Curbing with Kenya’s dependency on donations

Health systems in most low- and middle-income countries face two major obstacles: insufficient domestic funding and inefficient use of available resources. While the problem of insufficient domestic funding has partly been mitigated by foreign aid, these arrangements are changing quickly: As countries move from low- to middle-income status, they are perceived as capable of financing their health systems. 

My findings suggest several actions that can be taken to better appreciate Kenya’s current reliance on external funding and to make arrangements for its exit from aid.

Firstly, Proactively prepare for CHANGE, even where it is not an immediate reality. Kenya should accelerate plans to identify and manage areas of health system vulnerabilities via a domestically formulated transition readiness plan. Developing this plan is a nontrivial pursuit and will likely require resources that some might argue could be better spent elsewhere. However, if long-term sustainable financing through domestic resources is a goal worth pursuing, then developing a transition plan is a necessary next step.

Secondly, Increase domestic resources for health. Although financing alone will not resolve all change-related concerns, ensuring adequate funds are available for all health programs is essential for meaningful progress toward health. The major hurdle to overcome will be how best to increase domestic health spending in the face of economic challenges made worse by the COVID-19 pandemic and, more important, the increasing burden of servicing external debt. Can stakeholders muster the political will to preserve and increase health care budgets while other sectors face potential budget cuts?

Thirdly, Address health system inefficiencies. Fully replacing donations may not be necessary if inefficiencies were created as part of donor programs. The World Health Organization (WHO) estimates that improving efficiency in health systems of current health spending. So, identifying and remedying areas of inefficiencies will help Kenya as it deals with change in both the short and long term. Improving efficiencies requires a willingness to:
(a) put more emphasis on improving health care workers’ competencies and skills rather than health worker numbers, (b)modify programs that are not working optimally, permanently stop practices/programs that no longer work, or require closer integration of donor-funded health programs with country health systems, and (c) more integration of donor-supported programs into the health system to avoid duplication and reduce administrative costs.

Fourthly, Improve tracking and reporting on external reliance on health aid. Existing measures of donor dependency and donor concentration are not comprehensive, and often exclude major considerations such as capital investments. So, it is difficult to assess the true extent of donor dependency and donor concentration. Furthermore, tracking progress is difficult as it requires frequent collection of high-quality data that might be difficult to achieve without necessary budgetary provisions.

Finally,Identify clear pathways for sustaining effective coverage. Donors should evaluate and adapt their transition planning and approaches to ensure they are helping countries meet the overarching goal of a transition from aid: maintaining effective service coverage. In some cases, the long-term goals of sustaining effective coverage on one hand and ensuring successful transition on the other hand, might lead to opposing policy prescriptions. Both donors and in-country stakeholders should be open to exploring different options within a monitoring framework that encourages learning and adaptation.