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Outline of the Project

Project Name

Organizational Capacity Development Project for Management of the Devolved Health Systems in Kenya



Date of R/D Signed

July 8, 2014

Project Site

All forty seven counties in Kenya

Term of Cooperation

November 9, 2014 to November 8, 2019

Implementing Organization

Ministry of Health


Under the two-tier governance system introduced with the new constitution, there is an urgent need in health sector in Kenya to strengthen the mechanisms for ensuring coherent implementation of national policies and priority programs. The constitution of Kenya 2010, which was enacted in August 2010, introduced devolution and the eight regions were restructured into 47 counties. The two-tier governance system was put in operation in March 2013 and health service delivery was transferred to the counties while the national government retained the functions of leadership in policy development, management of national referral facilities and capacity development. Ensuring equitable access to healthcare and adequate financial protection against excessive medical expenditure to the entire population, which is a priority in the national development policies and the key ingredient of Universal Health Coverage (UHC), now requires concerted effort by both sides of the two-tier system. Inter-governmental coordination mechanisms, such as the Health Sector Inter-governmental Forum, are being structured to facilitate dialogue and collaborative work between the Ministry of Health and the county governments. Such mechanisms need to be further strengthened.

Coordinated support for the capacity development of the counties, together with conditional grants to reward the good performance of the counties, will be important mechanisms to ensure coherent implementation of national policies and priority programs. Implementation of many of the Flagship Projects for health included in the Second Medium Term Plan (2013-2017) of the Kenya Vision 2030 (SMTP 2013-17), such as "country-wide scale up of community health high impact interventions" and "improve access to referral systems" requires proactive actions by the counties. Capacity development of the counties is a cross-cutting agenda throughout the plan, under the theme of "making devolution work". As the needs and demands for capacity development are substantial and diversified, coordinated effort by the Ministry of Health, the county governments, development partners and other stakeholders is essential. Funding streams which flow from the national government to the county-managed health facilities as conditional grants, such as Results-based Financing component of Health Sector Services Fund (HSSF/RBF) and subsidy for Free Maternity Services (FMS), which are integral part of the Flagship Project on "health care subsidies for social protection" in SMTP 2013-17, are important mechanisms to reward the good performance of the counties. Health Insurance Subsidy Program for the Poor (HISP), which is also a component of the same Flagship Project, is expected to provide demand-side incentives to the indigents to increase their use of healthcare.

The Government of Kenya requested JICA's technical cooperation project to strengthen management capacity for devolved health system, while exploring the possibility of financial assistance to HSSF/RBF, FMS and HISP through the dispatch of technical advisor on healthcare financing to the Ministry of Health, as a component of programmatic support to promote UHC in Kenya under the two-tier governance system. The request was based on the achievements of the "Project on Strengthening Management for Health in Nyanza Province (JICA SEMAH Project)" which was jointly implemented by the former Ministry of Public Health & Sanitation (MOPHS) and JICA between 2009 and 2013. JICA SEMAH Project developed comprehensive program on health systems management to improve performance and equity of health systems through the organizational capacity development of Provincial Health Management Team and District Health Management Teams in Nyanza Province. The Project resulted in improving essential health service delivery including immunization, deliveries by skilled birth attendants and utilization of family planning commodities by 28% in average within the 4 year period. The approach was highly appreciated by the Government of Kenya, other development partners and stakeholders. The results were partly reflected in the current effort of standardizing leadership and management training for the county executives and managers, through the works of the Ministry of Health and other partners. Based on the request, JICA dispatched a mission in November 2013 and March 2014 respectively, to formalize the design of the technical cooperation project. JICA is also continuing consultation with the Government of Kenya and relevant stakeholders to formulate financial assistance project, through the dispatch of technical advisor on healthcare financing to the Ministry of Health.

Overall Goals

Devolved Health Systems are strengthened to ensure equitable and quality services in achieving Universal Health Coverage in entire Kenya.

Project Purpose

Managerial functions of County Health Management Teams (CHMTs) are strengthened.


  • (1) Managerial support functions and coordination mechanisms in the national level are strengthened.
  • (2) Leadership and managerial capacities in CHMTs are strengthened.
  • (3) Horizontal learning mechanism among and within CHMTs is strengthened.

Project Activities

1-1 To identify and strengthen county coordination and support mechanism in MOH.
1-2 To strengthen coordination mechanism of national expertise to deliver harmonized training and mentoring for CHMTs.
1-3 To strengthen the coordination mechanism of Inter-governmental Health Committee and coordination of the development partners' support.
1-4 To strengthen national monitoring mechanism to assess the progress of managerial capacity development and the performance of CHMTs.
2-1 To conduct assessment on skills gaps and challenges facing the devolved health systems.
2-2 To conduct trainings (TOT) and mentoring support to CHMTs by national expertise.
2-3 To support implementation of good managerial practices at stakeholder forums, TWGs etc.
2-4 To support CHMTs to conduct managerial trainings and supportive supervision to sub-county, health facilities and community health systems.
2-5 To demonstrate and verify good managerial practices at model CHMTs.
3-1 To establish horizontal learning mechanism to support development of devolved health systems.
3-2 To document and publish lessons-learnt, good practices and research results.
3-3 To reinforce recognition mechanisms and dissemination fora for good practices.


Japanese Side

  • Dispatch of Experts (Chief Advisor, Deputy Chief Advisor/Health System Management, Community Health Planning, Health Monitoring and Evaluation, Training Planning, Communication and Advocacy, Project Coordinator/Training Coordination)
  • Training of Kenyan Personnel involved in the Project in Japan and/or Third Countries
  • Office Equipment

Kenyan Side

  • Assignment of counterparts
  • Facility, machinery and equipment
  • Counter budget


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