Roadmap - DOC by wuyunyi



                     Republic of Kenya
                      Ministry of Health

                                           Reversing the Trends
         The Second National Health Sector Strategic Plan


                                                     Ministry of Health
                                           Afya House, Nairobi, Kenya
                                    P.O. Box 30016-General Post Office
                                                 Nairobi 00100, Kenya
                                                        February 2008

Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part,
provided the source is acknowledged. It may not be sold or used in conjunction with commercial
purposes or for profit.

Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – ROADMAP

Published by:   Ministry of Health
                Sector Planning and Monitoring Department
                Afya House
                PO Box 3469 - City Square
                Nairobi 00200, Kenya

                                                 Table of Contents

Acronyms ....................................................................................................................... 4
Chapter 1: Introduction and Background................................................................. 6
Chapter 2: Synopsis of Key Documents ..................................................................... 7
Chapter 3: Achievements and Challenges at Mid Term ........................................ 10
   NHSSP II Objectve 1: Increase equitable access to health services .................. 10
   NHSSP II Objective 2: Improve the quality and responsiveness of services.... 11
   NHSSP II Objective 3: Foster partnerships in improving health and delivering
   services .................................................................................................................... 12
   NHSSP II Objective 4: Improve the efficiency and effectiveness of service
   delivery .................................................................................................................... 12
   NHSSP II Objective 5: Improve financing of the health sector......................... 13
   Management and Leadership ............................................................................... 14
Chapter 4: Priority Recommendations .................................................................... 15
   Implementation Mechanisms ................................................................................ 15
   NHSSP II Objective 1: Increase equitable access to health services ................. 15
   NHSSP II Objective 2: Improve the quality and responsiveness of services.... 16
   NHSSP II Objective 3: Foster partnerships in improving health and delivery
   services .................................................................................................................... 16
   NHSSP II Objective 4: Improve efficiency and effectiveness ............................ 17
   NHSSP II Objective 5: Improve financing of the health sector......................... 19
Chapter 5: Monitoring and Evaluation ................................................................... 21
Chapter 6: Implementation Matrix .......................................................................... 22


AIDS       Acquired Immunodeficiency Syndrome
AOPs       Annual Operational Plan (s)
BEOC       Basic Essential Obstetric Care
CDF        Community Development Fund
CEOC       Comprehensive Essential Obstetric Care
CE         Chief Economist
CFO        Chief Finance Officer
CHEW       Community Health Extension Worker
CHW        Community Health Worker
CoC        Code of Conduct
CU         Community Unit
DANIDA     Danish Development Agency
DHMT       District Health management Team
DHRM       Department of Human Resource Management
DHS        Demographic Health Survey
DMS        Director of Medical Services
DfID       Department for International Development
DP         Development Partners
DRH        Division of Reproductive Health
EMS        Essential Medical Supplies
EDL        Essential Drug list
GDC        German Development Cooperation
GDP        Gross Domestic Product
GoK        Government of Kenya
H/C&RS     Head, Curative and Rehabilitative Services
HENNET     Health Non-governmental organisation Network
HIV        Human Immunodeficiency Virus
HMIS       Health Management Information System
H/PPHS     Head, Preventive and Promotive Health Services
HR         Human Resource
HRH        Human Resource for Health
HRM        Human Resource Management
H/SPMD     Head, Sector Planning and Monitoring Department
HSSF       Health Sector Services Fund
ICC        Inter-agency Coordinating Committee
ICT        Information Communication Technology
IDSR       Integrated Disease Surveillance and Response
IFMIS      Integrated financial Management Information System
IP         Implementing Partner
ISO        International Standard Organisation
IMR        Infant Mortality Rate
IPT        Intermittent Presumptive Treatment
ITN        Insecticide Treated Net
JFA        Joint Financing Agreement
JICA       Japanese International Cooperation Agency
JPWF       Joint Programme of Work and Funding
KSh        Kenya Shilling
KDHS       Kenya Demographic and Health Survey
KEMSA      Kenya Medical Supplies Agency
KEPH       Kenya Essential Package for Health
KHPF       Kenya Health Policy Framework
KHSWAp     Kenya Health Sector Wide Approach
KNBS       Kenya National Bureau of Statistics
KSPA       Kenya Service Provision Assessment
MDGs       Millennium Development Goals
MEDS       Mission Essential Drugs and Supplies
MMU        Ministerial Management Unit
MoH        Ministry of Health
M&E        Monitoring and Evaluation
MTEF       Mid Term Expenditure Framework

MTR      Mid term Review
NCDs     Non Communicable Diseases
NGO      Non Governmental Organisation
NHA      National Health Accounts
NHISF    National Health Insurance Fund
NHSSP    National Health Sector Strategic Plan
NSHIF    National Social Health Insurance Fund
PAC      Principal Accounting Controller
PERs     Public Expenditure Reviews
PETS     Public Expenditure Tracking Survey
PHMT     Provincial Health Management Team
PFM      Public Financial management
PME      Performance-based Monitoring and Evaluation
PMIS     Procurement Management Information system
RBM      Results Based Management
RH       Reproductive Health
SWAp     Sector Wide Approach
SC       Service Charter
SOP      Standard Operation Procedure
TB       Tuberculosis
TCR      Treatment Completion Rate
TWG      Technical Working Group
UNFPA    United Nations Population Fund
USD      United States Dollar
USG      United States Government
WHO      World Health Organization
WB       World Bank

Chapter 1: Introduction and Background

Recently the Government of Kenya initiated a mid-term review (MTR) of the
implementation of the second National Health Sector Strategic Plan (NHSSP II).
MTR report documents progress made in the implementation of NHSSP II, the
outstanding challenges, constraints and recommendations for action.         An
independent external review team validated the MTR findings and provided a
succinct set of recommendations on what needs to be done to address the current
challenges in the health sector.

To take forward the MTR recommendations, the Ministry of Health and its
stakeholders undertook a policy dialogue retreat in Mombasa in November 2007.
The aim of the retreat was to identify and elaborate actions to accelerate the
implementation of the NHSSP II strategies based on the MTR recommendations.
The Roadmap for Acceleration of implementation of interventions to achieve the
Objectives of the NHSSP II summarises the MTR report and outlines the decisions
agreed at the health sector policy dialogue. In addition it outlines the implementation
matrix and the framework for monitoring the implementation of the recommended

The purpose of this document is to:
   - provide an overview of the health sector performance and priority actions to
      be undertaken to remove the bottlenecks for attaining the NHSSP II
      objectives and the Millenium Development Goals related to health.
   - serve as the basis for allocation of resources in the second half of the NHSSP
      II implementation period
   - provide a monitoring framework for          the implementation of the MTR

It should be emphasised that this document does not define the entire package of all
interventions that the health sector will be implementing and as such does not define
the full investment for the health sector. The overall investment in the health sector
will still be guided by existing sector plans (see Chapter 2 below).

It is also important to note that the MTR recommendations stress on processes as
well as actions for accelerating implementation. The agreed implementation
mechanisms focus on inclusiveness, coordination and accountability to address the
challenges identified. This comes at a time of renewed international interest and
commitment for better coordination, harmonisation and alignment of inputs into the
health sector to accelerate achievement of outcomes. Together with the Code of
Conduct, this document also serves as Kenya‟s plan for the International Health

       Chapter 2: Synopsis of Key Documents

       The KHPF1 provides the overarching Health Policy imperatives for the country
       covering the period 1994-2010. These are:

       1      Ensure equitable allocation of Government of Kenya resources to reduce
              disparities in health status;
  i.          Increase cost-effectiveness and efficiency of resource allocation and use;
 ii.          Manage population growth;
iii.          Enhance the regulatory role of the government in health care provision;
iv.           Create an enabling environment for increased private sector and community
              involvement in service provision and financing; and
v.            Increase and diversify per capita financial flows to the health sector.

