Prospects for Scaling Government-managed TB Service Contracting in Kenya: Assessment Report

The plan aims to increase domestic financing, use key TB resources more efficiently, build in-country technical and managerial competence and leadership, and support policy formation and dissemination. The NTLD-P and county governments have not yet contracted TB services to non-government or private organizations. To guide the scale-up of this type of contracting, information is required on the legal and regulatory environment, previous health service contracting experiences, capacity gaps among current and prospective purchasers and contractors, and willingness of contractors to engage in government-managed TB service contracts. The assessment objectives are to assess the political, legal, and regulatory environment for contracting, including laws, regulations, policies, and operational guidelines in place relating to contracting. The assessment also aims to uncover any issues that purchasers and contractors previously involved in government-managed health service contracting have had with existing legal and regulatory tools, reveal any other implementation challenges faced by purchasers and contractors previously involved in government-managed health service contracting, establish NTLD-P's and county governments' capacity to issue and manage TB service contracts, understand the capacity of contractors previously involved in government-managed health service contracting to implement such contracts for TB services, and evaluate donor-managed TB service contract implementers' interest in engaging in government-managed TB service contracting. The assessment involved a desk review and 16 key informant interviews across four categories: government purchaser, government-managed contract implementer, donor-managed contract implementer, and non-purchaser non-contractor. The key findings from the desk review and key informant interviews are as follows. The existing legal, regulatory, policy, and operational documents constitute a solid foundation for expanding government-managed health and TB service contracting with the private sector in Kenya. A relevant act, regulations, and standard tender document all exist and contain language that is open to health services contracting. According to interview respondents, there is expected to be at least some support from public, private, and educational sectors for government-managed TB service contracting. Respondents cited several potential barriers to government-managed TB service contracting, of which a few can be directly addressed by the health sector. For the most part, open tendering—the preferred procurement method under the Public Procurement and Assets Disposal Act—has been followed in the government-managed health service contracts examined. Besides some contract payment issues, experiences with government-managed health service contracting were reported as generally positive in Kenya. The capacity of both NTLD-P and county governments should be strengthened in most of the contracting areas discussed. The respondents interviewed agreed that the Public Procurement and Asset Disposal Act is the appropriate governing document for government-managed health service contracts. The assessment highlights the need for NTLD-P and county governments to strengthen their capacity in contracting areas, including procurement, contract management, and monitoring and evaluation. The assessment also highlights the need for contractors to be willing to engage in government-managed TB service contracting. The respondents interviewed reported that donor-managed TB service contract implementers are interested in engaging in government-managed TB service contracting, but there are concerns about the capacity of NTLD-P and county governments to manage such contracts. Overall, the assessment provides a comprehensive understanding of the political, legal, and regulatory environment, previous health service contracting experiences, capacity gaps among current and prospective purchasers and contractors, and willingness of contractors to engage in government-managed TB service contracting in Kenya. The findings of the assessment will inform the development of a costed action plan for scaling up government-managed TB service contracting in Kenya.