THINKWEL PESTEL ANALYSIS 2024

PREPARED BY

DIANA WANDIA KIMONDO

MARCH 2024
 TABLE OF CONTENTS

Introduction......................................................................................................................................3

PESTEL Analysis............................................................................................................................3

Political Factors...............................................................................................................................3

Economic Factors............................................................................................................................7

Sociological Factors.........................................................................................................................9

Technological Factors....................................................................................................................12

Legal Factors.................................................................................................................................14

Conclusion.....................................................................................................................................16

REFERENCES..............................................................................................................................18
Introduction

Founded in 2011 ThinkWell is an international healthcare organization that provides

bold, creative, and practical solutions to health care financing in developing countries.
ThinkWell is a global organization with a mission to enhance the health and well-being
of society. To accomplish this, ThinkWell has developed a distributed leadership model,
such that there is no formal “headquarters,” and each country office plays a leading role
in its operations, programming, and strategy. In Africa, Thinkwel operates in the
following countries: Kenya, Uganda, Zambia, Nigeria, Burkina Faso, Mozambique and
Tanzania.

PESTEL Analysis

PESTEL analysis in healthcare is an important part of strategic management for any

organization in the field. Besides, it is an economic tool to scan the environment. It will
helps Thinkwell to detect factors influencing the industry and activities of companies. As
a result of considering such effects, Thinkwell can plan strategies to take advantage of the
situation. They can also mitigate and prevent negative impacts. This tool is not only very
useful for strategic planning in economics, but in any sphere of life, with every person or
entity being affected by the environment. This is a PESTLE analysis to help assess the
macroeconomic factors that may affect ThinkWell in the African region

Political Factors

Many African countries have a shortage of health workers. The goal of this Thinkwell
strategy is to secure increased access to quality health services for the people of Africa by
2030, so as to improve their quality of life and promote the achievement of SDG3 and the
African Union's Agenda 2063 goal on health.

Uganda: Uganda's health system has both private and government funded facilities. The
government regulates operations of all healthcare facilities. Uganda's health system is
composed of health services delivered to the public sector, by private providers, and by
traditional and complementary health practitioners. It also includes community-based
health care and health promotion activities. Uganda's healthcare system is still struggling
to provide access to basic healthcare services, especially in rural areas. High disease
burden: Uganda has a high prevalence of infectious diseases such as malaria, HIV/AIDS,
and tuberculosis, which puts a strain on the healthcare system.

Kenya: The major challenges noted in the post devolution era within the health sector
include inadequate resources/funds from the national government and understaffed health
facilities.

Zambia: Zambia: Zambia is among the most politically stable countries in Africa, and
has continued to experience uninterrupted peace since its independence in 1964. The
country has a multi-cultural society, characterized by different racial and ethnic groups,
religious and traditional groupings, urbanization, and increasing access to the internet and
other sources of information, with significant potential for promoting good health.
However, there are some social, cultural and religious beliefs and practices that
negatively affect health. These include cultural practices, such as sexual cleansing of
surviving spouses, unsafe traditional male circumcision procedures, early marriages for
the girl child, gender discrimination in favour of males, and risky traditional health
practices.