       To date two NHSSPs, which outline the medium term strategic objectives of the
       sector, have been developed to support the implementation of the KHPF. By the
       end of 2004 it became clear that the implementation of NHSSP had not led to
       improvements in most targets and indicators of health and socioeconomic
       development as expected. Health outcomes stagnated or worsened and utilization
       declined in an environment of decreasing per capita GOK allocation (from USD 12/pp
       in 1990 to USD 6/pp in 2002). Poverty levels went up from 47% in 1999 to 56% in

                                                                          Box 1: The Community Strategy
       The National health Sector Strategic Plan II              Objective: The community strategy intends to improve the
       (NHSSP II) covering the period 2005 - 2010                health status of Kenyan communities through the initiation and
       aimed to reverse the downward trend in                    implementation of life-cycle focused health actions at level 1 by:
       health indicators by applying lessons learned              Providing level 1 services for all cohorts and
                                                                     socioeconomic groups, including the “differently-abled”
       and searching for innovative solutions. It is
                                                                     taking into account their needs and priorities
       designed to re-invigorate the implementation               Building the capacity of the community health extension
       of the Kenyan Health Policy Framework                         workers (CHWs) and community-based resource persons
       (KHPF) through:                                               to provide care at level 1.
                                                                  Strengthening health facility–community linkages through
          (i)      increasing equitable access to                    effective decentralization and partnership for the
                   health services;                                  implementation of LEVEL ONE SERVICES.
          (ii)     improving service quality and                  Strengthening the community to progressively realize their
                                                                     rights for accessible and quality care and to seek
                   responsiveness;                                   accountability from facility based health services.
          (iii)    improving        efficiency   and             Main innovations:
                   effectiveness;                                 Established norms for level one services : One level one
                                                                     unit will serve 5000 Kenyans and be manned by 50 CHWs
          (iv)     fostering partnership; and                        and 2 Health extension workers: 1 CHW for 20-50
          (v)      improving financing of the health                 Households
                                                                  CHWs will work on voluntary basis with stipends paid to
                   sector                                            them
                                                                  CHEWs will be on government pay roll
                                                                  Payment and control for both cadres will be through the
       Implementation of the NHSSP II has involved                   health facility and village committees
       the introduction of following three key                    a comprehensive message and commodity kits will be
       strategies:                                                   developed and used by CHWs
                                                                  Provision of the commodity kit to manage minor illnesses.
       1. Kenya Essential Package of Health
       (KEPH), with a human capital based definition
       of essential packages. The KEPH constitutes a paradigm shift from the conventional
       „managing illness‟ approach to promoting healthy life styles. It defines the various
       services that need to be delivered for six different age cohorts2 (from birth to old age)

         GOK, MOH, 1994, Kenya Policy Framework Paper, 1994-2010. The policy framework paper is still
       valid and functional, but a new policy paper will be in pace in 2010 together with NHSSP III.
         The six cohorts that are defined in KEPH has been pregnancy and new born, early childhood (below
       five years), late child hood (7-12 years), adolescent health (13-24 years); adults (25-69 years) and
       elderly (60+). The six levels of health service delivery are defined to include community,

and at each of the six levels of service delivery (Level 1: community, up to Level 6:
Tertiary hospital). It brought together the two apparently conflicting concepts of
continuum of care together – life cycles and levels.
2. Community Health Strategy recognising the community level as part of the formal
health service delivery system. The MOH has developed a Community Strategy3 to
strengthen the interface between facility and community based health services and
offer services at the community level (see box 1).

3. Kenya Health Sector Wide Approach (KHSWAp), defined as „a sustained
partnership with the goal of achieving improvements in peoples’ health’. The
emphasis in the KHSWAp is less about funding modalities and more about joint
planning, monitoring and reporting. It places emphasis on joint regular review of
performance against jointly defined milestones and targets as defined in the Joint
Programme on Work and Funding (JPWF) and operationalised in Annual Operational
Plans (AOPs).

The JPWF outlines the joint priority health interventions to be implemented over the
period 2006-2010, their resource implications and financing situation and therefore
drives the partnership of all actors in the health sector. In order to reduce transaction
costs and improve effectiveness of external support, the Government and its partners
designed a framework agreement for coordination, harmonisation and alignments of
activities in the health sector, which is also used to track the Paris Declaration on Aid
Effectiveness in Kenya. This partnership framework, known as the Code of Conduct
(COC), has now been signed by all the key partners in the sector.

Figure 2.1 below outlines the linkages between the programme areas of the Joint
Programme of Work and Funding for the Kenya Health Sector to the development
goals and objectives of the NHSSP II

dispensary/clinic, health centre/maternity /nursing homes, primary hospitals, secondary hospitals and
finally tertiary hospitals
  MOH, 2006, Taking the Kenya Essential package for health to the community, strategy for the
delivery of Level One Service. Four implementation tools have been developed and are in use since

      Fig. 2.1 Linkage between JPWF and development objectives and goals

                               Kenya Health Policy Framework strategic theme: Investing in health

        NHSSP II goal: Reduce health inequalities and reverse the downward trend in health-related outcome and impact

                                                           Policy Objectives

      Increase          Improve the quality and         Foster partnerships in     Improve the efficiency        Improve
      equitable         responsiveness of               improving health and       and effectiveness of          financing of the
      access to         services in the sector          delivering services        service delivery              health sector
      health services

                                      Joint Program of Work and Funding Sector priorities

      1. Address equity, and    2. Enhance health gains           3. Enhance efficiency and         4. Strengthen sector
      expand access to                                            budget effectiveness              stewardship and partnership
      basic services                                                                                with all stakeholders

vi.      Scale up of a          1. Strengthen and scale up        1.   Operational and              1.   Joint planning,
         comprehensive             the delivery of cost-               effective procurement             implementation and
         community                 effective interventions             system                            monitoring mechanisms
         approach to               (especially at levels 2-4),                                           in line with a Sector Wide
         delivery of the                                          2.   Operational and                   Approach
         Kenya Essential        2. Strengthen availability and         effective public financial
         Package for Health        management of human                 management (PFM)             2.   Coordinated financing
                                   resources for health (HRH)          system                            modalities for defined
                                                                                                         priorities in line with the
                                3. Strengthen availability and    3.   Operational                       need for harmonization of
                                   management of                       performance-based                 support
                                   infrastructure, equipment,          monitoring and
                                   communication and ICT               evaluation system
                                                                       (PME) and results
                                4. Strengthen availability and         based management
                                   management of                       (RBM) procedures.
                                   commodities and supplies
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                  Chapter 3: Achievements and Challenges at Mid Term

                  As shown in Table 1 below, overall progress towards achievement of key health
                  outcomes appears to be improving. The first half of the implementation of the NHSSP
                  II saw key improvements, particularly in child health, and disease control. Some
                  weaknesses are still evident, particularly in relation to maternal health.

