Maternal Health in Kenya:An Important Agenda

Maternal Health in Kenya:An Important Agenda

Abdo Yazbeck, Health Practice ManagerLead Health Economist

World Bank

Nairobi, August 2014

Outline

Which comes first, Health or Wealth?How is Kenya doing on health outcomes?Kenya’s health systems challenges (financing,

quality, coverage)Amazing county level variations in performanceGlobal best practice for health systems and

maternal healthTake home messages

Health or Wealth First?

In East Asia, both Health and Wealth Improved fast, but Health Came First and Drove Wealth (e.g. the Demographic Dividend)

Green Line=GDP/capita; Blue dots=Child Mortality (4 graphs)

Health or Wealth First?

In SS Africa, Wealth is growing fast, but Health is not (Wealth is not Producing Health)

HEALTH OUTCOMESA Mixed Story for Kenya

Under-5 Mortality and health exp.: deviations from estimates based on per capita income and education

Kenya underspending with average Under-5 Mortality

19601962

19641966

19681970

19721974

19761978

19801982

19841986

19881990

19921994

19961998

20002002

20042006

20082010

20120

50

100

150

200

250

117

48.7

196.1

72.9

Infant and < 5 mortality, per 1,000 live births

Under five mor-

tality

Infant mortality

Child and Infant Health outcomes

Start-Stop-Start Performance on Child Health in Kenya

8

490

1,400

400320

0

200

400

600

800

1,000

1,200

1,400

Kenya Tanzania Uganda Burundi Rwanda

Mat

erna

l dea

ths p

er 10

0,00

0 liv

e bi

rths

1990 1995 2000 2005 2013

Maternal Mortality in Kenya and Neighboring Countries

Kenya’s Maternal Mortality Rates Declined, but more modestlycompared to countries in the neighborhood

Female Adult Mortality Rank

Kenya’s Female Adult Mortality position faltering

TFR 1960-2012 (Stagnation in Kenya)

Comparable to Brazil in 70s

HEALTH SYSTEMSFinancing, Quality, Accessibility, and County Variations

Kenya spends about only 6.5% of its budget on health…

Tanzania Ghana South Africa Uganda Botswana Kenya -

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

13.9

12.8

11.9

10.4 10.2

6.5

Public health expenditure, % of government spending, Average 2007-2011

Limited Public Commitment to Health Spending

13

29.6 29.3 28.8

54.039.3 36.7

16.431.0 34.5

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2001/02 2005/06 2009/10

Public Private Donors

• Health sector continues to be predominantly financed by private sector sources (including by households’ out-of-pocket (OOP) spending);

• Public sector financing has remained constant over the last decade, at about 29 percent of THE;• Donors contribution has more than doubled, from 16 percent in 2001/02 to 35 percent in 2009/10.

Sources of Health Financing

Sarajevo, September 23, 2009

15

Proportion of health facilities offering Basic-Emergency Obstetric care

Health System Global Best Practice

Improving the availability of a skilled birth attendant closely connected with a capable and acceptable referral system (these include): Making midwife backbone of the initiative (Sri Lanka and Malaysia) Increasing availability of facilities that can provide basic and essential

obstetric care. Effectively using birthing centers/waiting homes (Honduras, Indonesia

and Zimbabwe).  Kenya is doing this with support from partners in the Coast and North East.  

Reducing demand side barriers through free services (Malaysia and Sri Lanka) and recently announced by Kenya.  This however requires close monitoring to ensure quality.

Reducing the cultural barriers - involvement of traditional birth attendants (Malaysia) to link with formal midwives.

Main Messages One mother dies every two hours in Kenya

Most maternal and new born deaths are preventable and the interventions are well known which are not expensive

With the devolution, you are uniquely placed to address this persisting scrooge by implementing  interventions that are relevant for your counties (marrying global knowledge with local response)

The partners gathered here are fully committed to collectively to support you