2012年-世界发展银行全球_Health_Equity_and_Financial_Protection_in_Kenya_33页_1mb

Health Equity and Financial Protection Report - Kenya Summary

Core Content

This report provides an analysis of health equity and financial protection in Kenya, using data from the 2008-09 Kenya Demographic and Health Survey (DHS), the 2004 Kenya World Health Survey (WHS), and the 2005-06 Kenya National Health Accounts (NHA). It examines health outcomes, health behaviors, health care utilization, benefit incidence of government spending, and the impact of out-of-pocket (OOP) payments on household financial well-being.

Main Points

1. Health Equity and Financial Protection as Policy Goals

• Kenya's government aims to improve equity and financial protection in the health sector through the National Health Sector Strategic Plan II (NHSSP II).
• The plan focuses on increasing equitable access, improving quality of services, enhancing regulatory capacity, fostering partnerships, and improving health financing.

2. Health Financing System

• Kenya spends 4.3% of GDP on health (2009), which is lower than the average for other low-income African countries.
• Government health spending has declined from 7.6% (2005) to 5.4% (2009) of total government expenditure.
• Government spending accounts for 33.8% of total health expenditures, with private sources covering the remaining 66.2%.
• Out-of-pocket (OOP) payments account for 51.2% of total health expenditures in 2009.
• The National Hospital Insurance Fund (NHIF) covers only inpatient costs, and is limited in scope, offering weak financial protection.

3. Health Care Delivery System

• The health care delivery system is organized into six levels: community, dispensaries and clinics, health centers, primary hospitals, secondary hospitals, and tertiary hospitals.
• The Ministry of Public Health and Sanitation oversees primary care, while the Ministry of Medical Services manages higher-level care.
• Private sector plays a major role, owning about half of the facilities at levels two to four.
• User fees are collected at public facilities, with a portion of revenue retained by facilities for non-clinical staff and supplies.
• Health workers are unevenly distributed, with a large proportion working in urban hospitals, disadvantaging the rural poor.

4. Inequalities in Health Outcomes

• Ill health is more concentrated among the poor, particularly in child health indicators:
  • Under-five and infant mortality rates are higher among the poor.
  • Stunting and underweight are more common in poorer households.
  • Diarrhea and acute respiratory infection (ARI) are more prevalent among the poor.
  • Malaria is more common among the poor.
• Some adult health conditions are also more common among the poor:
  • Tuberculosis, arthritis, difficulty with work and household activities, and poor self-assessed health status.
• Conversely, conditions like obesity, diabetes, and HIV prevalence are more common among the better-off.
• Fever incidence is suggestive of inequality but not statistically significant.
• Smoking is more prevalent among the poor, while concurrent partnerships are more common among the better-off, though condom usage is also higher among the wealthy.

5. Inequalities in Health Care Utilization

• Maternal and child health (MCH) interventions are more utilized by the better-off:
  • Skilled antenatal care and skilled birth attendance are more common among the wealthy.
  • Contraceptive prevalence is also higher among the better-off.
• Preventive care utilization among adults is not significantly unequal.
• Curative care utilization is slightly higher among the wealthy, particularly for inpatient care.
• Outpatient care utilization is evenly distributed but not statistically significant.

6. Benefit Incidence of Government Spending

• Government spending on health is neither pro-rich nor pro-poor using two of the three benefit incidence methods.
• Outpatient subsidies are mildly pro-poor, but not statistically significant.
• Inpatient hospital care becomes significantly pro-rich under the third method (proportional cost).
• Total subsidies are not significantly pro-rich or pro-poor.

7. Financial Protection and Impoverishment

• Out-of-pocket payments have a modest effect on household financial well-being:
  • Less than 20% of households spend more than 10% of total consumption on health.
  • Only about 3% spend more than 40%.
• Using a non-food measure, 35.3% of households spend more than 10% of non-food consumption on health.
• Catastrophic OOP payments are slightly concentrated among the poor for all non-food thresholds.
• Impoverishing OOP payments are more common among the rich at higher total consumption thresholds.
• Health spending contributes to impoverishment, with an increase in the poverty rate equivalent to 2.4% using the US$2.00 a day measure and 5.0% using the US$1.25 a day measure.
• The depth of poverty (poverty gap) increases by 5–8%.

Key Information

• Health expenditure data (2009):

  • Health expenditure as a share of GDP: 4.3%
  • Government expenditure as a share of GDP: 27.2%
  • Government health expenditure as a share of total health expenditure: 33.8%
  • Out-of-pocket expenditure as a share of total health expenditure: 51.2%

• Health insurance:

  • NHIF covers inpatient costs but not outpatient or pharmaceutical costs.
  • NHIF insures 7.1% of the population as of 2007.
  • Private insurance covers 1.6% of the population.

• Key Inequalities:

  • Child health indicators show significant concentration among the poor.
  • Adult health conditions such as tuberculosis and arthritis are more prevalent among the poor.
  • Obesity, diabetes, and HIV are more common among the better-off.
  • Smoking is more common among the poor.
  • Concurrent partnerships are more common among the wealthy, but condom use is also higher among them.

• Concentration Indices:

  • Negative values indicate higher prevalence among the poor.
  • Positive values indicate higher prevalence among the better-off.
  • The larger the absolute value, the greater the inequality.

• Health care utilization:

  • MCH interventions and inpatient care are more used by the wealthy.
  • Outpatient care is evenly distributed but not statistically significant.

• Financial protection:

  • OOP payments are a major source of health financing.
  • Catastrophic OOP payments are a concern, particularly for the poor.
  • Impoverishment due to OOP health spending is moderate.

Conclusion

The report highlights that while Kenya has made progress in some areas of health equity and financial protection, significant challenges remain. Ill health and underutilization of health services are more prevalent among the poor, and the current health financing system, which relies heavily on OOP payments, may contribute to financial hardship. The NHIF provides limited financial protection, and there is a need for more inclusive and equitable health financing mechanisms.