                      Table 1: Kenya’s status with respect to the Millennium Development Goals (selected
MDG                           Target                                                         Baseline            Baseline          Output          Current        Target
Goal                                                                                           MDG               NHSSP I          NHSSP I          estimate        MDG
 No                                                                                            1990             1999/2000           2003            s 2007         2015
Kenyan Population                                                                           21.4                                  28.7                           NS
MDG Development Outcomes / Outputs
       Prevalence underweight children < 5 yrs                                              32.5               33.1               28                  11         16.2
4. Child Health

       Reduce IMR/1000 by 2/3 between 1990 and 2015                                         67.7               73.7               78                  79         25
       Reduce UFMR /1000 by 2/3 between 1990 and                                            98.9               111.5              114                120         33
       Proportion 1 year old immunised against Measles                                      48                 76                 74                  80         90
       Proportion of Orphans due to AIDS                                                    27.000             890.000            1.2 M              1.2M

                       Reduce MMR /100.000 by ¾ between 1990 and                            590                590                414                            147
                       Proportion births attended by skilled health staff %                 51                 NA                 42                  37         90
5. Maternal,

                       Coverage of Basic Emergency Obstetric Care                                              24                                                100
Sexual –


                       % WRA receiving FP commodities                                       --                 --                 10                  43         70
                       HIV prevalence among 15-24 yr old pregnant                           5.1                13.4               10.6               6.1         NS

                       Malaria Prevalence of persons five yrs and above                     NA                                    30%                            NA
                       Malaria In-patient Case Fatality Rate                                NA                                    26%                            NA
                       Pregnant women / children <5 sleeping under ITN                      NA                                    4/5              36.5 / 69     65 / 65
6 Disease


                       TB Case Detection Rate                                               NA                                    47%                 50         60
                       Treatment Completion Rate (TCR, Smear +ve                            75%                                   80%                            90%
7                      Access to safe water (National) (%)                                  48                 55                 48                 62          74
7                      Access to good sanitation (%)                                        84                 81                 50                 42          NS
8                      % Population with access to essential drugs                          NA                                    35%                            NA
                  Adapted from the National health Sector Strategic Plan II (NHSSP II), 2005 – 2010, and mid term Review of the
                  NHSSP II, 2007.

                  Achievements and Challenges for each NHSSP II objectives are summarised
                  below. For more detail, please refer to the NHSSP II Mid Term Review Report.

                  NHSSP II Objectve 1: Increase equitable access to health services
                  A three-pronged strategy to a) improve geographical access; b) improve financial
                  access; and c) address social and cultural barriers to services.


                    UNICEF: State of the World’s children report, 2008
                    UNICEF: State of the World’s children report, 2008
                    Figure for ALL pregnant women
                    This includes all fever cases treated as malaria. Malaria sentinel surveillance report of 2002 estimated it at less than 5%.
                    Malaria indicator survey, 2007
                    WHO/UNICEF joint monitoring report, 2007
                     WHO/UNICEF joint monitoring report, 2007
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Many achievements have been made in expanding the coverage of facilities,
institutionalising the needs of clients, and improving pro-poor financing. Challenges
remain in relation to following through on policy implementation, and scaling up

Achievements                                       Challenges/Constraints
1,600 health facilities built using Constituency   Coordinating the investment to ensure
Development Funds (CDF). CDF-MOH                   facilities are built according to priorities and
planning mechanism now established.                commensurate with available operational
Inputs to strengthen referral such as mobile       Accelerating the drafting process to guide
phones, equipment, ambulances provided.            investments in other health systems.
Drafting of referral strategy has begun.
3,649 health workers recruited and working in      Inequitable distribution of health workers
under served areas                                 remains significant.
National Social Insurance Scheme designed          Insufficient consultations during development
and debated.                                       of the NSHIF resulted in legislation not being
Reduction in user fees (20/10 policy)              Dissemination of KEPH incomplete and
consolidated. Free deliveries at levels 2 and      implications not fully institutionalised (DP
3.                                                 support not fully aligned; implementation
                                                   guides not completed; staff not
                                                   oriented/trained; some services not yet
                                                   scaled up)
Pro-poor resource allocation defined and in        Geographical dimension of poverty not
use                                                sufficiently incorporated into allocation
Surveys suggest client satisfaction is rising.
Waiting times reduced. Annual client
satisfaction review findings have informed
Service Charter developed, which defines
rights and obligations.

Even though there have been noticeable achievements in improving equitable
access to health services, the current political crisis has provided extra challenges to
the sector. There has been challenges to ensure that the health sector provide
emergency health sector response to the affected communities and to ensure that
that there is short and long term plans for the health sector response to the crisis and
any other emergencies.

NHSSP II Objective 2: Improve the quality and responsiveness of services
Comprises a) improving health worker performance; and b) improving
responsiveness to client needs.


Government-wide roll-out of results based management has underpinned the
performance appraisal. A recent pay rise for health workers has also provided a
conducive environment for reform. However, key systems and inputs such as supply
chain management and transportation remain key challenges. A number of activities
in Strategy 1 contribute to Strategy 2.

Achievements                                       Challenges/Constraints
Introduction of target based performance           Reaching targets through efficiency gains
appraisal system.                                  without increased resources is proving a
Supervisory checklists developed and used.         Transport is constraining regular supervision.
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Achievements                                    Challenges/Constraints
Growing use of clinical audits, including for
maternal mortality (no. of MM audits year on
Availability of drugs substantially improved    Supply chain management has improved, but
(extent of improvement?                         periodic stock outs continue.

NHSSP II Objective 3: Foster partnerships in improving health and delivering
This involves parternships with civil society, not for profit organisations, and
development partners, and improving inter sectoral collaboration. GOK recognises
effective partnership requires a results orientation, accountability, participation and

Commendable planning frameworks have been developed, and the health sector is
rapidly decentralising its planning process. Commitment has been shown on all
sides to substantially strengthen partnership arrangements, but full and timely
discussion and disclosure of financial decisions are yet to be realised.

Achievements                                    Challenges/Constraints
JPWF, MTEF and AOPs are established             Planning and budgeting processes at
framework documents and processes.              national level are disjointed. Significant
Decentralised planning implemented;             activity not aligned to existing plans.
participation steadily improved.
Code of Conduct signed and inclusive of         Capacity of IPs to fully engage in sector is
implementing partners (NGOs).                   limited.
Joint Financing Arrangement being               Significant external funding still not captured
developed.                                      in government budget. Transparency of
                                                resource allocation decisions and
                                                predictability of funding remain a challenge.
Quarterly reviews of progress initiated         Quarterly reviews not yet instituitonalised at
                                                every level.
                                                MOH still not fully adapted to carry out SWAp
                                                stewardship, with structure and functions
                                                based on vertical programme approach.
                                                Mechanisms for IP and DP accountability not
                                                yet in place.

NHSSP II Objective 4: Improve the efficiency and effectiveness of service
Strategy focused on cost efficiency and cost effectiveness, planning, management
and administration.

Progress is being made to enable funds to flow directly to lower level service
delivery. The Health Sector Services Funds (HSSF) pilot shows that this is likely to
accelerate service delivery outputs. Plans have been developed to strengthen
certain health systems. However, implementation has been lacking, and plans are
needed where they have not yet been developed.

Achievements                                    Challenges/Constraints
A mechanism to direct funds to health           Finalisation of the JFA is experiencing delays
facilities (HSSF) was successfully piloted;     due to GOK capacity constraints and DP
national arrangements are being Gazetted;       harmonisation challenges.
roll-out is being planned.
A shadow/functional budget exercise has         Capacity at implementation level for planning
been initiated to establish operational         and monitoring remains weak. Not all DPs
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Achievements                                        Challenges/Constraints
linkages between the government budget              follow the planning calendar.
format and sector planning format.
Harmonisation of HMIS indicators was                Data collection and use remains inefficient
initiated.                                          and sporadic. Findings from operational
                                                    research not fully incorporated into decision
Plans to strengthen financial management,           Internal controls remain weak, and fiduciary
human resources and supply chain                    risk is perceived to be high.
management (including procurement) have
been developed. Annual procurement
planning process has been introduced.
Transport assessments were conducted in             A strategic approach to the management of
two provinces.                                      infrastructure, communication and ICT is
A national communication strategy has been
Government-wide ICT policy is being
implemented by the MOH.

