Source: OECD Creditor Reporting System)
Highly Indebted Poor Countries (HIPC) Debt Relief:
Kenya does not participate in the HIPC Initiative.
Expanded Programme of Immunization:
- According to the WHO/UNICEF JRF, government routine EPI expenditures were US$5.8m in 2006, $10.9m in 2007, $7.1m in 2008 and $6.3m in 2010. No expenditure data were reported for 2009. The 2010 government investment was about $4.55/infant.
- According to the 2005-2010 cMYP, $20.6m were spent in 2005 specifically on the routine KEPI program ($16 per infant born that year). Adding in shared health services expenditures to support KEPI increases this to $35.4m ($27 per infant). The government financed $5.8m of the specific routine KEPI expenditures (16.5 percent), about $4 per infant.
- In the 2011-2015 cMYP, the government proposed a national KEPI budget of $6.5m in 2011, increasing to $9.8m in 2015. Elsewhere the document states that $249m were spent on the routine immunization program in 2010. The Government of Kenya reportedly contributed 54% of this amount, which would be about $134.5m, while subnational governments contributed another 22 percent (about $54.8m).
- GAVI funds are being used to introduce newer vaccines. Kenya began making its GAVI co-payments (for pentavalent and yellow fever vaccines) in 2008. Pneumococcal vaccine was introduced with GAVI funding in 2011.
- Amount spent (USD) by the government of Kenya on routine immunization per infant Kenya (2000-2010)

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Budgeting:

In Kenya, the preparation of the budget is nested within five-year national and district development plans, which spell out broad government policy objectives.
The Budgetary Supply Department, MoF, produces the annual budget. A (three-year) medium-term expenditure framework is used. Each ministry is given a budget ceiling. The ceilings are reviewed and revised annually.

In a typical budget year, the MoF sends a budget circular to the line ministries in September (Budget Outlook Paper).

During September-November, line ministries review past expenditures and program performance. Districts contribute to these Ministerial Public Expenditure Reviews.

The ministries organize sector hearings and consult with donor partners. The Budget Outlook Paper is reviewed and a Budget Strategy Paper is begun. The MoF sets spending targets in the Budget Outlook Paper in December.

December-March: Line ministries prepare and submit proposed budgets (sector bids) to MoF. The Budget Outlook Paper and Draft Budget Strategy Paper are submitted to Cabinet for approval.

Once approved by Cabinet, the budget ceilings are communicated to line ministries in March.

During April-May, line ministries negotiate their final three-year, itemized budgets with Budget Supply Department (MoF). After review and approval, MoF submits the final budgets to Cabinet.

Cabinet approves the final budget in May. The budget contains sixty line items.

By law, the Minister of Finance delivers the Budget Speech no later than 20 June. The budget is then delivered to Parliament for debate.

The new fiscal year begins on 1 July. Ministries function on interim funding approved by Parliament.

Parliament approves the final budget in September.

According to a 2007 survey, the MoF and line ministries do not use (non-financial) performance against targets information to formulate budgets (Source: CABRI/OECD Africa Budget Survey).

An estimated 51-75% of external aid appears in proposed and approved budgets (Source: MoPHS Strategic Plan 2008-2012).

Sources: Nyaboke Oyugi, L. (2005) The Budget Process and Economic Governance in Kenya. Working Paper No. 98. Windhoek: Namibian Economic Policy Research Unit.

In 2010 the MoPHS updated its comprehensive multi-year plan (cMYP) for immunization. The plan provides annual budgetary projections for the period 2010-2015. In the baseline year (2010), $249m was spent on the routine immunization program. The Government of Kenya contributed 54% of this amount, about $134.5m.

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Budget Flows and Reporting:

The MoF publishes quarterly reports on budget execution. Routine reports do not include program (non-financial) performance information. The Government Integrated Financial Management Information System has not yet been implemented in the MoPHS (Source: MoPHS Strategic Plan 2008-2012).
Absorptive capacity is less than 100% in Kenya. In the 2010-2011 Budget Speech, the Prime Minister called on the government to absorb 90% of domestic and 80% of external funding available for development the coming year.
In 2010, the Government began direct transfers to health facilities through a new Health Sector Services Fund. The initial disbursement was Ksh 143 million to 590 health centers- about US$3000 per facility.

