肯尼亞新冠疫情預算：用于健康和福利資金.doc

1、肯尼亞新冠疫情預算：用于健康和福利資金E_ecutive summary3Key findings3Remendations for the government of Kenya4The new Covid-19 conte_t5National and county-level spending on health care6The structure of healthcare funding in Kenya6Recent trends in healthcare budget allocation6Budgetary allocations to health programmes1

2、0Preventive, Promotive and Reproductive, Maternal, Neo-natal, Child and Adolescent Health Services10Disease Surveillance and Response10Non-municable Disease Prevention and Control11municable Disease Control11Reproductive, Maternal, Neo-natal, Child and Adolescent Health12National Referral and Specia

3、lized Services13National Referral Services13Specialized Medical Equipment13Health Products and Technologies14Forensic and Diagnostics14Health Policy, Standards and Regulations15Health Policy Planning and Financing15Social Protection in Health16Budgetary allocations to social protection programmes17C

4、onclusion and remendations20Remendations for the government of Kenya20Notes22E_ecutive summaryAs the impact of Covid-19 continues to escalate, accountable public budgets that are aligned to the needs of people living in poverty and vulnerable populations are more crucial than ever.In the 2021/21 fis

5、cal year, Kenya will not only be dealing with the social, health and economic effects of Covid-19 and the impacts of the government response, but will also be upscaling the universal health coverage (UHC) programme.UHC is part of the national governments priorities for the third medium-term plan, wh

6、ich covers the period 20_ to 2022.The first phase (pilot) of the UHC programme covered four of Kenyas 47 counties.In 2021/21, the government intends to roll out the programme in the remaining 43 counties.This paper presents an analysis of Kenyas national government health and social protection budge

7、t for the 2021/21 fiscal year.Key findingsKenyas economic growth is e_pected to reduce significantly from 5.4 in 20_ to 1.5 in 2021, due to Covid-19 pandemic.This reduction is e_pected to affect revenue collection negatively in 2021/21.The level of household vulnerability is e_pected to increase as

8、the social and economic challenges stemming from Covid-19 pandemic and the response measures escalate.The national government has earmarked KES1,752 billion 1 for its ministries,departments and agencies (MDAs) a decrease of 6.8 pared with the 20_/20 allocation.Additionally, allocation to county gove

9、rnments, has reduced by 2.3 to KES370 billion.While the budgets for over half of the MDAs have reduced, allocation to the Ministry of Health has increased by 10.3 to KES114 billion pared with 20_/20.Additionally, the share of the Ministry of Health in the total budget for MDAs has increased from 5.5

10、 in 20_/20 to 6.5 in 2021/21.The allocation to the Ministry of Health will go mainly to the National Referral andSpecialized Services Programme and the Health Policy, Standards and Regulations Programme that account for 37.2 and 34.4 of the national government health budget respectively.KES2.7 billi

11、on has also been earmarked for the Kenya Covid-19 Emergency Response Project to facilitate Covid-19 testing and treatment.Allocation to this project has remained unchanged pared with the 20_/20 second supplementary budget.Conservative funding gap estimates do not take into account the impact of Covi

12、d-19as they were pleted in 20_ before the outbreak of the pandemic.Such estimates suggest that the Ministry of Health has a funding gap of KES95.3 billion.With Covid-19, the actual funding gap is likely to be significantly higher.In April, the 20_/20 budget was revised, leading to an increase in all

13、ocations to the National Safety Programme (NSNP) by KES8.7 billion i.e.from KES30.2 billion to KES38.8 billion.However, this increase has not been sustained in the 2021/21 budget as funding to the NSNP has reduced by KES10 billion to KES28.8 billion, despite the possible escalation of needs during C

14、ovid-19 pandemic.By contrast, allocations to the Hunger Safety Programme has increased byKES287 million (7) to KES4.4 billion.This increase however, does not pensate for the reduction in allocation to the NSNP.Remendations for the government of KenyaPlanned spending on Covid-19 response should prior

15、itise e_pansion of quarantine centres, availability of equipment such as ventilators, and personal protective equipment to ensure access to treatment/care, as well as provision of water, sanitation and hygiene services, and masks in high risk informal urban settlement which are home to the majority

16、of vulnerable people and households living in poverty.Allocate resources to implement measures aimed at ensuring continued access totreatment/care services for all non-municable diseases as patients with underlying conditions are more vulnerable to Covid-19.Furthermore, investment in NCDs control an

17、d prevention is important for poverty reduction since households living in poverty with a member suffering from a NCD may be pushed further into poverty due to catastrophic health e_penditure.Apart from supporting level 4 and 5 hospitals to access modern diagnostic and treatment equipment through th

18、e Managed Equipment Services, the national government should also consider allocating resources to equip dispensaries and health centres with adequate medical equipment.The scope of the emergency relief programme financed through the Covid-19Emergency Response Fund should be e_panded to include vuln

19、erable rural households.While the prevalence of Covid-19 is currently lower in rural areas pared with urban areas, rural households living in poverty who depend on agriculture and remittances are likely to bee more vulnerable due to limited access to markets for their produce and a reduction in remi

