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Integrated Service Delivery Case Study:
Kenya
Erin E. Sullivan, Ph.D.
Global Health Delivery Project
Harvard School of Public Health
July 16, 2010
Kileken ole-MoiYoi, Erin Sullivan, Nayana Dhavan, George
Kimathi, Joseph Rhatigan, Ephantus Kabiru,
Rebecca Weintraub
Data Collection
• 50 key informants
– Well-defined roles in the country’s health
system
– Represented:
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Government of Kenya
Kenya-based NGOs
Internationally-based NGOs
Multilateral organizations
Private sector
Kenya: Country Context
Population:
38.5 million
Life expectancy:
56 for females
53 for males
UN Human
Development Index: 147 out of 182
GDP per capita:
US$ 1,590 (in PPP)
Kenya: Health System
Integration of HIV Program with
Health System
Health System Function
Integration with Health System
Stewardship and Governance
None
Financing
None
Planning
None
Service
Delivery
•Human
Resources
None
•Infrastructure
Moderate
•Procurement &
Supply Chain
Moderate
Monitoring and Evaluation
Limited
Demand Generation
None
HIV Program Financing
Office of the President
GoK
NACC
Ministry of Medical
Services
Ministry of Public
Health &
Sanitation
Integration of HIV Program with
Health System
Health System Function
Integration with Health System
Stewardship and Governance
None
Financing
None
Planning
None
Service
Delivery
•Human
Resources
None
•Infrastructure
Moderate
•Procurement &
Supply Chain
Moderate
Monitoring and Evaluation
Limited
Demand Generation
None
Integration of HIV Program with
Health System
Health System Function
Integration with Health System
Stewardship and Governance
None
Financing
None
Planning
None
Service
Delivery
•Human
Resources
None
•Infrastructure
Moderate
•Procurement &
Supply Chain
Moderate
Monitoring and Evaluation
Limited
Demand Generation
None
Integration Challenges
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•
•
•
•
Global Fund model
Limited infrastructure to support programs
Poor M&E structures
Conflicts of interest within the CCM
Delays in funding
System-wide Effects
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Concerns about long-term sustainability
Neglect of non-target diseases
Parallel systems
Human resource challenges
Conclusions
• Disease programs should improve integration
with public health system
• A relatively strong health system maximizes
Global Fund resources
• Investments in workforce, infrastructure and
government capacity ensure sustainability
• Coordination and alignment between health
system stakeholders is needed
Further Research
• Sustainability and governmental capacity
• Donor alignment and management
Integration
• ‘integration’—a term loosely used to describe a
variety of organizational arrangements for a
range of programmes in different settings.
• we define integration as the extent, pattern, and
rate of adoption and eventual assimilation of
health interventions into each of the critical
functions of a health system which include, (i)
governance, (ii) financing, (iii) planning, (iv)
service delivery, (v) monitoring and evaluation
(M&E), and (vi) demand generation.