Kenya has yet to leverage the full potential of the private sector in the reproductive, maternal, newborn, child, and adolescent health space, said Dr. Bashir M. Issak, head of the department of family health at Kenya’s Ministry of Health. Further engagement, especially following COVID-19 is planned, he said.
According to research, the number of maternal deaths — which stood at 800 women a day in 2019 — have increased amid the pandemic.
While the specifics around the ministry of health's private sector strategy are not yet finalized, Dr. Isaak believes it is key to achieving universal health coverage across the country.
Private sector engagement
As defined by the Organisation for Economic Co-operation and Development, this is an activity that aims to engage the private sector for development results, which involve its active participation. The definition is deliberately broad in order to capture all modalities for engaging the private sector in development cooperation, from informal collaborations to more formalized partnerships. Read more about the definition and how Maternity Matters: Funding the Future is exploring the topic.
Kenya’s health care system is currently made up of a mix of different types of providers. Of the more than 12,000 health facilities in Kenya, approximately 48% of facilities are considered public, 41% are private sector owned, 8% are run by faith-based organizations, and 3% are NGO-managed.
Issak explained that the government has created a conducive policy environment for working with the private sector and that it wants to facilitate further partnerships that align.
Speaking to Devex, Issak explained how the Kenyan government aims to further optimize its engagement with the private sector and how public-private partnerships may help in achieving RMNCAH goals.
This conversation has been edited for length and clarity.
What is your take on the current RMNCAH landscape in Kenya?
In the past decade, we have made tremendous improvements in maternal and child health. The most recent demographic health survey we have is from 2009 to 2014. We are doing the next one within this year… but as far as the difference between 2009 and 2014 are concerned, there was a tremendous improvement. Our skilled birth attendance has risen 62% to 84%. Child mortality has equally reduced both for children under the age of 5 and children under 1.
“We have public and private but the systems, the data, the training are all standardized and therefore we expect the same or better.”
—Maternal mortality has not changed much, but our focus for the last three or four years and in the future, will be reduction of neonatal death so we’re investing heavily in that. But as far as newborn, maternal, and child health is concerned we have had directives where maternal health or delivery is free and child health or medical treatment for children are all free.
What are your targets for RMNCAH over the coming years?
Our target is to have [90% to 95%] skilled birth attendance. Our family planning [contraceptive prevalence] right now is at 61% and our target is 66% by 2030, but we believe we can reach it before that. Our child mortality is about 30 [deaths per 1,000 live births] now but our neonatal rate is about 21 per 1,000 live births. Our maternal mortality ratio is about 342 [per 100,000 live births], and our target is 111. We are not on track on maternal mortality, but we are on track for the rest.
What support from the global health community would help you achieve these targets?
To invest more in primary health care and community health services. To help us achieve universal health coverage [across] all the counties and all the health facilities based on the primary health care model. We are just starting; we have done a four-county pilot, which was successful and now we are rolling out in all 47 counties.
It started with insurance coverage of school-going individuals and the elderly where the government, through the National Hospital Insurance Fund, pays the premium on behalf of these vulnerable populations. We also have a free maternity program [called] Linda Mama which covers 1.2 million pregnant women annually to access free antenatal care, delivery, postnatal care, and neonatal care.
What is the private sector’s role within RMNCAH in Kenya?
We have public and private but the systems, the data, the training are all standardized and therefore we expect the same or better. There are different levels of private; there’s private for-profit, private for lower-income, there’s private for nonprofits and NGOs, and there’s private for faith-based. Generally, the standards are the same and we expect the skills and training of the people who are manning them to be the same.
Is there a role for the private sector to play in bridging the $33 billion annual financing gap for RMNCAH?
Opinion: Private sector, UHC, and maternal mortality amid COVID-19
MSD for Mothers' Temitayo Erogbogbo explains why now is the time to create deeper alliances across sectors at scale or risk losing the opportunity to make real, sustainable change.
There is definitely a big role and the government is trying its best, but [the number of] donor initiatives have gone down and with COVID-19, we expect a huge decline in donor funding. With COVID-19, we have tried to continue providing essential health services. We have separated COVID-19 care — which took [our] attention in the first six months of the pandemic in Kenya.
We almost lost the gains [made] in the last 10 years on essential health services but we have re-tracked and [made] strategies. COVID-19 care is now independent of essential maternal and child health care and we have strategies and guidelines on that. As far as financing is concerned and as far as filling in the gap on funding is concerned, of course, there is huge demand and requirement for the private sector to play. The government welcomes all initiatives to help.
How have you seen Kenya leverage the private sector so far and what plans do you have going forward?
Private health service providers are one layer, NGO [providers] are another layer, the faith-based [providers] are another layer. There is a lot of engagement. For the faith-based and NGO hospital facilities, the government provides commodities and health workers for free.
The Linda Mama, or the free maternity policy, is both for private, public, and faith-based [facilities]. They just take the Linda number of the client and the government reimburses that. There is the national health insurance fund, which actually works with more of the private sector than the public sector. Immunization services are happening for free, family planning commodities are provided for free, vaccines are provided for free by the private sector. They only require a service fee of a dollar or two so they’re also helping the government increase the coverage of service delivery. The service fees for immunization excludes COVID-19 vaccines, which are wholly free.
When we train for any activity, we train both the private and the public sectors. COVID-19 vaccines, training, the supplies, and the reporting of the data, all are open to the private and the government. The platform is controlled by the government, but the private sector has access to upload their data and provide services. The quality control and inspections of health facilities to keep standards is the duty of government regulatory authorities. The private sector is a member of all stakeholder forums in government-led structures and consultations are done even at policy formulation level.
The Funding the Future series is supported by funding from MSD, through its MSD for Mothers program and is the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.