VZCZCXYZ0007
RR RUEHWEB

DE RUEHNR #2628/01 3550530
ZNR UUUUU ZZH
R 210529Z DEC 09
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 0191
INFO RUEHNR/AMEMBASSY NAIROBI

UNCLAS NAIROBI 002628 
 
SIPDIS 
FOR: AID GH/HIDN CHRISTOPHER BONNER 
 
E.O. 12958: N/A 
TAGS: EAID KHIV KWMN KOCI KE
SUBJECT: GLOBAL HEALTH INITIATIVE: KENYA COMMENT 
 
REF: 09 STATE 125761 
 
¶1.  Post appreciates the opportunity to comment on 
goals and principles of President Obama?s Global Health 
Initiative.  As stated, individual government agencies 
involved in defining practices, implementation, and 
governance have been actively involved in discussions 
(e.g. HHS/CDC, USAID, STATE), and have engaged with the 
field.  Note: Post was visited by S/GAC?s A. Gavaghan 
on November 10, 2009; she facilitated a GHI Listening 
Session where inputs from all agencies were solicited. 
 
¶2.  Kenya currently has the largest USG health 
portfolio globally (approximately $600 million/year), 
with major financial support from PEPFAR and the 
President?s Malaria Initiative (PMI). USG health 
programs in Kenya are implemented by four agencies: 
USAID, HHS/CDC, USAMRU, and the US Peace Corps. Beyond 
HIV and malaria interventions, USAID also is authorized 
to provide technical and financial support for family 
planning, maternal/child health, and tuberculosis. 
Both HHS/CDC and USAMRU provide substantial support for 
public health research, surveillance, and national 
surveys, and both have substantial research capacity 
through large field sites. HHS/CDC research focuses on 
malaria, HIV/AIDS, and emerging infectious diseases, 
and its programmatic work also extends to outbreak 
investigations, refugee health, and influenza in a 
strong partnership with the Ministries of Health.   The 
robust combined USG bilateral program aims to improve 
specific health outcomes, and to build capacity of the 
host country to assume key functions while promoting an 
increase to the GOK budget line item for health. 
 
¶3.  The principles of GHI ? a women-centered approach, 
strategic integration, leverage multi-lateral 
institutions, country ownership, sustainability, 
improve M&E, promote research development and 
innovation ? exist now in Kenya as pillars of the 
current program.  For this reason, much attention has 
been given to the health program in Kenya. 
Specifically, integration of vertical disease 
interventions has resulted in comprehensive, 
?horizontal? services delivered as a package to 
clients.  An example of a best practice, USAID has 
?blended? resources resulting in substantial health 
improvements in technical areas receiving relatively 
small funding (e.g. child health).  2008/09 Demographic 
and Health Survey (DHS) saw a welcome drop in the under 
five mortality rate from 114 to 74, thanks in large 
part to increased use of malaria bednets and childhood 
immunizations.  Integrated or ?wrap around? programs 
have been implemented in Kenya at large scales, with 
wide-spread HIV counseling and testing services also 
reaching family planning needs of all clients.  Some 
implementing partners are conducting door-to-door HIV 
testing, bringing a key package of health services into 
the privacy of one?s home.  Historically, Kenya has 
embraced the GHI principle of integration and 
demonstrated measurable results from this strategic 
approach. 
 
¶4.  USG agencies have also been keenly aware of 
development issues related to sustainability. 
Programming over $.5billion annually, USG is challenged 
to continue achieving great success while moving the 
country towards more sustainable health services. 
Capacity building, in the form of provider training, 
has helped produce a cadre of skilled health workers. 
Training in basic management and leadership skills is 
greatly improving the country?s ability to manage and 
supervise programs in the public and private sectors. 
HHS/CDC supports a Field Epidemiology and Laboratory 
Training Program that has greatly enhanced indigenous 
capacity for outbreak response and surveillance, and 
USG-supported research has contributed to dozens of 
Kenyan scientists obtaining higher degrees. 
Institutional capacity building in Kenya has allowed 
for some young NGOs to grow and mature, becoming 
eligible to raise funds and manage health programming 
at a standard respected by the international community. 
While sustainability challenges are great, Kenya is 
maximizing efforts to build the capacity of both 
individuals and institutions for long term health 
sector improvements. 
 
¶5.  The Kenya program places the client at the center 
of all health interventions.  While this has proven to 
help bring comprehensive services to mothers, children 
 
and their families, recent data has suggested that more 
could be done to focus on the health of mothers. 
Specifically, 2008/9 DHS data demonstrate that while 
major improvements are happening elsewhere in the 
country, maternal mortality is on the rise.  This has 
produced a national response, calling for greater 
emphasis on women as targets of primary health care. 
Safe motherhood programs will need to be expanded into 
rural regions to help reduce the risks associated with 
pregnancy and delivery.   Such programs should be 
integrated with current and future efforts to prevent 
mother-to-child transmission of HIV. In keeping with 
the GHI women-centered principle, Kenya programs will 
re-commit to investing in life-saving interventions 
that impact mothers and their newborns. 
 
¶6.  Other opportunities relevant to GHI include the 
principle of country ownership.  Large health 
portfolios, like that in Kenya, must face country 
ownership as an element of sustainability. GHI will 
need to emphasize GOK institutions ? Ministries, 
Universities, Regulatory Bodies and others, ? in 
addition to continuing support civil society and 
public-private partnerships.  Benchmarking of proxy 
indicators among host country governments will become 
increasingly important as part of the development 
assistance program.  For example, countries like Kenya 
could be encouraged to build annual increases into 
budget line items (e.g. anti retroviral procurement) 
with the aim of eventually supporting the majority of 
HIV patient drug needs.  Similarly, support for 
expanding access to social health insurance for the 
poor will remove financial barriers to care.  Research 
around market segmentation or private sector analysis 
of client preferences can help shift paying clients to 
private services and reduce the burden now placed on 
public facilities.  All of these proposed finance 
schemes reflect the need to shift ownership from 
international donors to the host country. 
 
¶7.  As expressed during the November Listening Session, 
USG agencies were unified in their belief that labor- 
intensive reporting requirements need to be better 
balanced against time needed to oversee the design, 
implementation, monitoring, and evaluation of on-going 
activities. PEPFAR has not benefited as much as it 
could have from operational research and the processes 
for learning quickly from implementation experience 
will have to be made simpler than the currently 
cumbersome Public Health Evaluation system. 
 
¶8.  In sum, Kenya?s large health program already aims 
to meet many of the GHI goals and principles.  With 
multiple USG agencies engaged in Kenya, in-country 
governance structures are well-established at both the 
policy and project levels (for HIV and malaria).  New 
structures might duplicate already highly functioning 
systems in countries where the health portfolio is 
stable, and mature.  Overall, GHI principles are firmly 
reflected in Kenya?s strong bilateral health program. 
RANNEBERGER