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Budget Performance:

In 2008, Kenya's routine EPI Program immunized 954,157 children with DTP3 and spent around US$7.5 per DTP3 immunized child (US$7,199,775 total), down from $19.5 per DTP3 immunized child in 2006. (Source: GAVI Annual Progress Report, 2008 and GAVI Annual Progress Report, 2006)
Country Policy and Institutional Assessment:
The World Bank 2007 CPIA gave Kenya's budget and financial management systems (Indicator #13) a score of 3.5, equal to its 2005 score. (mean 2007 score for all IDA countries: 3.2) Read more here.
Open Budget Index: Kenya scored 57% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides some, "albeit incomplete" budgetary information to the public. Read more here. Kenya's score has increased since the Open Budget Index 2006, when it scored a 48%. Read more about Kenya's performance in the 2006 Open Budget Index here.

Reforms, food shortages and displaced person resettlement costs caused the government to shift part of the 2008-09 health budget for these other needs.
According to the MoPHS Strategic Plan (2008-2012), public health expenditures increased from Ksh6.09 billion in 2005/06 to Ksh7.6 billion 2006/07, but declined to Ksh6.9 billion in 2007/08.
The 2009/10 Annual Operating Plan targets 1,188,698 of 1,402,820 eligible infants (85%) for full immunization before age 1 year.
Absorptive capacity is a problem in curative care. The percentage of budget spent by the MoMS decreased from 87% in 2004/05 to 69% in 2006/07 (Source: MoMS Strategic Plan 2008-2012).

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Parliamentary Notes:

Kenya has a unicameral parliament.
The President is elected separately from Parliament. The President names cabinet members without parliamentary approval. All government ministers must be Members of Parliament, however, the President can name ministers who then become ex officio MPs. President may dismiss Cabinet and may dissolve Parliament. Doing the latter, however, triggers a new presidential election, as happened in 2007.
The 10th Kenyan Parliament was seated in 2008. The National Assembly (Bunge) has 220 seats.
Kenya's Parliament follows the Westminster model wherein parliament cannot substantively alter the government's budget.
Particularly relevant to immunization are the standing Public Accounts Committee and the Committee on Health, Housing, Labour & Social Welfare.
Government does not routinely report information on performance against (development) targets to parliament.
Next parliamentary and presidential elections will be held in December 2012 (Source: ElectionGuide).
The Kenyan Public Health Act (Chapter 242) outlines smallpox vaccination requirements (Sec 104), identifies vaccination as a requirement for school entry (Sec112), gives the Minister of Health the power of regulating immunization (Sec 114) and empowers the government to assure vaccine quality (Sec 158). No other vaccination-related provisions exist, however, as of March 2011 parliament was circulating draft legislation on immunization financing.
In 2011 the Health Committee of the National Assembly drafted a bill covering vaccines and vaccination activities. In its 2012 session, parliament will consider five major health bills. Health Committee members are considering which bill should incorporate new vaccine-related provisions.
In January 2012, following the approval of the new constitution, the Ministry of Health began a review of all existing health legislation. The Parliamentary Health Committee and Ministry will coordinate their legislative work on vaccine-related provisions. The aim is to complete the legislative update before the session ends and national elections are held in late 2012.

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Immunization Performance Indicators:^*

Percent of districts reporting at least 80% coverage (DPT3), 2008^*: 44%

^*Source:
WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Kenya. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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Disease Burden:

Population (2008): 38,765,000
Births (2008): 1,506,000
U5 Deaths (2008):
- total 189,000
- preventable by routine EPI: 26,460¹
- preventable by routine EPI and new vaccines: 47,250²

(Source: UNICEF "State of the World's Children" 2009 )

¹ Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
² Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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Senior Program Officer:

Program Activities:

Health Sector Architecture:

Health Financing:

Budgeting:

Budget Flows and Reporting:

Budget Performance:

Parliamentary Notes:

Immunization Performance Indicators:^*

Disease Burden:

Useful Links:

Interactive map

Kenya

Senior Program Officer:

Program Activities:

Health Sector Architecture:

Health Financing:

Budgeting:

Budget Flows and Reporting:

Budget Performance:

Parliamentary Notes:

Immunization Performance Indicators:*

Disease Burden:

Useful Links:

Interactive map

Immunization Performance Indicators:^*