BÉCQUER, ROSALÍA DE CASTRO Y EL PREMODERNISAAO
PEREDA, VALERA Y PALACIO VALDÉS
4. En el capítulo inicial de Valera o la ficción libre, Madrid, 1957.
Unprecedented global recession, high inflation and pervasive poverty in Kenya, as well as the transition from one sector and one ministry, mean that the overall risk to this plan is assessed at medium to high.
9.2 Risk Assessment
T
he plan will be implemented during aperiod of unprecedented global recession. In Kenya, the plan coincides with an inflationary trend that has affected all segments of consumers. The world’s leading economies, which are also the principal contributors to public health interventions, are under siege with a potential knock-on effect to official develop- ment assistance (ODA). Without Government intervention, Kenya’s low and middle income groups are facing the threat of unaffordable basics of life, including adequate access to food. In view of these circumstances and in the light of the transition from one sector and one ministry, the overall risk to this plan is assessed at medium to high. Some key risks that may hinder the ability of MOPHS to implement the
Ministry of Public Health and Sanitation
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NHHSP II Objective Strategic thrust – MOPHSGoal for 2012 Responsible unit
Increase the proportion of communities that live within 5 km of functional health facility from 52% to 62%
Division of Community Strategy
Increase financial access to health care services DFA /DPP /NHIF Increase equitable access to health services Improve equitable access to public health and
sanitation services Increase proportion of deliveries by skilled attendant from 42% to 60%
Div. RH /DHP Reduce the staff vacancy rate by 40% DHRM Increase proportion of health workforce trained by 100% DHRM Rehabilitate and adequately equip 50% of level 2 and 3 and other
public health facilities
DCH Improve the quality and responsiveness of health services in the sector Improve the quality and responsiveness of public health and
sanitation services Reduce proportion of facilities reporting stock outs by 100% DCH Increase number of districts with functional surveillance systems by 30%
Div. HMIS Increase number of facilities with health care waste management
system from 20% to 100%
DEH&S/DHP Increase sanitation coverage from 46% to 66% DEH&S/DHP Increase the proportion of households utilizing safe water by 20% DEH&S /DHP Increase client satisfaction by 50% DPHS Reduce the incidence of food-borne diseases/illnesses by 5% DEH&S /DHP Reduce mortality rate due to emergency to below 1/10000 persons DEPR Increase the utilization of cost-effective RH services by 50% DFH Increase the utilization of cost-effective child health care services by 50%
DCAH
Reduce new HIV infections by 50% NASCOP/DDPC Increase TB case detection and treatment to 90% NASCOP Reduce malaria incidence to 15% through utilization of cost-
effective control measures
DDPC/M Reduce the incidence of malnutrition in children <5 years by 30% Div. N Reduce vacancy rate by 60% DHRMD Improve efficiency and effectiveness of service delivery Improve efficiency of the public health system
Increase the proportion of staff who are trained as per the Government training policy by 50%
DHRMD Increase the proportion of employee job satisfaction to 90% DPHS Increase the availability and utilization of ICT by staff by 60% DICT Improve provision and utilization of transport services by 50% DFA Achieve 100% disposal of obsolete, unserviceable and surplus
assets annually
DFA Ensure all facilities receive financial resources based on needs by 2012
DPP/DTP Increase efficiency in utilization of resources DPP/DTP Improve financing of the health sector Improve financing of the public health and
sanitation services Increase financial resources to MOPHS by 20% over a period of five years
DPP/DTP Strengthen governance structures at levels 1–3 by 2012 DCH Foster partnership in improving health and service delivery Foster partner- ships in improving public health service delivery
Improve coordination and partnership arrangements at all levels Department of Technical Planning
Table 9.2: Objectives, goals and responsible parties
planned strategies are discussed in the following sections.
9.2.1 Risk A: Government Funding
Does Not Increase
The trend in government allocation to the health sector has stagnated at around 7%. Historically, public health has received comparatively insigni- ficant government allocations. During this year’s budget, the allocation to the Ministry remained low but was an improvement from past alloca- tions. This is paradoxical in the fiscal planning of the country, as preventive and health promo- tion services are considered to be public goods.
Mitigation:MOPHS engaged in the MTEF process for the first time, and
public health and sanitation costs are reflected in the framework. It is ex- pected that this will lead to Govern- ment commitment to preventive and health promotion services through support to the Community Strategy and to life saving procedures such as immunization and vaccination, provi- sion of ART, and free LLITNs.
9.2.2 Risk B: Development Partners
Reduce Funding to the Health
Sector
Despite the bleak economic outlook among the countries providing most aid to public health interventions, particularly for HIV/AIDS,
tuberculosis and malaria, the commitment to the sector remains high. However, as partner countries sink deeper into recession, the risk is real that they may be forced to re-programme or even reduce their aid. This will be in response to pressing domestic needs and the need to inject more money into the markets.
Mitigation: The external political commitment towards Kenya is not likely to change, particularly if the country continues with the post- election violence reform agenda. The growing advocacy in support of the MDGs, for example through Interna- tional Health Partnerships (IHP), Providing for Health (P4H) and other initiatives, will rally support to public health programmes in Kenya and similar countries. The Kenya Health SWAp and public–private partnerships (PPP) will be expected to contribute to aid effectiveness and efficiency in public health and sanitation.
9.2.3 Risk C: Corruption in the Country
Remains Unchanged
Kenya continues to be on the list of countries with a high corruption index. The negative impact and corrosion affects all the sectors of the country including health. Corruption in the health sector has the outcome of reducing the availability of resources through actual haemor- rhaging, inefficiency and poor quality of care, leading to low utilization. This will be accentuated by the concerns about Global Fund support.
Mitigation: Government has put in place public service reforms that in- clude streamlining procurement, recruitment and performance con- tracts. In addition, Government is planning to re-think the civil service salary structure. These initiatives, together with efforts of the Kenya Anti- Corruption Council, are expected to provide strong disincentives to corrup- tion. Efforts by civil society groups and the media to educate the public should also help to reduce corruption.
9.2.4 Risk D: Further Increase in
Poverty Levels
In view of the bleak economic outlook, more Kenyans may slip through the gaps and an increasing number fall below the poverty line. Poor people are sick more often and less produc- tive than those who are better off financially. Most sick and poor people suffer from prevent- able disease, thus putting greater demand on the services of MOPHS. The poor also often live in substandard housing in marginalized areas, whether in rural or urban settings, predisposing them to poor access to health care.
Mitigation:The Government has embarked on the implementation of the MTP, which is the guide for the first phase in transforming the country into a middle income economy by 2030. The plan proposes more investment in areas of production including manufactur- ing, tourism and services. Better market regulation measures are also envisaged.