Kenya's health transitions

Country data summary

October 2021

Kenya is undergoing four key transitions in its health sector—demographic transition, changes in disease burden, a transi-
tion away from development assistance for health, and a shift towards domestic financing for health. Despite health gains
in previous decades, Kenya is facing a high burden of communicable diseases and a rapidly increasing burden of non-com-
municable diseases (NCDs). It is also experiencing high population growth and financial challenges resulting from donor
transitions. In this profile, we summarize the key transitions that will have an impact on achieving universal health coverage
(UHC) in Kenya.

Demographic transition Disease (epidemiological) transition

Kenya is a young country with about 60% of its citizens be-
low the age of 24, and it will remain relatively young for the
next couple of decades.1 The country is also rapidly urbaniz-
ing: while three-quarters of the population still live in rural
areas, nearly half of the country’s population is projected to
live in cities by 2050.2 The Kenyan government will need to
understand its current and changing demography to fulfill
the health needs of its population.
Kenya is increasingly facing the problem of a double dis-
ease burden. Despite a fall in the annual mortality rate from
communicable diseases, communicable diseases continue
to make up the greatest number of annual deaths in Kenya
(54%).3 At the same time, deaths from NCDs and injuries are
on the rise. It is projected that NCDs and injuries will be the
primary cause of death in Kenya by 2030. 4 Disability-adjust-
ed life years (DALYs) also follow this same pattern.

Domestic finance transition Donor health aid transition

Domestic government expenditures for health have been
increasing as a share of total health expenditure in recent
years (up from 29% in 2000 to 43% in 2017) while external
aid as a share of total health expenditure is on the decline
(down from 28% in 2006 to 18% in 2017.)5 Despite prog-
ress in domestic resource mobilization for health, domestic
health expenditure as a share of general government ex-
penditures, a measure of health sector prioritization, has re-
mained fairly stagnant since 2005 (7% in 2005, 8% in 2017.)5
Despite overall declines in donor resources for health in re-
cent years, donor aid continues to play an important role in
Kenya’s health financing landscape. In particular, the United
States is the largest donor, with most of its funds focused
on HIV/AIDS.6 Kenya is facing several key donor transitions
in the near-term future that could impact its health financ-
ing landscape and it must prepare accordingly.

Development indicators Health statistics

GDP $87.9 bn 2018 Life expectancy at birth 66.7 2018
Gross national income (per capita) $1,620 2018 Infant mortality rate per 1,000 live births 35 2019
Domestic public health expenditure (% GDP) 2.10% 2017 Maternal mortality ratio per 100,000 live births 342 2017
Literacy rate, adults 81.50% 2018 Doctor- population ratio per 1,000 population 0.157 2018
Human Development Index 0.579 2019 Public health expenditure (% GDP) 4.80% 2017
Source: World Bank Development Indicators7
Abbreviation: GDP, gross domestic product

This is one in a series focusing on middle-income countries that are transitioning out of official development
assistance for health. The profiles are part of a broader study called Driving health progress during disease,
demographic, domestic finance, and donor transitions led by the Center for Policy Impact in Global Health.
 Kenya's health sector transitions: impact data summary n 2
Demographic transition
Key takeaways
• Between now and 2050, Kenya’s population structure will rapidly grow, urbanize, and informal sector (thereby leaving them unqualified for employer-provided insurance),
age, creating profound challenges for the healthcare system. and are at higher risk of NCDs and injuries.
• To achieve UHC, annual health spending per person needs to grow faster than the • Healthcare in Kenya will need to evolve to tackle the increasing burden of risk factors
rapidly growing population. associated with a rapidly urbanizing population and the changing geographic distribu-
• Currently, Kenya has a “young” population. Kenya will need to address the health con- tion of health service needs.
cerns of its youth, who face high unemployment rates, work disproportionately in the

Population of Kenya (2000, 2020, and 2050) Population growth (millions)

Source: United Nations, Department of Economic and Social Affairs9

Source: Population Pyramids of the World 8
Working age dependency ratio (% population) Demographic transition
120
2000 2020 2050

Source: Population Pyramids of the World 8, The World Bank7,

United Nations, Department of Economic and Social Affairs9
100
% of working-age population

Median age (years) 17 20 28

80 0-4 (% of population) 17% 13% 9%
Source: World Development Indicator7

60 5-19 (% of population) 40% 37% 26%

20-64 (% of population) 41% 48% 58%
40
>64 (% of population) 2% 2% 8%
20
Age dependency ratio 89.06% 80.87%* -