NHSSP II Objective 5: Improve financing of the health sector
Focus on increased funding, improving pro-poor resource allocation, achieving an
appropriate balance between access and quality.

Resources have increased, and allocative efficiency has improved with more funds
channelled to cost effective basic health services. Resolving bottlenecks in spending
GOK funds remains a priority.

Achievements                                        Challenges/Constraints
Increase in allocation and per capita spend         Percentage of budget spent has decreased
on health (see Table 2 below)                       from 87% to 69% 2004/05-2006/07.
Increased DP funding, especially for scale up       Difficult to make strategic resource allocation
of priority public health interventions such as     decisions with only partial knowledge of
for malaria and HIV.                                resource flows to the sector. Donor
                                                    conditionality further fragments information
National Hospital Insurance Fund increased
benefits package to include vulnerable
Resource allocation has been reduced at
higher levels and increased at lower levels of
the system (15.6% 0f the MOH budget
allocated to tertiary level)
Expenditure reviews and expenditure
tracking surveys conducted to rectify
expenditure bottlenecks.

                       Table 2: Trend in public expenditures on health
                                              2004/05             2005/06              2006/07
Approved budget (KShs million)                21,977              27,832                33,526
US$ per capita                                  8.7                10.8                  14.5
Share of total government expenditure (% )     7.24                7.27                  7.27
Share of GDP (%)                               1.71                1.78                  1.91
Actual expenditure (KSh million)             19,158.40           20,636.00            23,178.00
US $ per capita                                 7.6                 8.0                  10.0
Share of total government expenditure (%)      6.31                5.39                  5.02
Share of GDP (%)                               1.49                1.32                  1.32
$/KSh exchange rate                            77.3                77.3                   68
Population projections (in millions)           32.8                33.4                   34
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Management and Leadership

Whilst management and leadership are subsumed within the strategies above, it is
important to identify shortcomings in this area to avoid business as usual and ensure
that bottlenecks really are addressed. The MTR has shown that some of the
improvement plans in JPWF have not been implemented as planned. Key
managerial bottlenecks around the implementation of the sector strategic approaches
     Lack of willing and committed champions to lead and inspire the
       implementation of the reform program; whenever there is willingness, the
       capacity for managing and leading the reform process is found quite weak.
     When such champions exist in some of areas, there is lack of adequate
       support in terms of resources to implement the reforms agendas;
     Some of the reforms agendas are core functions of other Ministries, where
       Ministry of Health cannot implement reform programs on its own. These
       include financial management, procurement, and human resources. Some of
       the actions therefore require sanction and agreement from these Ministries.
     Adequate effort was not made to make the various heads accountable for
       results. Though monitoring reports were produced and review meetings were
       held, these have not improved performance where it is needed most.
     Adequate partnership to support follow up of implementation was not fully
       achieved. A Health Sector Coordinating Committee was set up as part of the
       process of operationalising the sector‟s governance structure. However,
       Technical Committee‟s to coordinate partnership in specified areas of focus
       were not yet functional. Linkages to existing technical partnership structures
       such as the ICC‟s that were set up for Global Fund, and other specific
       programmes were not created.
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Chapter 4: Priority Recommendations

For a full list of MTR recommendations, please refer to Annex 1. Here we focus on
the recommendations related to:
     Priority actions to remove bottlenecks;
     Priority strategies that have experienced no/slow implementation (primarily
         health system strengthening); and
     Priority public health interventions that have received less support to date, but
         are critical to achieving NHSSP II targets (and MDGs).
Most of the recommendations are concerned with reforming the health sector,
strengthening health systems, and facilitating alignment and harmonisation. The
priority recommendations are summarised below. For a full description, please refer
to Annex 2. Implementation mechanisms are described, to address management
and accountability issues, followed by categorisation by NHSSP II objectives.

Implementation Mechanisms

In order to address the bottlenecks identified at the end of the last chapter, the
following arrangements will be initiated:
 A Team Leader for each core area of activity will be assigned from the MOH as a
     champion. This Team Leader is responsible and accountable for delivering the
     results that are outlined in this plan. S/he will form a team comprising key
     stakeholders to fast track the implementation process. A mechanism for
     rewarding and sanctioning Team Leaders based on their performance of the plan
     will be designed and implemented.           Linkages will be made to existing
     performance contracts and the performance appraisal system.
 The improvement plans are funded from development partners and government
     to ensure that appropriate technical and financial support is provided.
     Development and implementing partners have also nominated respective leads
     on each area to support the Team Leader. The financial and technical support
     needs have been identified so that the financier is accountable to all stakeholders
     alongside the Team Leader.
To complete the SWAp governance structure, Technical Working Groups will be
established for core areas to facilitate consultation, problem solving and coordination.

NHSSP II Objective 1: Increase equitable access to health services

Ten actions are identified as necessary to enable achievement of this objective..
They relate to ensuring comprehensive implementation of the KEPH by level and
cohort in an equitable manner.

Actions to strengthen implementation of KEPH across all cohorts
 (i)   Support to ensure universal access to Maternal and neonatal health services
       for cohort 1, involving demand creation and supply side interventions such as
       free delivery, skilled attendants, effect referral and other emergency obstetric
       care components;
 (ii) Comprehensive implementation of guides and frameworks for cohorts 4 and
 (iii) Development of a policy, strategic approach and an implementation
       framework for NCDs to address healthy lifestyles and provision of direct
       medical care for individuals in a clinical setting (all cohorts)
 (iv) Reduce morbidity and mortality from malaria by accelerating implementation
       the National Malaria Strategy that has been revised in line with NHSSP II,
       particularly targeting cohorts 2, 3 and 5
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  (v)    Strengthen implementation of existing service delivery efforts for Child health
         for cohorts 2 and 3, with a particular focus on coordination
  (vi) Accelerate implementation of TB control initiatives (cohort 5)
  (vii) Accelerate Community Strategy implementation (level 1), through
         operationalising community health worker structure, providing behaviour
         change communication, scaling up outreach services, etc.
  (viii) Accelerate Kenya Essential Package for Health (KEPH) dissemination
         throughout the sector
  (ix) Develop a strategy to influence the implementation of KEPH outside the
         health sector
  (x) Strengthen public-private partnerships in delivery of services, particularly in
         underserved areas, through improving formal frameworks and facilitating
         access to the HSSF

  The sector needs to develop immediate, short and long term health sector
  response to the post-election events. These plans should include strategies for
  ensuring that systems as well as services return back to normalcy without reversing
  the gains that have been achieved in the first half of the implementation of the

NHSSP II Objective 2: Improve the quality and responsiveness of services

The actions for acceleration of implementation for this objective are:
 (i)   Roll out of service charter, to be displayed publicly containing information on
       services, standards, complaints, and the mechanisms to redress
 (ii) Development and implementation of country specific hospital reforms to
       support and complement services at the primary care level
 (iii) Re-categorisation and accreditation of health facilities in line with KEPH to
       guide the identification of inputs required within the context of existing KEPH
       Norms and Standards.
 (iv) Update and implementation service delivery clinical & management
 (v) Creating facility based incentives to improve quality of services such as
       institutionalising processes for recognition and reward
 (vi) Put in place national strategy for Integrated Supportive Supervision, involving
       clear definitions and implementation arrangements, and linkages to annual
       plans and performance appraisal, and incorporating new service delivery
 (vii) Fast track Leadership and management capacity strengthening initiatives in
       accordance with the decentralisation of management in the sector, including
       in-service training and patient centred accountability.

