1. Health care funding sources Sources Proportion (%)MechanismsDistribution Gvt 30Taxes (direct & indirect)D –progressive ID-regressive?? Donor 16Thro’ budget/Off budget?? HH 51OOP/insurance (Private/NHIF,CBHI) Regressive Firms 2.3Insurance (private/NHIF/CBHI) ???? NGOs/other 0.7Programmes/projects???

2. How are funds pooled % of PopnGroups covered Distributi on Allocation mechanism Purchasing Payment mechanis m NHIF7.1 Formal SES?? Regressive AccreditationAccreditation &contracting Reimburse hotel costs Private Insurance 2.3 SES- formal& informal Regressive Risk rated premiumcontracting Fee for service CBHI Very Minimal InformalRegressive Community ratingContractingCapitation/ fee for service Gvt59%???All?? Need based/historical FacilitiesBudget allocation &salaries NGOs41???All??? Priority programmes?? Facilities??

3. Payment mechanism Services included in the benefit package: –NHIF- ‘hotel costs’ –Private insurance- all but depends on the premium. –Govt-all? Equitable financing and delivery Who bears the burden? OOP- the poor( no discrimination at the point of purchase)- inequitable Govt (Taxes)- All NHIF-inequitable-there is a “cap” after a cont of Kshs.320 Private insurance-the rich-inequitable

4. Who benefits from health care Govt- (Rich)70% of Govt resources goes to hosp care- based in urban where the rich are found. – Utilization of health care at hosp. is dominated by the rich while at primary health care facilities by the poor (BIA). OOP- Rich?? Private insurance-rich NHIF-Relatively rich

5. Factors contribute to equity/inequity in financing What factors contribute to equity/inequity in financing in your country –Distribution of facilities –Distribution of financial &human resources –Quality of care –Mechanisms to protect the poor are not working To what extend does the system protect the poor –Waivers &exemption mechanisms –10/20 policy –Free health care for the under five/maternity ?? –Free health care for HIV/AIDS patient-only ARVs, pay for CD4 count & other tests

6. Way forward towards universal coverage Phased implementation Define the package and keep on expanding it as the contributions and economy improves Distribution of health personnel Rehabilitate facilities Address the issue of quality of care Improve governance efficiency issues-NHIF and MoH

7. Lesson learnt Sustained economic growth Stakeholders involvement Political will Policy champion