0 Rural (% of population) 80% 72% 54%

1980
1981

1983
1984
1985

1988
1982

1986
1987

1989

1991
1992
1993

1995
1996
1997

1999

2003
2004
2005

2010
2000
2001

2014

2016
2017
1998

2006

2008
2009

2011
2012

2019
1990

1994

2002

2007

2013

2015

2018

Total population (millions) 31,965 53,771 91,575

Disease (epidemiological) transition

Key takeaways
• Communicable diseases are still the primary drivers of mortality in Kenya. But the • As its NCD burden continues to grow, Kenya must ensure NCD service access and
burden from NCDs and injuries is on the rise. affordability; currently, services are costly and there are disparities in access.10
• Kenya, like many lower-middle income countries, faces a double burden of disease— • Kenya must also continue to improve and expand access to essential healthcare
tackling communicable diseases amidst a rising burden of NCDs and injuries. for communicable diseases and maternal and child health (MCH) conditions, while
accounting for regional and socio-economic disparities.

Main causes of mortality Adult morbidity and mortality (15-59 years) Neonatal mortality rate & maternal mortality ratios
Deaths, rate per 100,000 population 60,000 900 30 800
Deaths (rate per 100,000 population)
DALYs (rate per 1000,000 population)

4%, 13,413
6%, 18,555 800
7%, 20,463 50,000 700
25
19%, 60,782 700

MMR (per 100,000 live births)

NMR (per 1,000 live births)

600

Source: Global Health Data Exchange11, World

29%, 90,473 40,000 600
20
500
39%, 114,524 500
Source: Global Health Data Exchange11

30,000
400 15 400

20,000 300 300

77%, 252,756 10
65%, 200,906 200

Development Indicator7
10,000 200
54%, 158,901
100 5
100
0 0
0 0
2001

2005

2007

2008

2014
2010

2011
2000

2003
2002

2004

2006

2009

2012

2013

2015

2016

2017

2000 2010 2019

Injuries
Non-communicable diseases
Communicable, maternal, neonatal, and nutritional diseases DALYs Deaths Neonatal mortality rate Maternal mortality rate

DALYs, rate per 100,000 population

4%, 799,343 Top causes of deaths per year (both sexes, all ages, Disease burden (types of disease, both sexes, all ages)
6%, 1,087,597 per 100,000 population)
17%, 3,674,571 7%, 1,184,581
2000 2010 2019 Avg. AROC*
27%, 5,224,569 2000 2010 2019 Deaths
Source: Global Health Data Exchange11 (per 100,000)

37%, 6,514,141
1 HIV/AIDS & STIs HIV/AIDS & STIs Enteric infections
Communicable, maternal, neo-
252,756 200,906 158,901 -2%
Source: Institute for Health Metrics and

2 RIs and TB RTIs and TB Cardiovascular diseases natal, and nutritional diseases
79%, 16,615,777
67%, 13,018,387 3 Enteric infections Cardiovascular diseases RTIs and TB NCDs 60,782 90,473 114,524 3%
56%, 9,981,772 4 Maternal & Neonatal Enteric infections Neoplasms
Source: Global Health

Injuries 13,413 18,555 20,463 2%

5 Cardiovascular diseases Maternal & Neonatal Enteric infections
Data Exchange 11

All diseases 326,951 309,934 293,888 -1%

6 Other infections Neoplasms Maternal & Neonatal
Evaluation (IHME)12

2000 2010 2019

7 NTDs & malaria Digestive diseases Digestive diseases DALYs
Injuries
Communicable, maternal, neo- 16,615,777 13,018,387 9,981,772 -3%
Non-communicable diseases 8 Digestive diseases Other infections Diabetes & kidney diseases
Communicable, maternal, neonatal, and nutritional diseases natal, and nutritional diseases
9 Neoplasms Diabetes & kidney diseases Other infections
NCDs 3,674,571 5,224,569 6,514,141 3%
10 Nutritional deficiencies Unintentional injuries NTDs & malaria
Injuries 799,343 1,087,597 1,184,581 2%
All diseases 21,089,691 19,330,553 17,680,494 -1%

Abbreviations: RIs, respiratory infections; TB: tuberculosis; NTDs, neglected tropical diseases; STIs, sexually transmitted infections; NCDs, non-communicable diseases; DALYs, disability-adjusted life years; AROC, annual rate of change.
 Kenya's health sector transitions: impact data summary n 3
Domestic finance transition
Key takeaways
• Kenya’s domestic financing for healthcare is showing positive trends: domestic cuts for key initiatives like UHC.13 Achieving UHC by 2022 in the current economic
financing is increasing as a share of total health spending while external financing and climate remains a herculean task.
out-of-pocket payments (OOPs) are declining. • Kenya’s domestic revenue mobilization and budget execution capacity will need to
• However, the COVID-19 pandemic has strained Kenya’s economy, leading to budget improve to sustainably finance UHC.

