DOMESTIC RESOURCE MOBILISATION A guide to Kenya’s Health Sector

IntroductionThe health system in Kenya, while comparatively robust and well supported financially both by the government and donors, requires a shift in focus to harmonisation and coordination of health systems strengthening activities to increase effectiveness and efficiency in the use of funds and also act as a catalyst to crowd in other resources. In pursuit of SDG 3 – Health for All.By strengthening relationships and creating an enabling environment

for both private and public partnerships, Kenya’s health sector has an opportunity to grow further, mobilise more resources through multi-disciplinary efforts.

Fostering partnerships shall also have the added benefit of deriving more value from traditional donors in an efficient manner, grow the sector’s absoptive capacity for ODA and crowd in other sources of finance by increasing the capacity to reach out to more development partners.

ODA in Kenya

Domestic Resource Mobilisation The health sector has immense capacity to mobilise

resources locally by: Building allocative efficiencies to better manage

available resources; Implementing better fee collection systems to

ensure collection and accountability of client payments;

Setting up sub-national (county level) resource mobilisation secretariats to tap into non-traditional donors and other official flows by initiating and managing relationships with these development partners

Kenya’s types of ODA Financing Instruments

ODA Activity ODA to the health sector averaged $ 741,648,600 in

the last 5 years (see graph on slide 3), while the country showed growth in concessional loans received, as evidenced by the significant increase in the loans holding with comparatively negligible growth in interest payments.

This goes to show the country is moving towards more complex financing instruments and places the health sector in an advantageous position totailor finance to needs, by matching financing instruments to specific needs, as recommended by Susan McAdams, World Bank Group Senior Advisor, Financing for Development https://class.coursera.org/fin4devmooc-001/lecture/view?lecture_id=17.

Health Sector ODA Harmonisation The significant ODA for health in Kenya is inefficiently spent,

affected by factors ranging from lack of capacity (human resource, skills, knowledge etc) to lack of coordination between donors. Also, the country’s new devolved system of government makes efforts to align activities at a sub-national level more challenging than before devolution.

Ngozi Okonjo-Iweala, former finance minister in Nigeria, in her video-talk on Domestic Resource Mobilisation (link below) makes a case for sub-national governments critical role in development, suggesting incentives to mobilise and efficiently use resources. These same sub-nationalgovernments should each take it upon themselves to initiate activity creates harmonisation of ODA in the health sector that crowds in other sour

ces of finance such as other official flows and philantrophic funds. https://class.coursera.org/fin4devmooc-001/lecture/view?lecture_id=19

Leveraging ODA 1 Again, Ngozi Okonjo-Iweala, in her video-talk

(link below) on the Importanceof ODA,makes the case for ODA’s impact going beyond actual finances to act as a catalytic source of finance, over and above direct sectoral investment but as a pull to attract private sector resources and mitigate risk. She also speaks of the reducing ODA to Africa, presenting an opportunity to grow this by leveraging current ODA.

https://class.coursera.org/fin4devmooc-001/lecture/view?lecture_id=11

Leveraging ODA 2 In Kenya’s health sector, ODA (in the form of technical assistance)

from various donors including the World Health Organisation, the World Bank, CDC, THE German Development Corporation (GIZ) and others came together for the launch of the private sector and academia led Health Sector Development Partner Forum (HSDPF); a platform for North-South, South-South and Triangular partnerships and coordination.

HSDPF, within its remit, focuses on domestic resource mobilisation and its participants include the county governments, civil society and faith based organisations, professional associations, health sector businesses and others, collectively working with development partners to strengthen the health system through a coordinated approach that creates an enabling environment for the private sector, a platform for dialogue and knowledge sharing and a collectivised effort to domestic resource mobilisation and crowding in resources.

Leveraging ODA 3 As a specific example of crowding in resources, HSDPF

used the technical assistance given by the WHO and World Bank Group to form a Public Private Partnership with the Kenya Medical and Dental Practitioners Board and the Kenya Pharmacy and Poisons Boards to approach the E.U.’s Horizon2020 multi-lateral fund, via an EDCTP grant www.edctpgrants.org , in response to a €3,300,000 grant opportunity to strengthen national oversight bodies, Part of which shall be used to fund a secretariat to raise more funding.

This shall provide a new source of funding for the country’s health sector from a previously untapped donor, effectively increasing ODA inflows, partners and impact in the country.

Logic Overview for Relevance Tying the donor inputs (in this case ODA,

as in the diagram on the next slide with resultant activities and the immediate results of these activities to mid and longer term outcomes and impact respectively provides an overview of how ODA is being used in a creative manner, as recommended by Ngozi-Okonjo-Iweala in the video ‘The importance of ODA’ https://class.coursera.org/fin4devmooc-001/lecture/view?lecture_id=11

The health sector in Kenya

• • Consistent with national/regional development policy•• End users are involved• Fits the gender specific context

Output-outcome-impact logic overview

Inputs Activities OutputsImmediate results of project activities

OutcomesShort-term / intermediate

ImpactsLong-term

No, or mitigated, negative social and environmental consequences• Financially sustainable project• Parties involved are capable and have the capacity to carry out the project• Technology is suitable•Consistent with national policy ;• Institutional, financial and judicial factors have been taken into account

Assumptions (for a sustainable project)

Knowledge and know-

how

Project budget / ODA

Capacity Building

Awareness creation and Communication

Domestic Resource Mobilisation

Policy Dialogues

Networking

Business case is

carried out,:1.Health Care

Providers Trained;

2. End users, general pubic,

professionals reached3. Joint

Projects;4. Increased

funding;5. Impact

health policy;6. Secretariat

.

Improved board Recognition

Improved Board Functionaity

Improved Board performance

Changes in poverty alleviation and self

reliance

Changes in sustainable growth

Changes in social and economic

burden of disease

Foreseen results

SDG 17 Partnerships for the Goals HSDPF as detailed

above creates a platform for partnerships, including Public Private Partnerships s to achieve SDG 17;

These partnerships in turn target specific SDG’s, such as SDG 3 – Health for all;

HSDPF uses ODA creatively to build local capacity and crowd in other sources of finance as one of it’s domestic resource mobilisation activities.

WHO Endorsement I commend the organisers for

the theme “Sustainable Health Care Partnerships in Devolution” and called for: domestic resource mobilisation, people-centred integrated care, affordability, access, sufficient capacity of health workers and recognition of the role other sectors play in assuring human health.

Dr. Mandlhate also encouraged pursuit of global goals in the new SDG framework.

The World Health Organisation County Director Kenya Dr. Custodia Mandlhate delivering the Keynote speech at the opening of the Inaugural Health Sector Development Partner Forum.http://www.slideshare.net/EmmanuelMosoti/who-country-representative-dr-custodia-mandlhate-keynote-speech-at-the-launch-of-the-health-sector-development-partner-forum-8102015