Maternal Health in Kenya: An Important Agenda Abdo Yazbeck, Health Practice Manager Lead Health Economist World Bank Nairobi, August 2014

Outline  Which comes first, Health or Wealth?  How is Kenya doing on health outcomes?  Kenya’s health systems challenges (financing, quality, coverage)  Amazing county level variations in performance  Global best practice for health systems and maternal health  Take home messages

Health or Wealth First? In East Asia, both Health and Wealth Improved fast, but Health Came First and Drove Wealth (e.g. the Demographic Dividend) Green Line=GDP/capita; Blue dots=Child Mortality (4 graphs)

Health or Wealth First? In SS Africa, Wealth is growing fast, but Health is not (Wealth is not Producing Health)

HEALTH OUTCOMES A Mixed Story for Kenya

Under-5 Mortality and health exp.: deviations from estimates based on per capita income and education Kenya underspending with average Under-5 Mortality

Child and Infant Health outcomes Start-Stop-Start Performance on Child Health in Kenya

8 Maternal Mortality in Kenya and Neighboring Countries Kenya’s Maternal Mortality Rates Declined, but more modestly compared to countries in the neighborhood

Female Adult Mortality Rank Kenya’s Female Adult Mortality position faltering

TFR (Stagnation in Kenya) Comparable to Brazil in 70s

HEALTH SYSTEMS Financing, Quality, Accessibility, and County Variations

Kenya spends about only 6.5% of its budget on health… Limited Public Commitment to Health Spending

13 Health sector continues to be predominantly financed by private sector sources (including by households’ out-of-pocket (OOP) spending); Public sector financing has remained constant over the last decade, at about 29 percent of THE; Donors contribution has more than doubled, from 16 percent in 2001/02 to 35 percent in 2009/10. Sources of Health Financing

Sarajevo, September 23, 2009

15 Proportion of health facilities offering Basic-Emergency Obstetric care

Health System Global Best Practice Improving the availability of a skilled birth attendant closely connected with a capable and acceptable referral system (these include):  Making midwife backbone of the initiative (Sri Lanka and Malaysia)  Increasing availability of facilities that can provide basic and essential obstetric care.  Effectively using birthing centers/waiting homes (Honduras, Indonesia and Zimbabwe). Kenya is doing this with support from partners in the Coast and North East.  Reducing demand side barriers through free services (Malaysia and Sri Lanka) and recently announced by Kenya. This however requires close monitoring to ensure quality.  Reducing the cultural barriers - involvement of traditional birth attendants (Malaysia) to link with formal midwives.

Main Messages  One mother dies every two hours in Kenya  Most maternal and new born deaths are preventable and the interventions are well known which are not expensive  With the devolution, you are uniquely placed to address this persisting scrooge by implementing interventions that are relevant for your counties (marrying global knowledge with local response)  The partners gathered here are fully committed to collectively to support you