200

Health expenditure (2019, US$ billions) Health expenditure per capita (by sources) Source of health financing

Source: Institute for Health Metrics and Evaluation (IHME)14

180
4.5 4.6
4.2 160
Government
4.1 4.2
Donors
0.8 1.0 140
Government health spending 3.7 0.8 Corporations
Out-of-pocket spending 3.5

Source: Kenya National Health Accounts:

0.9 Households
3.3 1.0 120
Pre-paid private 12%

Int$ (PPP)
3.1 0.7

Source: WHO’s Global Health

Development assistance for health 0.9 0.6 0.7
Total health spending 2.9 0.8 100
2.7 0.7 0.6 0%
2.5 0.5 33%

Expenditure Database5
0.6 80
0.5

FY 2015/2016: 2019 update15

2.3 0.6 0.4
2.2 0.4 0.4 1.2
2.1 0.4 1.2 1.1 60 22%
1.9 2.0 0.3 0.4 0.4
1.8 0.3 0.3 0.3 1.2 1.2
0.1 0.2 0.3
0.1 0.2 0.2 0.2 1.2 40
0.2 0.2 1.1 1.2
0.2 1.1
1.1 1.1 20
1.1 1.1
0.9 1.0 1.0 1.0
0.9 0
1.7 1.8 1.8
1.4 1.5
1.1 1.1 1.2 33%
0.8 0.8 0.9 1.0
0.6 0.6 0.6 0.7 0.7 0.7 Current Health Expenditure (CHE) per Capita
Domestic General Government Health Expenditure (GGHE-D) per Capita
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Domestic Private Health Expenditure (PVT-D) per Capita
External Health Expenditure (EXT) per Capita
Out-of-Pocket Expenditure (OOPS) per Capita

Breakdown of health expenditure by source (% of current health expenditure)

11 11 10 10 8 10 11
12 12 11 12 12 12 12 13 15
Health expenditure (comparing Kenya with all low- and middle-income countries)
16 18 19

Source: The World Bank World Development Indicators7

Low- and middle- 12 13 14 16 19 17

Kenya 28
29 29 26 24 23 20 18 16
income countries 29 29 16 16

Source: WHO’s Global Health Expenditure Database5

2000 2018 AARC* 2000 2018 AARC*
25 24 24
27
CHE per capita (US$) 21 88 8% 22.9 85.7 7.60% 47 46 44 45 45 32
29
44 32
GGHE-D (% of current health 28.6 42.1 2% 31.30% 33.20% 0.30% 38 36 33 32 30
31

expenditure)
EXT (% of current health 12.4 15.5 1% 3.50% 3.20% -0.05%
expenditure)
43 43 42
OOPS (% of current health 47.1 23.6 -4% 59.20% 55.70% -0.03% 34
37
40
30 31 32
expenditure) 29 29 29 26 28
25 26 27 28 29

*Average annual rate of change

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

GGHE-D (% of CHE) OOPS (% of CHE) EXT (% of CHE) Other (% of CHE)

3.1 3.3 3.0 3.0 3.2 3.3 3.4 3.3 3.0 2.5 2.3 2.5 1.7 1.5 0.7 0.7
4.6 5.6 6.3
Abbreviations: GGHE-D, domestic general government health expenditure; CHE: current health expenditure; OOPS, out of pocket spending; EXT, external
5.7health
6.2expenditure.
5.4 5.4 5.9 6.1 6.3 7.9 7.9
6.2 7.9 8.4 9.9 10.3
6.7 7.3 12.4 12.3
17.0

Donor health aid transition

Key takeaways
64.5 66.0
• Kenya is facing several key donor transitions in the near-term future and must 60.7 services
65.0 72.8 for key populations
70.5 70.9 in particular, since most of these programs are still
72.8 74.5
76.9 74.7 72.8 71.9 75.2 77.2 76.6
prepare accordingly. 60.2 funded from external resources—primarily from one70.9 donor,
71.9 the U.S. President’s
• However, external sources of health financing still play a critical role in Kenya’s Emergency Plan for AIDS Relief.
health system. • Kenya will face the challenge of absorbing donor-funded programs and services if it
• Transitions from aid could have a negative impact on HIV/AIDS services and wants to avoid potential backsliding.