Since 1992, the Zambian Government has been implementing significant health sector
reforms, aimed at strengthening health service delivery in order to improve the health
status of Zambians. The reforms have yielded significant results in form of strengthened
health systems, improved access to health care and improved health outcomes as reported
in the 2007 Zambia Demographic Health Survey. However, these achievements are yet to
put Zambia on course to achieve the Millennium Development Goals (MDGs) by 2015.
The country has remained under significant pressure to further reduce the disease burden
and improve the health status of Zambians. This National Health Strategic Plan (NHSP)
2011-2015 is the fifth in the series of the strategic plans implemented under these
reforms. The plan presents a major departure from the past strategic plans, in that the plan
is organized around the World Health organization (WHO) health system building blocks
rather than disease or target group programs.
Zambia is facing a serious Human Resources for Health (HRH) crisis, both in the
numbers and skills mix. The critical shortage of skilled manpower is a major obstacle to
the provision of quality healthcare services and to the achievement of the national health
objectives and MDGs. There are three main problems, namely the absolute shortages of
health workers, inequities in the distribution of health workers and skills-mix, which all
favour urban areas, than rural areas. During the period under review, MOH implemented
the National Human Resource for Health Strategic Plan 2006 to 2010 (HRH-SP 2006-10)
and significant achievements were made, though the shortages have continued. The total
number of staff in the health sector increased from 23,176 in 2005 to 29,533 in 2009,
representing 57% of the approved establishment of 51,414. In both rural and urban areas
health infrastructure is inadequate. In rural areas 46% of households live outside a radius
of 5 km from a health facility (compared to 1% in urban areas) making it difficult for
many people to access the needed services. The main bottlenecks to physical accessibility
include insufficient or inappropriate infrastructure; ; inaccessibility due to geographic
factors; sparsely distributed population in rural areas; inadequate resources for outreach
(fuel, vehicle, bicycle, motor-bike, boats); and poor scheduling of services leading to
missed opportunities.

Mozambique: The health sector in Mozambique is faced with multiple financing

challenges, limited domestic resources, plateauing donor support and increasing absolute
level of out-of-pocket expenditures. This contributes to limiting access to care for people
in need. The National Health System (NHS) lacks the capacity to reach the majority of
the rural population. The Ministry of Health has developed Health Sector Strategic Plans
(PESS) since 2000, to guide the development of the Mozambican Health System,
particularly the National Health Service (NHS) and improve the health status of the
population. The first sector strategic plan covered the period 2000- 2005, the second
2007-2012 and the third 2014-2019, with projections to 2023. The socio-economic and
political context in which the current plan was developed was marked by natural
disasters, which significantly impacted health services; by increased demand from
citizens for quality services, particularly among youth – who represent the majority of an
increasingly urbanised population; in addition to an increase in the number of actors in
the sector. However, the health system still does not have the capacity to address these
additional challenges. In 2002, the central Government launched the public sector reform
strategy with the view to improving the provision of services to the people of
Mozambique. The strategy was developed on the basis of six components one of them
being decentralization. The development of new laws and integration of and crosscutting
changes, particularly, the Local Government Act (LOLE) and corresponding financial
and procurement systems, set the scene for sectors to propose associated reforms. Still,
the MoH’s institutional structure merely adapted over time and continued focusing on
core functions, which include the development of sector policies and sector plans,
regulation, financing, and oversight, along with direct management of public health
services and conducting supervision. The situation partly results from the lack of
institutional mechanisms to manage reform processes that often follow vertical
approaches and have limited impact on health services. Conversely, the fragile state of
district level health services limits the capacity to take advantage of benefits arising from
decentralization.

Burkina Faso: Burkina Faso faces challenges amid political instability, violence and
weak rule of law. Economic challenges are compounded by external shocks and a
dependence on agriculture, yet rising mining exports offer some respite. Burkina Faso
faces challenges amid political instability, violence and weak rule of law. Economic
challenges are compounded by external shocks and a dependence on agriculture, yet
rising mining exports offer some respite. Country’s young, growing population continues
to struggle with high poverty and human rights violations. Internet access remains
limited, yet the number of mobile subscriptions continues to increase. Burkina Faso has
undertaken decentralization reforms in the health care sector to improve the performance
of the health system. This resulted in the establishment of health regions, divided into
health districts that are the operational level for implementation of the national health
policy. The district health services are organized into two levels, the first of which
comprises the primary health care centers that provide communities with basic preventive
and curative primary health care. The second level consists of district hospitals that
represent the point of referral for primary health care centers. District hospitals are
managed by a district health management team and are led by a medical officer. The
health district funding is largely obtained from the central government.
As part of the decentralization process, a decision was taken in 2009 by the central
government to transfer the health resources and skills to local governments. These local
administrative entities (called communes) are run by elected mayors that are autonomous
in the management and financing of health resources without any formal hierarchical
relation with the health districts. This transfer first involved primary health care centers.
An institutional agreement was made to define the roles and responsibilities of each party
(central government, local governments, health districts, and primary health care centers).
As a result of this agreement, the local governments' roles now include the management
of health care centers, procurement and supply of drugs and medical commodities,
disease prevention, and sanitation. The central government only plays a regulatory role,
which includes defining the national health policy and orientation, setting norms and
standards for the health infrastructure, equipment, health services functioning, and
management. It also oversees health facilities and allocates financial resources through
grants and subsidies to local governments