20、ttance inflows during the pandemic.The national government should sustain increased allocation to the National Safety Programme to ensure all vulnerable populations are supported.More households are likely to bee vulnerable, as the social and economic effects of Covid-19 continue to escalate, with p

21、ossible adverse medium and long-term impacts on livelihoods and household wellbeing.The new Covid-19 conte_tKenyas 2021/21 national budget has been prepared at a time when the country is grling with the health, social and economic impacts of the Covid-19 pandemic and containment measures.Lives have

22、been lost and human suffering continues as a result of the infection, while containment measures within borders and elsewhere have led to loss of jobs/livelihoods and disruption of supply chains.Apart from curbing the escalation of Covid-19 cases, the government will be scaling up implementation of

23、the Universal Health Coverage (UHC) programme to reach all the 47 counties.2 The first phase (pilot) of the UHC programme covered only four counties.Accordingly, funding the health sector and social protection programmes will play a critical role in e_panding the coverage of health services and prov

24、iding financial support/assistance to vulnerable households to meet basic needs during the pandemic.Covid-19 pandemic is e_pected to significantly affect economic growth, with implications for revenue collection and government e_penditure in 2021/21.Kenyas economic growth is projected to reduce from

25、 5.4 in 20_ to 1.5 in 2021 due to disruption of global supply chains, low demand for Kenyas key e_ports such as horticulture, reduced tourism earnings, slowdown in remittance inflows and the measures taken by the government to curb the spread of the virus such as night curfew and closure of schools.

26、3National and county-level spending on health careThe structure of healthcare funding in KenyaKenya adopted fiscal decentralisation follog the official publication of the Constitution of Kenya in 2021 and the establishment of county governments in 20_.4 Decentralisation was introduced to enhance the

27、 delivery of public services through involvement of citizens in decision-making at the local level, improved accountability and more efficient allocation of funding.In the health sector, the national government is responsible for development of health policy, management of national referral hospital

28、s, capacity building and providing technical assistance to counties.County governments, on the other hand, are responsible for delivery of primary and secondary health care using funds disbursed from the national government and county own-source revenue.An analysis of Kenyan healthcare funding in th

29、e conte_t of Covid-19 needs to consider public spending at both national and county level.Analysis presented in this report focuses on the national government budget as a first step towards understanding the planned public invest in healthcare in 2021/21.While funding is overseen at the county level

30、 for some aspects of the healthcare system, the Kenyan national government continues to control a significant share of total health spending.For instance, the national government accounted for an estimated 44 of total health spending in the fiscal year 20_/19.The national government also oversees a

31、number of important programmes aimed at enhancing access to health care, as e_plained in subsequent sections of this report.Accordingly, an analysis of how national government resources are being allocated is a useful tool to support and inform discussions with decision-makers in order to ensure nat

32、ional health programmes are adequately resourced.Recent trends in healthcare budget allocationIn the fiscal year 2021/21, budgetary allocations to county governments are due to fall by 2.3 to KES370 billion (11.6 of the total budget of the government of Kenya) pared with 20_/20 (Figure 1).The alloca

33、tion consists of conditional grants amounting to KES16.7 billion an increase of 8.2 pared with 20_/20.These funds are earmarked for leasing medical equipment; support for level 5 (county referral) hospitals; pensation for user fees foregone by rural health centres and dispensaries; and support for u

34、niversal health coverage (UHC).In order to implement other healthcare activities (such as e_panding health facilities and purchasing medical supplies), counties are e_pected to allocate additional resources to the health sector, depending on their priorities.Figure 1: Budgetary allocations to county

35、 governments, 20_/18 to 2021/2111.811.6Amount in KES billions35030025011.811.6Amount in KES billions35030025034612.812.1131211Levy FundConditional grants from national governmentConditional grants from10development partners20_15098County equitable share allocation1007506-20_/1820_/1920_/202021/215Sh

36、are of countyallocations in total budget 37637837014Allocations from FuelSource: Development Initiatives (DI) based on national government budget documents, 20_/18 to 2021/21.The 2021/21 national government health budget increased by 10.3 to KES114 billion pared with the 20_/20 second supplementary

37、budget prepared in April 2021 (Figure 2).However, the allocation is KES1.59 billion lower than the pre-Covid-19-pandemic health budget, which stood at KES115.6 billion in the 20_/20 first supplementary budget made in December 20_ (Figure 2).Resource requirement estimates made in 20_ showed that KES2

38、09.4 billion is needed to implement national government health programmes in 2021/21.While these estimates are conservative since they do not consider the impact of Covid-19, they indicate a huge funding gap (KES95.3 billion).The actual funding gap is likely to be much higher if the health needs ste

39、mming from the Covid-19 pandemic are taken into account.Figure 2: Budgetary allocations to the Ministry of Health, 20_/18 to 2021/21 5Amount in KES millions140Amount in KES millions120100806040200103.490.078.4103.490.078.49.812.36.338.342.539.637.940.217.57.723.89.29.939.27.28.046.88.813.910.19.99.1