26.9 25.9 25.6

18.3 21.3 18.4 21.2 19.9 17.9 15.9 13.6 14.4 16.2 14.3 13.3 16.4 13.0 14.2 14.9

External health expenditure as a percentage of domestic GGHE-D Aid received by health area 2009-2018
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Health area Total flow Total flow
115%
110% 106% 105% 99%
85% (US$ millions) (percentage)
Source: WHO’s Global Health

73% 75%
67%
62%
54%
STD control including HIV/AIDS 5334.0 63.2%
Expenditure Database5

54%
43% 44% 47% 44%
38% 37% 37%

Malaria control 709.9 8.4%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Infectious disease control 144.1 1.7%
Basic health care 634.3 7.5%
Reproductive health care 358.9 4.2%
Aid by top 5 donors each year from 2010-2019 (US$ millions)
$1,000.00

$900.00
Health policy & administrative management 400.9 4.7%
GAVI
Tuberculosis control 219.1 2.6%
$800.00 World Bank Group
Source: Organization for Economic Co-oporation and Development (OECD)16

United Kingdom Family planning 237.8 2.8%

$700.00
Global Fund
Basic nutrition 191.6 2.3%
United States
$600.00
Population policy and administrative management 33.7 0.4%
$500.00
Personnel development for population and 4.2 0.0%
Co-oporation and Development (OECD)17

reproductive health
Source: Organization for Economic

$400.00
Medical services 54.8 0.6%
$300.00
Health education 17.6 0.2%
$200.00
Health personnel development 10.1 0.1%
$100.00
Medical research 32.7 0.4%
$- Basic health infrastructure 36.9 0.4%
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Medical education/training 4.1 0.0%

Abbreviations: GGHE-D, domestic general government health expenditure; STD, sexually transmitted disease.
 Kenya's health sector transitions: impact data summary n 4

Donor health aid transition (continued) United States aid to health (US$ millions)
700

Top 5 donors (91%, US$7.7 billion, of all ODA for health, 2010-2019) 10 3
Other
9
23 Basic nutrition
Donor Total Percentage

Co-oporation and Development (OECD)16

600 5 9 31 30 Reproductive health care
7 16
18 20 6
21 26 Family planning

Source: Organization for Economic

46
United States $5,479.00 65% 33 13
25 12 3 16 15
6
Malaria control
11 14 39 26
500 9 STD control including HIV/AIDS
Global Fund $989.68 12% 4
12 44
23 21
31
39 6
14
World Bank Group $410.15 5% 3
27 16
5
4 9
11 40 27
400
United Kingdom $395.76 5% 25 19

46
Gavi, the Vaccine Alliance $382.74 5%
300
Other $788.86 9% 576

Source: Organization for Economic

528

Co-oporation and Development

482 490
472 467
445
200 386
374
60 332

United Kingdom aid to health (US$ millions)

100
6 Other
50

(OECD)16
4 Infectious disease control
Family planning 0

9 13 STD control including HIV/AIDS

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
40
21 6 3 Note: Other areas include infectious disease control, tuberculosis control, health policy and administrative manage-
1 Reproductive health care
0 2 0 ment, basic health care, population policy and administrative management, basic health infrastructure, personnel
4 Malaria control
1 4 1 development for population and reproductive health, health personnel development, and health education.
3 8 200
30 0 9
3
19
10 9 1 9
1
Global
180 Fund aid to health (US$ millions)
14
11 3 31
20 13 4 14
Economic Co-oporation and
160 25
0 Tuberculosis control
0
Source: Organization for

1 Malaria control
17 7 140
4 10 24 STD control including HIV/AIDS
10 1
Development16

20
16 16 120
61
11 13 3 12
8 1 10 1 8
7 12 5 16 18
4 100
0 12

Source: Organization for Economic

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 31

Co-oporation and Development16

80 46 34
Note: Other areas include basic nutrition, medical research, health policy and admin- 11 32
istrative management, basic health care, health personnel development, population 60 10
policy and administrative management, health education, other prevention and 2
101
treatment of NCDs, and medical services. 38 87
12
40 83
80 68 62
56 57

World Bank aid to health (US$ millions) 20

24
8
11
41

70
5
3 Other
0
2 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
60 2 Infectious disease control 80

Gavi, the Vaccine Alliance aid to health (US$ millions)

2
16 Reproductive health care
3 STD control including HIV/AIDS 70
50 2
1 Basic health care
Health policy and administrative management
1 25
11 Basic health care 60
40 17
Source: Organization for Economic

50
Co-oporation and Development16

30 27 13 0 12
2 6
15 5 1 40
7 6
3

Source: Organization for Economic

20 3 4 72

Co-oporation and Development16

2 2 4 10
2
31 5 4 30
4 4
12 24 3 3
10 19 48
17
43
12 12 10 11 10 20
37 36
6 34 32 33
0
24 24
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 10

Note: Other areas include basic health care, health policy and administrative management,
and family planning 0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Note: Basic health care as related to immunization and system strengthening

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This is one in a series focusing on middle-income countries that are transitioning out of official development assistance for
health. The profiles are part of a broader study called Driving health progress during disease, demographic, domestic finance,
and donor transitions led by the Center for Policy Impact in Global Health.