Table 1 Comparison between the World Bank policy document and the Kenyan policy document.

Year Published

1987

1994

Problems identified in the health sector

inefficient spending on cost-effective health activities

Internal inefficiency of public programmes "lower-level facilities are underused, while. hospitals are overcrowded (p.3)"

Inequity in the distribution of benefits from health services

"The Ministry of Health is seriously underfunded" (p.1)

"unnecessary congestion of hospitals by patients who should be treated at lower cost in health centres and dispensaries"(p.1)

"geographical disparities, which need to be addressed in order to achieve some equity" (p.4)

4 Proposed policy reforms

(Title/Catchphrase)

"Agenda for reform"

"Agenda for Reform"

Reform 1:

Charge user fees (p.3)

"The apparent willingness of households to pay at least some of the costs of health care" (p.3)

"raising of additional resources through widely accepted cost-sharing initiatives" (p.39)

Reform 2:

Provide insurance or other risk coverage (p.4)

shift part of financial burden to insurance schemes (p.40)

Reform 3:

Use non-government resources effectively - government to focus on community/public health measures, rather than individuals (p.5)

temporary government subsidies to NGO health providers (p.5)

Strengthening of NGOs, local authority, private and mission health service providers (p.37)

enabling environment, which may include subsidies (p.37)

Reform 4:

Decentralize government health services - planning, budgeting and purchasing: allow revenue to be collected and retained close to the point of service delivery (p.6)

"Further decentralization of planning, management and resource creation, control and use to the districts" (p.36)