Maternal Health in Kenya: An Important Agenda Abdo Yazbeck, Health Practice Manager Lead Health...
-
Upload
louise-henderson -
Category
Documents
-
view
213 -
download
0
Transcript of Maternal Health in Kenya: An Important Agenda Abdo Yazbeck, Health Practice Manager Lead Health...
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