NHSSP II Objective 3: Foster partnerships in improving health and delivery

The formation of Technical Working Groups, Team Leaders and DP and IP leads is
described above. Other actions to strengthen partnerships include:

  i.    Strengthen sector coordination and participation structures at all levels
            a. Implement sector Governance structures at all levels
            b. Link Governance structures to vision 2030 strategies
17 | P a g e

             c. Establish governance TWG
             d. Develop and implement Public Private Partnership policy
  ii.   Monitor adherence to COC principles and obligations, including the
        development of aid effectiveness indicators and targets and integrate their
        measurement in sector annual reviews
 iii.   Joint support and responsibility to strengthen common management
        arrangements, to ensure use of country systems for support
 iv.    Ensure partners are providing coordinated and demand driven technical
        assistance and cooperation
  v.    Support implementation of common monitoring tools and systems including
        utilization of the Joint Review Missions for review and planning of sector
 vi.    Develop mechanisms for generation, sharing, and use of information with
        implementing partners
 vii.   Build the capacity of coordinating secretariats for partnership (HENNET and
        Private sector)
viii.   DPs increasingly channelling funds through Joint financing arrangements and
        using in-country systems
 ix.    Establish and implement coordination mechanism for partner missions to the
  x.    Coordination and pooling of capacity development support particularly for
        systems strengthening

NHSSP II Objective 4: Improve efficiency and effectiveness

Key actions for acceleration to improve efficiency and effectiveness are:
 (i)   Fast tracking implementation of HRH initiatives
     Develop recruitment and deployment policy
          o Filling 601 existing established posts
          o Mapping of HR to guide where staff will be posted
          o Revision of staff establishment for new posts
     Finalisation and implementation of HRH strategic plan, with a focus on new
       employment on underserved areas.
     Strengthen workforce planning and information management
     Consolidate HRH management and development functions at national level
     Ensure coordinated management of functions of development, determining of
          o Employ sms technology to speed up resolution of staff problems
          o Design of appropriate incentive mechanisms for sustaining equity in
               distribution of HR
          o Develop policies on retention of staff in hard to reach areas
          o Design mechanisms for HRH support and management for non public
     Decentralise HR function
 (ii) Strengthening the management and availability of commodities and supplies
     Delineate clearly roles and responsibilities for procurement in Health Sector
          o Roles and responsibilities of MOH & KEMSA
          o Clarification of roles and responsibilities of KEMSA for non public
18 | P a g e

              o Transfer of all health commodity procurement to KEMSA
              o Role of MEDS, and other private procurement entities
         Review       health commodity procurement SOPs and align with new
          procurement regulations
         Ensure KEMSA has sufficient funding to support the supply chain
         Accelerated implementation of procurement improvement plan
         Implement the agreed 5% distribution cost of 5% of all commodities
          distributed through KEMSA
         Review health commodity procurement SOPs and
         Build capacity at all levels
         Finalize revision of National Drug Policy
         Develop, implement Pharmaceutical Sector Strategic Plan
         Revision of EDL
         Develop & implement EMS
         Scale up of demand driven supply system/pull system
         Decentralize KEMSA distribution system
         Operationalisation of MTC at National level and 50% of all hospitals
         Integration of Parallel commodities into the essential commodity system
         Strengthening of Pharmacovigilance function activities
         Introduction of quality assurance (including regular audit) for commodities and
         Tracking Commodity Supply Chain

  (iii)   Alignment of infrastructure, communication & ICT strategies to ensure they
          effectively support service delivery
         Strengthen strategic framework to guide investment in infrastructure,
          communication, transport and ICT
              o Development of policies and strategic guidelines (including financing)
                  in above areas
              o Annual maintenance as part of procurement plan for sector
              o Carry out a review/assessment of transport management in the health
                  sector      MOH, KEMSA, Provinces Districts) ( procurement,
                  maintenance, HR etc)
              o Develop transport guidelines
              o ICT implementation plan to guide investment in ICT in line with overall
                  Government Policy
              o Develop guidelines for donation of medical equipment
              o Definition of minimum specs for equipment to guide prioritization of
              o Guidelines on investment at facilities
              o Capacity building of managing resources at provincial and district
         Strengthened information management for infrastructure, communication,
          transport and ICT
              o Guideline and manual for collating information from all stakeholders
                  (especially from private sector)
              o Digitalization of information management
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               o Manuals for planning, management and maintenance in facilities and
             o Train staff in the use of IT equipment and software
        Development and implementation of approaches for quality assurance and
         audit for infrastructure, equipment maintenance and use
        Development and implementation of approaches for quality assurance in
         transport maintenance and use

  (iv)   Strengthening of the Public Financial Management systems
        Accelerated implementation of PFM improvement plan ( Some parts require
             o Fast track capacity strengthening in FM at all levels
             o Improve data capture on PFM
             o Introduction of IFMIS at all levels
             o Annual PETS
        Operationalisation of HSSF
        Review of the public health act to take care of financial issues
        Establishment of a Joint Funding Mechanism pooled funding

  (v)    Strengthen use of Strategies for Bottom up planning and Budgeting
        Build capacity of planning units at all units at all levels in planning, costing
         and budgeting
        Strengthen linkages between sector planning and budgeting
        Operationalise the strategy to integrate gender and human rights issues in
         planning in collaboration with other government departments
        Explore the role and use of medium and longer term planning mechanisms at
         Sub national levels

  (vi)   Scale up use of Performance Monitoring Mechanism (including HMIS)
        Acceleration of implementation of Monitoring improvement framework
             o Coordination of PM&E, HMIS and IDSR information sources
             o Incorporating information from systems, and other sources of
                  information like KNBS, DHS, KAIS etc
             o Participation of all stakeholders at different levels
        Strengthen data management capacity (collection, analysis, computerization
         and use) at all levels
        Dissemination of ME findings
        Follow up implementation of MTR recommendations
        Link IFMIS to HMIS
        Institute mechanism for ensuring allocation for M&E of 5% of recurrent
         budgets for GoK and partner programmes

NHSSP II Objective 5: Improve financing of the health sector
Key actions for acceleration of implementation are:
 (i)   Establish mechanisms to increase availability of resources
 (ii) Improve budget management and efficient and equitable resource allocation
       and utilization, particularly developing costing frameworks, improving pro-poor
       resource allocation formulae, instituting cost effectiveness analysis to aid
20 | P a g e

          prioritisation, availing finance/cost information to the public, and incorporating
          all sources for expenditure tracking
  (iii)   Complete and implement Health Care financing strategy
  (iv)    Implement HSSF, through more comprehensive district budgeting, finalisation
          of guidelines, training, and ensuring fiduciary risk is low
  (v)     Implement the shadow budget as a means to link planning and budgeting
          processes for entire sector
  (vi)    Improve predictability of resources by holding partners accountable to provide
          information on their frameworks and budgets, and quarterly disbursement
21 | P a g e

Chapter 5: Monitoring and Evaluation

The monitoring and evaluation of progress shall be done within the sector‟s ongoing
monitoring and evaluation mechanisms. Actions needed to be implemented shall be
part of the respective AOPs. Actions implemented in this financial year will be part of
the current AOP 3.

Each of the main areas of focus will be monitored by its Technical Working Group.
This TWG shall be composed of all sector actors; Government, Development
Partners and Implementing Partners, that are carrying out activities, or have an
interest in supporting the respective strategy. The Team Leader shall coordinate the
efforts of the TWG. The lead DP and lead IP shall ensure adequate communication
with their respective constituencies to ensure their obligations and expectations are

The TWG shall report on a quarterly basis to the SWAp umbrella Health Sector
Coordinating Committee (HSCC) on progress against milestones, issues and
challenges being met in implementation. It shall also bring any issues for decision at
this level.