Uganda: Corruption and a weak rule of law are hampering strides in economic freedom
in Uganda, whilst one party has maintained its grip on governance for decades. However,
robust economic performance has been buoyed by strong agricultural output and services,
whilst inflation has fallen markedly. Rising incomes and a growing populace will drive
the consumer market, but Uganda will remain largely rural. 5G networks have been
launched, but innovation is lacking and the fibre backbone faces challenges.

Nigeria: It can be opined that the entire Nigerian healthcare system is weak and
inadequate. Counterfeit drugs and other products is common-place. Healthcare is
underfunded, lack of medical professionals, inadequately used, and no full demand from
patients.

Economic Factors

Kenya: The Kenya health sector was devolved in 2013 in line with the
Kenyan constitution since devolution was seen as the best way to provide health services.
However, the decision has encountered numerous challenges that have often paralyzed
the provision of health services leading to strikes and many advocating for a reversal of
the decision.

Uganda: At the beginning of the 21st century, the government of Uganda began
implementing a series of health sector reforms that were aimed at improving the poor
health indicators prevailing at the time. A Sector-Wide Approach (SWAp) was
introduced in 2001 to consolidate health financing. Another demand side reform
introduced in the same year was the abolition of user fees at public health facilities,
which triggered a surge in outpatient attendances across the country.

Decentralization of health services began in the mid-1990s alongside wider devolution of

all public administration, and was sealed in 1998 with the definition of the health sub-
district. Implementation of the health sub district concept extended into the early 2000s

To improve medicines management and availability, the government of Uganda made

medicines available to private-not-for-profit (PNFP) providers. With decentralization of
health services, a "pull" system was instituted in which district and health facility
managers were granted autonomy to procure medicines they needed in the required
quantities from the national medical stores, within pre-set financial earmarks. The result
was better availability of medicines.

Zambia: Zambia’s economy, heavily reliant on copper exports, is vulnerable to global

market fluctuations. Despite projected economic growth, the nation grapples with the
demands of a young and rapidly growing population and enduring rural poverty. Zambia
is a Lower Middle Income Country and since 2006, the country has been imple menting
the Vision 2030, which aims at transforming it into a prosperous middle-income nation
by 2030. Over the past 5 years, the country recorded major improvements in macro-
economic performance, with the average annual economic growth rate, above 5 percent.
However, these improvements have not yet significantly impacted on the socio-economic
well-being of the population, majority of whom are poor and vulnerable. Zambia is
experiencing high levels of unemployment and weak socio-economic status of the
population, which have implications on the health status of the population. Income
inequity among the population has remained high, with the Gini Coefficient at 0.57 in
2004 (a drop from 0.66 in 1998). High poverty levels (67% in 2006) and poor access to
safe water and sanitation also remain serious factors on health.

Tanzania: Tanzania is a resource strained country with a weak healthcare system which
is challenged by high maternal mortality, child mortality, HIV/AIDS, pneumonia, and
malaria (Intenational Trade Administration, 2022). Healthcare financing in Tanzania is
complimented by international donors who contribute up to 40% of the health budget.
The US government, through USAID and CDC, contribute significantly to programs that
assist the Tanzania government. Health insurance coverage is still low with only 32% of
Tanzanians as of 2019 covered by health insurance. Of that number, only 1% are
members of private health insurance.

