Kenya will be able to reprogram nearly $30 million within an existing malaria grant to support the scale-up of universal access to vector interventions and treatment. The $30 million consists of $22.5 million in new funding from the allocation Kenya received for malaria under the new funding model, plus about $7 million left over from an earlier malaria grant.
The request, made in January, was reviewed with recommended revisions made by the Technical Review Panel in March. In May, the Grants Approval Committee decided that the request should proceed to the grant-making stage. Grant-making should be completed by the end of July. The final upper-ceiling amount for the grant, which includes both existing and new funding, is some $114 million.
Kenya asked for the reprogramming of the Round 10 grant to accommodate changes in the national landscape, specifically related to the devolution to county governance that began in 2013. Devolution has transformed the way the health system in the country absorbs and disburses funds, which contributed to delays in resource allocation to existing programming.
Another contributing factor affecting implementation is the time it took for the country to update its national strategy for malaria 2014-2018, which was due for release in the first quarter of 2015. The strategy is in its final phase of editing before its release by August this year.
The revised strategy emphasizes pursuit of universal access to vector control interventions through coverage of the population with long-lasting insecticide-treated bed nets (LLINs). Universal coverage means that there will be one net for every two persons in 25 counties in the Western, Rift Valley and Coast regions.
According to the 2014 Kenya Demographic and Health Survey, only 34% of households own at least one LLIN for every two persons.
Speaking during a press briefing preceding the 2015 World Malaria Day on April 15, Kenya's Health cabinet secretary hailed the distribution of 3.2 million nets in 2014 in six malaria-endemic counties as proof of the country's commitment to universal coverage. Under the national strategy, an estimated $54 million will be spent by 2018 to expand distribution to 25 counties, involving a total of 6.6 million additional replacement bed nets.
Also a priority in the revised strategy is a new focus on community case management of malaria, building on existing programs for diagnosis and treatment in the public and private sectors.
That new focus must be underpinned by improved “accuracy in reporting and the adherence to guidelines when managing cases, and make additional provision to train 1,000 health workers in the private sector,” the re-programming request stated.
The balance of funds will be spent on procurement, both of rapid diagnostic tests and artemisinin combination therapies (ACT): the most effective treatment regimen for malaria. ACT is free of charge for children below age five in the public sector and heavily subsidized for adults.
Kenya aims to expand its monitoring of malaria case management to all 47 counties: a new approach that deviates from a traditional focus exclusively on malaria-endemic and epidemic regions. This decision was driven by the need to improve the quality of malaria case management through evidence-based decision-making.
“This year, the ministry (of health) in conjunction with partners and stakeholders, will undertake a nation-wide survey to benchmark the progress and inform future strategic direction in malaria control,” explained Cabinet Secretary James Macharia.
A representative at the National Malaria Control Program explained that the strategy’s new focus on program management, of which the nation-wide survey is part, will emphasize strategic development at county level so that better targeting and prioritization can be done, leading to smarter decisions being made.
The Round 10 grants are due to expire in December 2016, and Kenya has asked that they be extended through December 2017. Both principal recipients -- the National Treasury and AMREF -- are expected to complete their contractual obligations for Phase II of the grants in that time period.
The funding reprogramming request will ensure maintenance of the existing programs.
Kenya’s allocation under the new funding model will respond to a disease that puts some 20 million of its estimated 43 million people at risk of infection annually. Malaria is a major driver of child mortality in Kenya, accounting for 20% of all deaths in children below five years, according to the World Health Organization.