The sector shall review progress annually, as part of the AOP monitoring and review
process. The progress made against each of the areas of focus shall be documented
in the AOP report for each subsequent year.

Final evaluation of the sector‟s performance at the end of the NHSSP II shall also
review the contribution that the implemented actions will have made towards overall

Monitoring indicators shall be the same as those used to monitor the NHSSP II, and
its AOP‟s. As highlighted in the recommendations from the Mid Term Review of the
NHSSP II, monitoring of partnership and coordination shall be in line with the Paris
Declaration indicators (Annex A).
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Chapter 6: Implementation Matrix

The implementation matrix (Table 6.1) outlines how implementation of the above
actions for acceleration will be carried out. The matrix elaborates:
    - Key milestones for achievement within 6 months (AOP 3), proceeding 1 year
       (AOP 4), and in the final year of the NHSSP II (AOP 5)
    - Responsible persons from Government (Team Leader), Development
       Partners (Lead DP), and Implementing Partners (Lead IP) for the key actions
    - Indicators for progress towards achievement of the actions, and
    - Resource requirements to adequately implement of the actions.

The total financial resources required for the implementation of the proposed planned
actions are Ksh4,185.1 million, Ksh12,993.5 million, Ksh13,958.0 million for the
second half of AOP 3, AOP 4 and AOP 5 respectively. The budget estimates does
not include the additional resources required for the health sector response to the
post election crisis.

The development of the implementation matrix assumed that the country situation
would remain politically stable and partnership and coordination of the sector would
continue as spelt out in the country CoC. However, the post election events have
affected partnerships in the country, with a number of commitments delayed, or
revisited to focus more on humanitarian activities. Predictability of Aid, a key principle
in the Paris declaration and in the country‟s own Code of Conduct, has been severely
restricted due to political events, which are out of the control of the health sector.
Regarding the sector‟s way forward, there are 3 potential scenarios arising from this
     i)     A political solution agreeable to all sides in the conflict is quickly
            arrived at: The reversal of the humanitarian situation would be done
            quickly. Many displaced persons would be able to return to their homes.
            Donor commitments would in most situations be honoured, and the sector
            would shift to a recovery phase. Some donor funds would be channelled
            to humanitarian activities, but most likely additional funds would be
            available to the sector for routine activities to address the resultant
            funding gaps.

    ii)        A political solution is agreed at, but not all sides are in full
               agreement: The immediate and visible signs of the humanitarian crisis
               (IDP camps, etc) would largely be addressed. However, simmering
               tensions would continue, with a high possibility of sporadic outbreaks of
               violence in the country. Many displaced persons would still not be able to
               return to their homes. A humanitarian focus would have to be maintained
               in the country in the medium term. A large number of the pre-election
               donor commitments would be honoured. However, a large proportion of
               their funds would also be channelled to humanitarian activities, leaving
               less funds available for routine sector interventions.

    iii)       No political solution is agreed at: The immediate visible signs of the
               humanitarian crisis would remain in some areas of the country, as it would
               prove difficult to assure security in all areas for affected persons.
               Tensions would continue in the country, with sporadic outbreaks of
               violence, A strong humanitarian focus would have to be maintained in the
               country in the medium term. A large number of the pre-election donor
               commitments would not be honoured. Of the fund available, a large
               proportion would be channelled to humanitarian activities, leaving minimal
               funds available for routine sector interventions.
 23 | P a g e

                                         TABLE 6.1 NHSSPII ACCELERATION IMPLEMENTATION MATRIX

NHSSPII         Strategies                        Responsibility          Indicator for            Targets                          Budget (Ksh.000,000)
Objectives                               TL        L/DP       L/IP        Progress      six months   AOP4              AOP5   six         AOP4      AOP5
 A. Increase
equitable                                               A1.Universal access to Maternal and neonatal health services
access to
                A1.1. Exploring                    GDC        HENNET* Increased no.        situational    Impleme Imple       1.2         TBD       TBD
                issues hindering                                      of women             analysis       ntation mentat
                utilization of                                        delivering           report                 ion
                maternal and                                          with skilled         disseminated           and
                neonatal services in                                  attendance           and                    review
                Kenya, such as                                                             designing
                attitudes of health                                                        attitude
                providers, male                                                            change
                involvement, etc
                A1.2                               UNFPA      HENNET* No. of CEOC          5              10           20     5           20        10
                Comprehensive                                         facilities
                Obstetric Care
                (CEOC) including
                care for the newborn
                at all level 4 through
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               nurseries, maternity
               theatres and
               laboratory and x-ray

               A1.3 Ensure             UNFPA   HENNET* % of Health      70% of HFs   80%   90%         1200   1300
               availability of                         facilities
               family planning                         reporting no
               commodity at point                      stock-out
               of use (commodity
               security and
               A1.4 Basic              UNFPA   HENNET* No. of Level 3   200          300   500   30    60     120
               Emergency                               offering BEOC
               Obstetric care
               (BEOC), including
               care for the newborn
               in all level 3
               A1.5 Availability of    UNFPA   HENNET* No. of           120          200   500   1.2   3      4
               Skilled attendants at                   operational
               births in the                           community
               community                               mid-wives
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               A1.6                            GDC       HENNET* Proportion of      Referral       Impleme    Imple 2   690   690
               Implementation of                                 facilities         strategy       nt 25%     ment
               Referral Strategy                                 implementing       disseminated   Referral   25%
                                      H/C&RS                     RS                                Strategy   Referr
               A1.7 Free deliveries   DMS      GDC       HENNET*
               in Health Facilities   TWG
               A1.8 24 hours a day             GDC,      HENNET*
               working hours in                WORLD
               Level 3 nation-wide             Bank                                 Agreed
                                                                    Proportion of   ve             Impleme
                                                                    Concept Paper   Maternal/Ne    ntation
                                                                                                           ion as   3   TBD   TBD
                                                                    Plan            wborn          as per
                                                                    implemented     requirement    plan
               A1.9 Implement                  GDC       HENNET*                    Concept
               strategies to ensure                                                 Paper
               financial access to
               Maternal Health

                                                     A2 A nation-wide implementation of community strategy
26 | P a g e

               A2.1 Establishment    H/SPM      UNICEF    HENNET* No.(CUs)
               of functional         D                            established
               community units                                                        150          480        960      600   1,000   1,634

                                              A3.Accelerate Kenya Essential Package for Health (KEPH) implementation

               A3.1.Comprehensiv                UNICEF    HENNET* % Schools           School health 5%        30%      2     32      50
               e implementation of                                implementing        strategy
               guides and                                         comprehensive       finalised
               frameworks for                                     school health
               cohorts 4                                          package

               A3.2 Develop a        H/PPHS     WHO       HENNET* % Strategy     Draft             Consens    15%     1      10      20
               policy, strategy &                                 implementation Policy/Strate     us & 5%    Strateg
               comprehensive                                                     gy and            Strategy   y
               implementation plan                                               implementati      impleme    imple
               cohorts 4& 6                                                      on plan           ntation    mentat
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               A3.4 Development         WHO      HENNET* % of health      Policy/strateg 10%       30%      1      12     12
               of a policy, strategic                    facilities       y and          planned   planne
               approach and an                           implementing     implementati             d
               implementation                            guidelines       ons plan
               framework for
               NCDs to address
               healthy lifestyles
               and provision of
               direct medical care
               for individuals in a
               clinical setting
               A3.5 Reduce              WHO      HENNET* % in patients   14%             14%       12%      3000   6000   6000
               morbidity and                             admitted due to
               mortality from                            malaria
               malaria by
               implementing the
               National Malaria
               Strategy that has
               been revised in line
               with NHSSP II
               A3.6 Strengthen          UNICEF   HENNET* % reduction in   Baseline       15        30              400    500
               implementation of                         under-five       data,
               existing service                          inpatient        implementati
               delivery efforts for                      mortality        on plan &
               Child health                                               disseminatio
               A3.7 Accelerate          WHO      HENNET* % increase in    20%            20%       20%      50     3000   3000
               implementation of                         case
               TB control activities                     notification
28 | P a g e

                A3.8 Modification      Head       DfID   HENNET* Proportion of                      Curricul 50%                  2.2        3
                of pre-service         curative                  institutions                       a revised faciliti
                curricula in line with                           participating in                             es
                Service Delivery                                 modified                                     using
                expectations                                     training                                     revise

                                   SUB-TOTAL BUDGET FOR NKSSP II OBJECTIVE A                                             3696.8   12,429.2   13,343.

