Research Paper

Transparency and Accountability in Kenya’s Health Financing Models

Chapter: Kenya | Year: 2018

Chapter details

About the chapter:

Founded in 1999 in Kenya, TI-Kenya is a not-for-profit organisation with the aim of developing a transparent and corruption-free society. TI-Kenya is one of the autonomous chapters of the global Transparency International movement. The organisation has 20 years’ experience in governance work at the national and county levels. These include direct engagement with the Government, the private sector, individuals and groups. TI-Kenya uses advocacy as its signature approach; this is complemented by other approaches such as partnerships’ development, research, capacity building and civic engagement, with the focus sectors comprising health, education, security (police), humanitarian aid, natural resource governance (climate governance, extractives and land).

CPI Score: 27

CPI Rank: 144

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National Partners:
Governmental Institution NGO or Civil Society Organisation

Theory of Change

Policy & Insititutional Change
Better Institutional Processes
Change Type:



Transparency and Accountability especially on resources for the Health sector has also been wanting. In 2017 for instance, the Health Sector witnessed major challenges flowing from industrial unrest by health practitioners, corruption and poor service delivery leading to wastage of public funds. The U.S. Embassy to Kenya on May 9, 2017 reported the suspension of approximately $21 million (2.1 billion KSH) in assistance to the Kenyan Ministry of Health. According to the U.S government, these drastic measures resulted due to ongoing concerns about reports of corruption and weak accounting procedures at the Ministry.

It is in view of the shortcomings identified in achieving Kenyans’ health goals as set out in the Constitution and other policy and legal frameworks that the need to assess the effectiveness of health financing models in Kenya is necessary. The research paper is important in identifying the various health financing models in existence including through the Kenya National and County Budgets, the National Health Insurance Fund, Private Health Insurance Companies, Development Partners(Including Donors, Faith Based and Non-Governmental Organisations) and Public Private Partnerships. The research paper also sought to determine how each of the identified models and avenues for health financing respond to Transparency and Accountability principles as elucidated in the Constitution including: access to information, public participation and value for money.


i. Identify and explain the various health financing models in use in Kenya.

ii. Evaluate the feasibility and attractiveness of the various models according to the following categories:

a. Enabling Environment: any laws, policies, rules, or regulations, at both a national and county-level, that might impede the effectiveness of the various health financing models.

b. Access to Information: the extent to which the identified health financing models are structured towards ensuring attainment of the highest attainable health standards including ensuring equitable, affordable and quality health care to all citizens.

c. Public participation: the extent to which public health financing models allow for effective public participation in their formation and implementation including transparency, accountability and feedback mechanisms.

d. Value for money: how the various health financing models respond to the need to ensure value for money in provision of services and health resources.

e. Recommend the most appropriate model(s), if any, with workable strategies identified to enhance people centred transparency and accountability principles in the health financing models.


  1. Delays in auditing of expenditures at facilities due to ineffective accounting systems leading to wastage and misappropriation of public funds.
  2. There is lack of reliable data to inform target setting and development of a need based assessment of budget requirements at the facilities.
  3. Insufficient human resource at facilities as well as insufficient capacity of members of Health Facility Management Committees to carry out their oversight and also lack formal structures for coordinating their work at Sub-County and County level.
  4. There are 6 health financing models in use in Kenya: 1. Tax-based financing: 2. Social health insurance (NHIF):. 3. Private health insurance: 4. Community-based health insurance 5. Donor funding 6. Out-of-pocket payments: care.


  1. Governments should carry out a comprehensive needs analysis for the Primary Health Facilities and ensure adequate allocation and disbursement of funds on quarterly timely - basis.
  2. Adopt comprehensive health information systems including on financial management.
  3. Enhance capacity building of health stakeholders on financial management and social accountability.
  4. Streamline budgeting, accounting and auditing processes.