The GFF’s Catalytic Role
The GFF Catalytic Role provides details on the GFF support for Kenya’s Reproductive, Maternal, Neonatal, Child, and Adolescent Health and Nutrition (RMNCAH-N) agenda. Details on past and ongoing work are provided along with plans for future support. The GFF Catalytic Role focuses on support provided in the areas of the Investment Case (IC), Health Financing and systems reforms, the country platform, partner alignment, and data use for decision-making.
- Developing a costed and prioritized investment framework: The investment framework prioritizes 20 counties across Kenya and informs county-specific, evidence-based, prioritized work plans linked to World Bank and GFF Trust Fund financing. Strategies focus on reducing coverage disparities in underserved counties and marginalized populations and addressing bottlenecks and gaps in the health system that hinder delivery of services and scale-up of evidence based, high-impact interventions.
- Prioritizing and implementing health financing and systems reforms: GFF support, linked to the Transforming Health Systems for Universal Care Project (THS-UCP), has helped counties increase budget allocation for health and shift to a model based on results for key indicators in alignment with national priorities. The reproductive, maternal, newborn, child, and adolescent health multi-donor trust fund technical assistance, directly aligned with the THS-UCP, has helped standardize planning and budgeting, improve supply chain management, and enhance coordination and accountability. The GFF also provided technical assistance to support the design and implementation of universal health care reforms and strengthened engagement with the private sector.
- Strengthening the country platform and convening financial and technical partners: The platform is currently focusing on the evaluation of the concluded investment framework, which will also advise ongoing engagements on RMNCAH-N in the country.
- Improving data for decision making: Prioritized work plans are monitored quarterly through the following methods: scorecard, resource allocation and mobilization, advocacy, identification of priority areas and decision making, progress monitoring, and performance review. In 2020, the government published its report, used to identify counties lagging in birth and death registration. In addition, birth and death registration will be accelerated through piloting a GFF-supported mobile civil registration unit for remote areas.
Core RMNCAH-N Impact Indicators
The 8 GFF core impact indicators reflect updates aligned with the in-country survey schedule which optimally occurs once every three to five years to determine population-based changes in important health and nutrition outcomes. These indicators are core to the GFF Logic Model, to reflect impact of aligned interventions over time. Collected by governments and development partners, these indicators are also used to monitor the Every Woman Every Child Initiative and the 2030 Sustainable Development Goals (SDGs) for RMNCAH-N. The country survey data includes Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), which are funded by domestic resources as well as by the World Health Organization (WHO), UNICEF, USAID and other multi- and bilateral organizations. The Covid-19 pandemic forced several countries to cancel or re-schedule plans for survey data collection these past two years.
The GFF highlights progress between the two most recent point estimates from population-based surveys approved by countries. The timing of the data points is dependent on when survey data are available, which introduces lags. In addition, it has been demonstrated that stillbirths tend to be under-reported in population based surveys1. For many of the indicators highlighted in this table, annual estimates are produced through global processes. The globally produced estimates can be found through the following sites:
- Maternal mortality country profiles
- Stillbirth, neonatal and under five mortality estimates
- Adolescent birth rate
- Stunting and wasting (for the latter, regional and global estimates only)
KDHS 2022 currently underway.
Core Health Financing Indicators
The six GFF core health financing indicators track changes to country budget and expenditures with a focus on health spending, to monitor the expected impact of increasing the total volume and value of funding allocated to health and nutrition. The GFF partnership supports financing reforms by engaging with ministries of finance and ministries of health to strengthen mobilization of domestic resources as well as allocative and technical efficiency. These indicators are tracked through country-specific data sources such as BOOST, NHA, and budget reports. Expenditure data are tracked through the Global Health Expenditure Database (GHED), for which data are available through the end of 2018. Through measurement of budgets and expenditures, the GFF partnership aims to accelerate the expansion of interventions that are high-impact, cost-effective, affordable, and feasible to accelerate progress on universal health coverage and in achieving SDG targets.
Survey and Estimated RMNCAH-N Coverage
The RMNCAH-N coverage data includes a standard set of 9 RMNCAH-N coverage indicators from available population-based surveys from 2010 to the most recent available survey. These indicators show progress towards key goals across maternal, child, and adolescent health and nutrition outcomes. Additional key nutrition-specific and/or education-specific coverage indicators are presented for countries where the GFF co-finances a nutrition-focused World Bank project or where education is a strong focus of the IC.
The RMNCAH-N coverage data are sourced from the most recent available population-based surveys. Data on immunization are presented from the WHO/UNICEF joint reporting process and recent population-based surveys.
Resource mapping is a key component of the GFF approach. The resource mapping exercise helps countries assess funding gaps, align donor and government resources, and improve the efficiency and equity of health spending. Resource mapping data for each country varies based on whether countries have completed one or more resource mapping exercises.
Resource mapping informs and supports the implementation of the RMNCAH investment framework. The financial requirement for RMNCAH investments for the 20 priority counties was estimated at US$989 million from 2017-18 to 2019-20, (according to RMNCAH investment framework). Although detailed information is not currently available, Kenya’s Ministry of Health estimates the government contributes 43% of all health expenditures, households (26%) through out-of-pocket payments, donors (18%), and other private sources (13%), representing a progressive trend toward an increased government share of funding and a decreased share from external partners. External contributing health partners include the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative, Global Fund, Gavi, the governments of Denmark, Japan (JICA), United Kingdom (DFID), and United States (PEPFAR, USAID, CDC), the United Nations H6 partners, and the World Bank.
Monitoring The Country-led Process
The GFF Logic Model highlights key elements of a GFF co-financed country-led process that contribute to the expected impact of improved RMNCAH-N outcomes over time. The GFF has developed a core set of indicators to monitor implementation of the GFF approach, considered as inputs and activities in the model, that emphasize prioritization and alignment to capitalize on efficiencies to improve transparency and accountability as well as health outcomes. Process monitoring includes tracking investment case development, country stakeholder engagement, health financing and the inclusion of gender and equity approaches.
Kenya Theory of Change
The Theory of Change highlights reforms prioritized by the country, and links them to output and outcome indicators which represent the measurable results that the reforms intend to help achieve. By selecting a specific reform within the drop down menu, the user can see the intended results that correspond with that reform as represented by specific output and outcome indicators. Where implementation progress is mature and data are available for output and outcome indicators, users can click on the arrow to access results in data section below.
Implementation Progress Data
The data in this section is aligned with the Kenya Theory of Change and data is provided for a selection of indicators from the Investment Case Results Framework, Health Financing priorities, and the World Bank Project as applicable. Please select indicators from the dropdown menu to view the data for each indicator. Where subnational data is available, the map will display subnational trends over time or the latest data available. Hovering over the map will display additional data for the select indicator. Clicking on a region will add it to the chart on the right. All data, including source information, may be downloaded by selecting the arrow to the right of the indicator dropdown menu.
Monitoring of Essential Health Services
The GFF supports routine monitoring of disruptions to essential health services. The essential health services data included in the graph below are sourced from country routine health information systems and shown monthly starting at the beginning of 2020. The analysis compared the observed service volume to what would have been expected had the pandemic not occurred, and reports the difference as a percentage. Positive values indicate a surplus of services, 0 indicates the expected level of services, and negative values indicate a lower volume than expected based on pre-pandemic values. In some countries, these changes in volume could be due to non-Covid-19 reasons.
The number of monthly deaths from Covid-19 is reported as a measure of the pandemic’s reach. The data on deaths from the Covid-19 pandemic were sourced from Johns Hopkins University (JHU) dashboards and compiled into monthly aggregates. The data used in this report were sourced 8/24/2021.