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.