Mozambique: In Mozambique, ongoing conflict and corruption exacerbate economic

challenges. The economy is hindered by high unemployment and reliance on agriculture.
The young and growing population remains impoverished, facing healthcare and
educational hurdles, compounded by humanitarian needs due to conflict. Technological
advancements are slow, with limited internet access but prospects for growth in mobile
and digital sectors.

Burkina Faso: Funding for the health sector in Burkina Faso comes from three main
sources: the national budget, external aid, and OOP payments from households.

Sociological Factors

Kenya: Kenya is experiencing persistently high levels of inequity in health and access to
care services. In 2018, decades of sustained policy efforts to promote equitable,
affordable and quality health services have culminated in the launch of a universal health
coverage scheme, initially piloted in four Kenyan counties and planned for national
rollout by 2022. Richer individuals in Kenya report better health status than those in
poorer households, although the prevalence of chronic and medical conditions is higher
in richer population groups, as is the average age. Higher educational achievement
(particularly at tertiary level) and formal employment (both at individual and household
head level) are exceedingly more likely in higher expenditure quintiles, and extremely
low among the poorest groups. Richer households tend to be smaller (4.4 household
members in the top expenditure quintile as compared to 6.8 in the lowest), located in
urban settings and report considerably higher availability levels of modern amenities.
Health care utilization in Kenya increases with socio-economic status. Larger shares of
rich individuals (5th expenditure quintile) as compared to poorer population groups use
outpatient care, inpatient care and preventive care.

Zambia: Zambia faces significant challenges, including widespread corruption and low
degree of economic freedom. Zambia has a high burden of disease, which is mainly
characterized by high prevalence and impact of communicable diseases, particularly,
malaria, HIV and AIDS, STIs, and TB, and high maternal, neonatal and child morbidities
and mortalities. The country is also faced with a rapidly rising burden of
noncommunicable diseases, including mental health, diabetes, cardio-vesicular diseases
and violence. Over the past five years, from 2006 to 2010, the health sector recorded
significant progress in most of the key areas of health service delivery, and health support
systems, leading to major improvements in most of the key health performance
indicators. According to the 2007 Zambia Demographic and Health Survey (ZDHS
2007), Maternal Mortality Ratio (MMR) reduced, from 729 deaths per 100,000 live births
in 2002, to 591 in 2007, Under-Five Mortality Rate (U5MR) reduced from 168 per 1000
live births in 2002, to 119 in 2007, and Infant Mortality Rate (IMR) from 95 to 70,
respectively. Neonatal Mortality Rate (NMR) reduced from 37 to 34, respectively.
During the same period, HIV prevalence in adults, aged 15 to 49 years, reduced from
16.1% to 14.3%. The malaria and TB programme performance reviews conducted in
2010, and other reporting health systems, also reported major improvements in the
prevention and control of malaria and TB. Malaria incidence per 1000 population
dropped from 412 in 2006, to 246 in 2009. TB treatment success rate improved from 79%
in 2005 to 86% in 2008. However, despite these achievements, the sector continues to
face major challenges, which include high disease burden, inadequate medical staff, weak
logistics management in the supply of drugs and medical supplies, inadequate and
inequitable distribution of health infrastructure, equipment and transport, and challenges
related to health information systems, inadequate financing, and identified weaknesses in
the health systems governance. During the NHSP 2011- 15 period, the sector will focus
on overcoming these constraints and challenges, in order to ensure effective
implementation of this plan, and attainment of the national health objectives

Tanzania: Although corruption remains a problem and the rule of law is weak,
Tanzania's state finances are sustainable and economic freedom is improving. The private
sector contributes to 53.6% of the health services provided while the public sector
accounts for 46.4%. (AfRICA Health Business, 2021). Tanzania’s population also has
some of the lowest rates of access to health personnel in the world. Over 60% of
Tanzania healthcare facilities are run by the government with the rest being either faith-
based or private. As the country, Tanzania is progressing towards universal healthcare, in
2020/2021 the government allocated $387.9 million for the health sector of which $155.5
million will be spent on development projects, which would help the government to
implement its health improving initiatives. The sector has been allocated TZS
1,109billion in 2022/2023.