B. Improve                                                 B1. Improvement of facility-based services
quality and
s               B1.1 Development                  GDC    HENNET* Proportion of                      5%           10%              10         10
                and implementation                               facilities
                of country specific                              implementing
                hospital reforms                                 reforms
                B1.2 Re-               Head       GDC    HENNET* % facilities        Draft          50%          100% 2           5          5
                categorisation of      curative                  categorised         guideline      Categori     Catego
                health facilities in                                                                sation of    risatio
                line with KEPH                                                                      facilities   n of
29 | P a g e

               B1.3 Roll out of         WB    HENNET* Proportion of      13 Intern       25% of     50%     1.8   3.6    3.9
               service charter (SC)                   facilities         training        L4         of L4
                                                      implementing       facilities      impleme    imple
                                                      SC                 implementin     nting SC   mentin
                                                                         g SC                       g SC
               B1.4 Update and          WHO   HENNET* Proportion of      Guidelines      50%        50%     10    5      5
               implement service                      facilities         disseminated    level 1-4 level
               delivery clinical                      adhering to                        facilities 1-4
               guidelines.                            guidelines                         adhering faciliti
                                                                                         to         es
                                                                                         guidelin adheri
                                                                                         es         ng to
               B1.5 Creating            WB    HENNET* Proportion of                      Agreed     10%           4      4
               facility based                         facilities                         Concept faciliti
               incentives to                          implementing                       Paper      es
               improve quality of                     agreed                                        imple
               services                               concepts                                      mentin

                                                  B2. Improving service responsiveness

               B2.2 Develop &    Head                   Proportion of    Headquarter     L5           L4
               Implement ISO-    MMU                    facilities ISO   ISO 9000        facilities   faciliti
               9000 Quality                             certified        certified       ISO          es ISO 5    20.5   22.5
               Management System                                                         certified    certifie
30 | P a g e


                B2.1 .Put in place               USG   HENNET*                Agreed        A           50%      1     2      3
                national strategy for                                         supervision   district    district
                Integrated                                                    tool          per         s per
                Supportive                                                                  province    provin
                Supervision                                                                 adhering    ce
                                        H/C&RS                                              to          adheri
                                                                                            integrate   ng to
                                                                                            d tool      integra

                                 SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE B                                      19.8   50.1   53.4
C. Strategies
for Scale up                                                C1 Human Resource for Health
in Efficiency
 31 | P a g e

effectiveness   C.1.1                    DHRM     DfID    HENNET     Proportion of     Draft           Approve     Imple    2   1    4
of Services     Rationalisation of                                   additional        deployment      d           mentati
                establishment and                                    posts filled      policy &        revised     on of
                deployment of staff                                                    revised         establish   approv
                                                                                       establishment   ment &      ed
                                                                                       in place        deloyme     revised
                                                                                                       nt policy   establis
                                                                                                       &           hment
                C.1.2. Finalisation               DfID    HENNET     Proportion of     HRH Plan        10 %        20 %   8     34   119
                and implementation                                   HRH Plan          launched        Plan        Plan
                of HRH strategic                                     implemented                       impleme     imple
                plan                                                                                   nted        mented

                                                         C2. Commodity Supply Management Improvement

                C.2.1 Institutionalise                               Proportion of     Comprehensi     Train       Train   5    15   20
                the Public Proc Act                                  facilities with   ve              Proc        Proc
                & regulations                                        functional        Guidelines/M    Committ     Comm
                                                                     Committees &      anuals and      ees in      ittees
                                         H/Proc                      KEMSA             Established     50% of      in
                                                                     increased         Proc            L4          additio
                                                                     responsibility    Committees      100%        nal
                                                                                       in 50% of L4    L5          50%
                                                                                       100% L5                     of L4
32 | P a g e


               C.2.2.Establishemen           WB/USG ?HENNET Proportion of            PMIS           PMIS        PMIS 3       10   10
               t Procurement                                facilities with          designed       establish   establi
               Management                                   functional                              ed in       shed
               Information                                  PMIS                                    50% of      in
               System(PMIS)                                                                         L4 &        additio
                                                                                                    100%        nal
                                                                                                    L5          50%
                                                                                                                of L4

                                          C3. Infrastructure, communication & ICT effectively support service delivery

               C.3.1 Strengthen      H/C&RS JICA        ?           Proportion of    Draft          5%          10%      5   15   40
               strategic framework                      HENNET      facilities       integrated     districts   district
               to guide investment                                  implementing     policy         impleme     s
               in infrastructure,                                   integrated                      nting       imple
               communication,                                       policy                          integrate   mentin
               transport and ICT                                                                    d policy    g
33 | P a g e


                                                   C4 Public Financial Management (PFM)

               C.4.1.increasing     CFO   WB     HENNET   % increase in                     10%        15%      2     5    3
               absorption capacity                        development                       absorpti   absorp
               including 5%                               funds                             on         tion
               KEMSA distribution                         absorption                        increase   increas
               funds                                                                                   e
               C.4.1Introduction of PAC   WB     HENNET   Proportion of      Integrated     50%        50%      20    40   40
               IFMIS at all levels                        compliant          IFMIS          district   district
                                                          districts          (national,     reportin reporti
                                                                             provincial &   g on-line ng on-
                                                                             district)                 line
               C.4.1 Capacity      PAC    DANIDA HENNET   Proportion of      Fiduciary      50%        50%      100   75   50
               building for HSSF                          facilities         training of    facilities faciliti
                                                          submitting         Committees,    participa es
                                                          accurate           facilities,    ting in    partici
                                                          financial report   district &     HSSF       pating
                                                                             provincial                in
                                                                             managers                  HSSF
34 | P a g e

               C.4.1 Review of the CE       DANIDA HENNET     Revised Public   consultant     -Draft      -Draft           2       2
               public health act to                           Health Act       contracted     amendm      amend
               take care of financial                                                         ents and    ments
               issues                                                                         cabinet     submit
                                                                                              memo        ted to

                                                            C5 Information Management

               C5.1. Incorporating CE       DANIDA            Annual health    2007 health    2008        2009    1.5      1.5     1.5
               information from                               facts and        facts and      health      health
               systems, and other                             figures          figures        facts and   facts
               sources of                                                                     figures     and
               information like                                                                           figures
               KNBS, DHS, KAIS
               C5.2 Strengthen data H/SPM   DANIDA HENNET     Proportion of     10% of        25% of      25%      35      43      55
               management            D                        districts        districts in   districts   of
               capacity (collection,                          reporting on-    Central and    nationall   district
               analysis,                                      line timely      Eastern        y           s
               computerization and                                             Provinces                  nation
               use) at all levels                                                                         ally

                             SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE C                                             181.5   272.7   207.1
35 | P a g e

D Fostering                                              D1.1 Joint Sector Planning strengthened.

