Development of the health sector

Project description

Title: Development of the health sector
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Kenya
Lead executing agency: Ministry of Health
Overall term: 2005 to 2016


Despite strong economic growth and the reform efforts of the Kenyan Government, the country’s health system remains underdeveloped. Kenya’s Demographic and Health Survey of 2008/9 revealed mixed results for some indicators. Positive trends are seen in child mortality, contraceptive use, immunisation and the use of mosquito nets. However, there have been no significant gains in maternal health. There are also wide provincial disparities that are masked by improved national statistics.

There is acting commitment to overcome the problems resulting from weak institutional capacities for providing quality services, as well as persistent inequities in the delivery of services. Financing of the health sector and addressing serious systemic weaknesses is key. The development of a roadmap towards providing universal access to health care for all Kenyans is in process.

The majority of poor Kenyans are excluded from good health care, especially in rural areas where there are few facilities and not many people can afford to use them. The social security system is inadequate and health services are often of poor quality; financial resources are insufficient and they are not used to the best possible effect.

Kenya is grappling with challenges to its health system that include a severe shortage of health workers, the need to provide and retain health workers in remote locations, and the need to improve performance management. At the same time, the country is in the process of decentralising its health system. This fundamental transformation is a result of the new constitution adopted in 2010. The new government, elected in 2013, is emphasising the importance of health, and has initiated many far-reaching reforms in the health sector. It has promised to provide free care during childbirth as well as free basic health services at public health facilities.


At national and county levels, state and non-state actors implement strategies for the increased uptake of high quality health services, especially for the poor and members of the informal sector.


The GIZ health sector programme supports the Kenyan Government in carrying out its various reform processes. This includes the introduction of a socially equitable financing system, the development and introduction of quality standards and quality management, and the mainstreaming of gender equality and human rights principles in the reform process.

The programme works with private sector networks to encourage private involvement in development partnerships in order to increase diversity, quality and competition in the reforms. Such development partnerships are an important tool for improving the cooperation and coordination of all providers in the health sector.

In some poorly resourced areas, GIZ provides advisory and financial inputs to help improve access to affordable and high quality health services for poor Kenyans. In its strategic approach, the programme is assisting the Ministry of Health and the National Health Insurance Fund (NHIF) in reforming and implementing a healthcare financing strategy.

To complement this, the programme is also supporting the decentralised health system at the county level with measures to improve both the management of health services, and their quality. It also supports the development of a national system of accreditation quality management for healthcare facilities.

Results achieved so far

The policy advice, capacity development measures and implementation support provided by the programme have contributed to several important developments in the health sector. These include:

  • Introduction of economically assessed approaches for waiver of user fees, and the establishment at the University of Nairobi of a Health Economics Unit, specialised in costing health services
  • Country-wide introduction of the Kenya Quality Model for Health (KQMH) for quality management in hospitals and health centres and the establishment of good application practices
  • Development and broad-based application of effective training courses for health and health management professionals, using a mentoring approach; this is now part of the curriculum at the Kenyan School of Government
  • Creation of platforms to facilitate the participation of non-state actors (NGOs, faith-based health care institutions and private service providers) in the development of the health system
  • Introduction of a standard protocol for the medical and forensic procedures in cases of gender-based violence (GBV); establishment of centres for care and counselling of affected women and young people
Marked improvements in performance have been achieved at district and facility levels as a result of the training and mentoring delivered to healthcare providers and managers, as well as the introduction of innovative approaches (including a mobile phone application for logistics management). The results, which have been used to influence policies, strategies and tools for a multi-level approach, included:
  • A larger share of pregnant women benefited from comprehensive antenatal check-ups (up from 22% to 60%), and from instruction in the use of modern contraception methods (from 39% to 50% in a target population of approximately 132,000 women)
  • Skilled birth attendance increased in supported facilities from 18% to 36% of cases (approximately 10,000 births)
In 2012, the health sector programme provided emergency relief in drought-affected areas, addressing a population of approximately 1.5 million. One result of this was that the proportion of boys and girls under the age of five suffering from acute malnutrition fell in the target regions by 15 percentage points.