Integrated Service Delivery Case Study:
Kenya
Erin E. Sullivan, Ph.D.Global Health Delivery Project
Harvard School of Public HealthJuly 16, 2010
Kileken ole-MoiYoi, Erin Sullivan, Nayana Dhavan, George Kimathi, Joseph Rhatigan, Ephantus Kabiru,
Rebecca Weintraub
Data Collection
• 50 key informants – Well-defined roles in the country’s health
system – Represented:
• Government of Kenya• Kenya-based NGOs• Internationally-based NGOs• Multilateral organizations • Private sector
Kenya: Country Context
Population: 38.5 million
Life expectancy: 56 for females 53 for males
UN Human Development Index: 147 out of 182
GDP per capita: US$ 1,590 (in PPP)
Kenya: Health System
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
HIV Program Financing
GoK
Ministry of Medical Services
Ministry of Public Health &
Sanitation
Office of the President
NACC
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
Integration Challenges
• Global Fund model
• Limited infrastructure to support programs
• Poor M&E structures
• Conflicts of interest within the CCM
• Delays in funding
System-wide Effects
• Concerns about long-term sustainability
• Neglect of non-target diseases
• Parallel systems
• Human resource challenges
Conclusions
• Disease programs should improve integration
with public health system• A relatively strong health system maximizes
Global Fund resources• Investments in workforce, infrastructure and
government capacity ensure sustainability• Coordination and alignment between health
system stakeholders is needed
Further Research
• Sustainability and governmental capacity
• Donor alignment and management
Integration
• ‘integration’—a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings.
• we define integration as the extent, pattern, and rate of adoption and eventual assimilation of health interventions into each of the critical functions of a health system which include, (i) governance, (ii) financing, (iii) planning, (iv) service delivery, (v) monitoring and evaluation (M&E), and (vi) demand generation.