               D.1.1.1                H/SPM   DANIDA HENNET       Launched AOP AOP4             AOP5        AOP1     42    44     46
               Strengthening joint    D                           by June
               annual planning
               linked with budget
               & KEPH
               D.1.1.2 Facilitate             DANIDA HENNET       Launched          Draft      Draft        NSSPI    45    40     10
               sector medium and                                  Policy            Policy     KHPF         II
               long term planning                                 Framework &       Framework  adopted &    launch
                                                                  NHSSPIII                     draft        ed
                                                  D1.2 Scale up use of Performance Monitoring Mechanism

               D1.2.1 Joint           H/SPM   ?       HENNET      Timely                        Quarterly   Quarte         24.2   26.6
               quarterly and annual   D                           adopted                       & AOP3      rly &
               reviews                                            performance                   Performan   AOP4
                                                                  reports                       ce report   Perfor
               D1.2.2 Institute an CE         DANIDA HENNET       % allocation in               2%          3%       Nil   Nil    Nil
               agreed mechanism                                   annual budgets
               for ensuring
               allocation for M&E
               of 5% of recurrent
               budgets for GoK and
36 | P a g e

               partner programmes

                                                        D.2 Partnership & financing

               D2.1. Annual         CE   WB               PERs and        2007 PETS   2008        2009   21.5   21.5   21.5
               expenditure tracking                       PETs Report     and 2008    PETS and    PETS
               mechanisms for                                             PER         2009 PER    and
               funds from GoK, DP                                                                 2010
               and IPs, using PETS                                                                PER
               and PER
               D2.2 Entrench        CE   WB    HENNET     Shadow          2008/9      2009/10     2010/1        1      1
               shadow budget                              budgets         shadow      shadow      1
               tracking – DPs,                                            budgets     budgets     shado
               NGOs, & HH                                                                         w
               costing                                                                            budget
               D2.3 Complete and    CE   GDC   HENNET     Health care     NHA         Health      Health 5      5
               implement Health                           financing       report,     care        care
               Care financing                             strategy        costing     financing   financi
               strategy including                                         report      strategy,   ng Act
               equity                                                                 health
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               D2.4 Creation of      CE      GDC        HENNET   Mapping report pilot phase    Mapping              2.5       25
               sector investment                                                completed      Report
               plan including CDF
               – all levels
               D2.5 Scale up                                     Proportion of    Harmonisati 20% of        50%      1        2          2
               strategies for                                    partners         on and      Partners      of
               harmonisation &                                   adhering to      alignment   adhering      Partne
               alignment to sector                               CoC              tool                      rs
               priorities & Govt                                                  designed                  adheri
               systems                                                                                      ng
               D2.6 Strengthen       H/SPM   DP Chair   HENNET   25% district     60%          80%          90%      170      110        100
               leadership &          D                           managers         Facility     facility     facility
               governance                                        trained in       Committees   Committe     Comm
               structures at all                                 leadership and                es, 480      ittees,
               levels                                            70% facility                  CUs          960
                                                                 Committees                    functional   CUs
                                                                 established                                functio

                               SUB-TOTAL BUDGET FOR NHSSP II OBJECTIVE D                                            287.0     272.7      207.1

                                 GRAND- TOTAL BUDGET FOR THE ROADMAP                                                4,185.1   12,993.5   13,948
       38 | P a g e

             Annex A: Indicators for monitoring progress in strengthening of
Indicat Paris declaration Description               Paris Declaration Target                  Country target
1       Partners have operational development       At least 75% of partner countries         -- (Already achieved)
        strategies — Number of countries with       have operational development
        national development strategies             strategies.
        (including PRSs) that have clear
        strategic priorities linked to a medium-
        term expenditure framework and
        reflected in annual budgets.
2       Reliable country systems — Number of        (a) Public financial management –
        partner countries that have procurement     Half of partner countries move up at
        and public financial management             least one measure (i.e., 0.5 points) on
        systems that either (a) adhere to           the PFM/ CPIA (Country Policy and
        broadly accepted good practices or (b)      Institutional Assessment) scale of
        have a reform programme in place to         performance.
        achieve these.                              (b) Procurement – One-third of
                                                    partner countries move up at least
                                                    one measure (i.e., from D to C, C to B
                                                    or B to A) on the four-point scale used
                                                    to assess performance for this
3        Aid flows are aligned on national          Halve the gap — halve the proportion
         priorities — Percent of aid flows to the   of aid flows to government sector not
         government sector that is reported on      reported on government’s budget(s)
         partners’ national budgets.                (with at least 85% reported on
4        Strengthen capacity by co-ordinated        50% of technical co-operation flows
         support — Percent of donor capacity-       are implemented through co-ordinated
         development support provided through       programmes consistent with national
         coordinated programmes consistent          development strategies.
         with partners’ national development
5a       Use of country public financial            5+      All donors use partner
         management systems — Percent of                    countries’ PFM systems.
         donors and of aid flows that use public    3.5 –   90% of donors use partner
         financial management systems in            4.5     countries’ PFM systems.
         partner countries, which either (a)        5+      A two-thirds reduction in
         adhere to broadly accepted good                    the % of aid to the public
         practices or (b) have a reform                     sector not using partner
         programme in place to achieve these.               countries’ PFM systems.
                                                    3.5 –   A one-third reduction in the
                                                    4.5     % of aid to the public sector
                                                            not using partner countries’
                                                            PFM systems.
5b       Use of country procurement systems —       5+      All donors use partner
         Percent of donors and of aid flows that            countries’ Procurement
         use partner country procurement                    systems.
         systems which either (a) adhere to         3.5 –   90% of donors use partner
         broadly accepted good practices or (b)     4.5     countries’ Procurement
         have a reform programme in place to                systems.
         achieve these.                             5+      A two-thirds reduction in
                                                            the % of aid to the public
          39 | P a g e

Indicat     Paris declaration Description          Paris Declaration Target                  Country target
                                                             sector not using partner
                                                             countries’ Procurement
                                                   3.5 – A one-third reduction in the
                                                   4.5       % of aid to the public sector
                                                             not using partner countries’
                                                             Procurement systems.
6      Strengthen capacity by avoiding parallel    Reduce by two-thirds the stock of
       implementation structures — Number of       parallel project implementation units
       parallel project implementation units       (PIUs).
       (PIUs) per country.
7      Aid is more predictable — Percent of        Halve the gap — halve the proportion
       aid disbursements released according        of aid not disbursed within the fiscal
       to agreed schedules in annual or            year for which it was scheduled.
       multiyear frameworks.
8      Aid is untied — Percent of bilateral aid    Continued progress over time.
       that is untied.
9      Use of common arrangements or               66% of aid flows are provided in the
       procedures — Percent of aid provided        context of programmebased
       as programme-based approaches.              approaches.
10     Encourage shared analysis — Percent         (a) 40% of donor missions to the
       of (a) field missions and/or (b) country    field are joint.
       analytic work, including diagnostic         (b) 66% of country analytic work is
       reviews that are joint.                     joint.
11     Results-oriented frameworks —               Reduce the gap by one-third —
       Number of countries with transparent        Reduce the proportion of countries
       and monitorable performance                 without transparent and monitorable
       assessment frameworks to assess             performance assessment frameworks
       progress against (a) the national           by one-third.
       development strategies and (b) sector
12     Mutual accountability — Number of           All partner countries have mutual
       partner countries that undertake mutual     assessment reviews in place.
       assessments of progress in
       implementing agreed commitments on
       aid effectiveness including those in this

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