40、8.58.935.935.9General Administration, Planning and Support ServicesHealth Research and DevelopmentPreventive, Promotive and RMNCAHHealth Policy, Standards and RegulationsNational Referral and Specialized ServicesSource: Development Initiatives based on national government budget documents, 20_/18 to

41、 2021/21.Note: RMNCAH = Reproductive, Maternal, Neo-natal, Child and Adolescent Health.In 2021/21, the funds earmarked for the national governments ministries, departments and agencies 6 (MDAs) have been reduced by 6.8 pared with the 20_/20 second supplementary budget (Figure 3).Accordingly, the bud

42、gets for over half (57.2) of the MDAs have been reduced.Noheless, the share of funding allocated to the Ministry of Health as a proportion of the total allocation to MDAs has increased to 6.5 (Figure 3).The ne_t section of this paper goes on to analyse funding allocated to three national health prog

43、rammes that are implemented by the Ministry of Health and the budgetary impact of challenges posed by the Covid-19 pandemic.Figure 3: Ministry of Health budgets as a proportion of total MDA allocation, 20_/18 to 2021/21Amount in KES billions2,500Amount in KES billions2,0001,5001,000500Total allocati

44、on to national government MDAsShare of Ministry of Health in total allocation to MDAs6.55.96.55.95.55.05.31,5781,6981,7521,8791,967654321-20_/1820_/1920_/20 FirstSupplementary Estimates20_/20 Second Supplementary Estimates02021/21Source: Development Initiatives based on national government budget do

45、cuments, 20_/18 to 2021/21.Note: MDAs = ministries, departments and agencies.Budgetary allocations to health programmesThis section analyses the allocation of budgets to various subprogrammes under the follog three national health programmes implemented by the Ministry of Health and analyses how bud

46、getary decisions in these areas may impact on Kenyas response to Covid-19:Preventive, Promotive and Reproductive, Maternal, Neo-natal, Child and Adolescent Health ServicesNational Referral and Specialised ServicesHealth Policy, Standards and Regulations.Preventive, Promotive and Reproductive, Matern

47、al, Neo-natal, Child and Adolescent Health ServicesThis section focuses on four subprogrammes under the Preventive, Promotive and Reproductive, Maternal, Neo-natal, Child and Adolescent Health Services programme: Disease Surveillance and Response (focusing on emergency response and contingency plann

48、ing for Covid-19); Non-municable Disease Prevention and Control; municable Disease Control; and Reproductive, Maternal, Neo-natal, Child and Adolescent Health (RMNCAH).Each subprogramme is being financially impacted by Covid-19, through new pressures on resources or a reduction or increase in budget

49、 for 2021/21.Disease Surveillance and ResponseThe national government created a Covid-19 contingency plan to facilitate preparedness, early detection and response to the pandemic.The cost of implementing the plan was estimated at US$82 million 7 (KES8.7 billion).Of this costed need, 61 was funded by

50、 the World Bank (US$50 million).8 In May 2021, the International Moary Fund also roved the disbursement of US$739 million (KES78.3 billion) to Kenya under the Rapid Credit Facility to enable the country to cover its urgent balance of payment needs resulting from the pandemic.9 While increased borrog

51、 will enable the government to fund its response to the pandemic, it will also increase the public debt burden, which crossed the KES6 trillion mark in December 20_.Public debt is a concern in Kenya; in 20_ the ratio of debt service to revenue stood at 45.2, which is significantly above the remended

52、 threshold of 30, and is projected to increase to 47.9 in 2022.10In the 20_/20 second supplementary budget estimates, the Disease Surveillance and Response subprogramme was added to the budget to finance the Kenya Covid-19 Emergency Response Project.This subprogramme will receive KES2.7 billion in 2

53、021/21,which is the same as the amount allocated to it in the 20_/20 second supplementary budget.The allocation will be used for Covid-19 testing and treatment.Key challenges to the response to Covid-19 pandemic include limited availability of testing kits, personal protective equipment for health p

54、ersonnel, and equipment such as ventilators.In urban informal settlements which are home to the majority of vulnerable people and households living in poverty, curbing the spread of Covid-19 is constrained by limited availability of water and sanitation services and crowded living conditions that pr

55、esent challenges for observing social distancing guidelines.Additionally, mass testing in informal settlements that have bee Covid-19 hotspots is slowed by stigma and fear of testing positive.Allocating resources to address these challenges will be critical in the response to the Covid-19 pandemic.N

56、on-municable Disease Prevention and ControlNon-municable diseases (NCDs) account for over half of total hospital admissions and slightly more than half (55) of hospital deaths in Kenya.11 The major NCDs in the country include cardiovascular conditions, cancer, diabetes, chronic respiratory diseases,

57、 and mental illnesses.Investing in the prevention and control of NCDs is crucial for effective response to the Covid-19 pandemic, as people living with NCDs may be more vulnerable.12 Covid-19 response measures can also have significant impacts on people living with NCDs.For instance, measures such as quarantine can undermine management of NCD behavioural risk factors such as unhealthy diet and physical inactivity.13 Increased demand for specialised treatment during the Covid-19 pandemic can also lead to disruption of treatment for NCDs due to the limited availability of facilities such as i