Kenya - Transforming Health Systems for Universal Care Project (English)

Ratings for the Transforming Health Systems for Universal Care Project for Kenya were as follows: outcomes were satisfactory, the Bank performance was satisfactory, and the monitoring and evaluation quality was also substantial. Some lessons learned included: future projects should consider balancing standardization of interventions for cross-cutting issues while also allowing for flexibility to address county specific gaps to allow for a simpler project design and manageable implementation supervision. The THS-UCP was largely implemented at the county level. County governments are autonomous and responsible for their own budgets and service delivery of health services. Given the results-based financing approach and recognizing the variation in priorities at county level and the autonomy of each county, the project was essentially implemented as 48 sub-projects, which put a strain on both the PMT and the World Bank task team. There are cross cutting issues that affect most if not all counties which can be addressed with a standard package of interventions; however, there are differences amongst the 47 counties which call for a flexible approach to support appropriate, context-specific, and efficient implementation of interventions. Having this balance in the future projects design will limit the complexity at implementation as well as monitoring implementation. Future similar health projects should consider the lessons learned from this project regarding timely disbursement of county allocations. Delays in funds flow was a major contributor in the suboptimal absorption of funds at the county level and delays in the THS-UCP implementation. These delays were further compounded by protracted procurement processes. For the most part throughout project implementation, for any given fiscal year, project funds were transferred to the counties between December and January in any given fiscal year, meaning that there was less than a year for absorption of funds and implementation. Design of future health projects should be mindful of these potential delays and include necessary mitigation measures.