Mozambique: Mozambique´s health status and disease burden is not uniform across
provinces and districts of the country, or population groups. People living in rural areas,
peri-urban areas and the poorest households are the most affected, as well as women and
children – who bear the greatest disease burden. Mozambique has great cultural diversity;
beliefs and taboos can nevertheless have a negative effect on health, for example, some
religious groups in different parts of the country refuse blood transfusions and
immunization; some claim to cure HIV, while others adopt practices that actually favour
its spread. Cultural constructions of gender social relations reveal differences between
men and women especially in access to resources, power or decision-making, and the
distribution of roles and responsibilities. All of these factors influence the health status of
the population – especially for women who often have limited decision-making capacity.
The influence of gender on health is manifested in different ways: through differentiated
exposure, risk and vulnerability; the nature, frequency and seriousness of health issues
affecting men and women; the perception of symptoms; health-seeking behaviour; actual
access to health services; ability to sustain medical treatment; long-term social and health
consequences etc
Burkina Faso: Burkina Faso faces major challenges in its health sector. The country is
marked by high rates of morbidity due to malaria and HIV prevalence in urban areas.
Compounding this vulnerability is a lack of basic hygiene equipment, the prevalence of
communal washing stations, and population overcrowding, as more and more Burkinabé
and their surrounding neighbors flee political unrest, particularly within the Sahel region.
Significantly, positive trends in improved health governance and the adoption of new
family planning and HIV policies are having a documented impact in the health sector,
including an increased contraceptive prevalence rate.

Nigeria: Nigeria is faced with some massive social challenges. For example, poverty,
inequality, high unemployment rate, poor literacy rate, high child mortality rate, crime,
urban housing problem, and a weak education system are at the core of the social
challenges.

Uganda: Uganda had estimated population of 41.087 million in the year 2016 and
expected to reach 49.059 million by 2022, which is expected to grow at a CAGR of 3%.
Uganda’s real gross domestic product (GDP) was around UGX 56751.83 billions in 2016
whereas the nominal GDP was UGX 89590.80 billions. This resulted in GDP deflator
157.864. Per capita GDP was estimated at USD 637.568 whereas purchasing power
parity (PPP) based per capita GDP was estimated to be at USD 2068.23.

Technological Factors

Kenya: Digital health technologies in Kenya offer immense potential for transforming
healthcare delivery, achieving universal health coverage (UHC), and improving health
outcomes. With a young population and increasing mobile phone and internet
connectivity rates, Kenya is well-positioned to leverage these technologies to address
healthcare access and quality challenges. Benefits include enhanced access to care in
remote areas through telemedicine, a strengthened healthcare workforce with training
opportunities, and improved efficiency through electronic health records and mHealth
applications. These technologies empower patients, reduce costs, and facilitate active
engagement in their own healthcare management.
Zambia: In the health sector, ICTs have been recognised internationally and by the
Government to be of strategic importance as it facilitates the sharing of health data,
information and resources between different stakeholders and the delivery of appropriate
services to the population. While internet usage is on the rise and mobile subscriptions
are increasing, rural areas still lag in infrastructure development. Zambia has developed a
well integrated health information system providing information for evidence based
planning, within the health sector. This system comprises both routine and non-routine
information sources, institutionalised among the various players within the health sector
and coordinated as part of the national monitoring and evaluation framework. SmartCare
is an electronic health record system developed in Zambia. It is an initiated nationally
scalable Electronic Health Record System designed specically for low resource,
disconnected settings. SmartCare has the objective of improving the quality of health care
and health by providing support to deliver “Continuity of Care” where existing paper
systems are failing to preserve a longitudinal data view, and where clinics may often have
no telecommunications.

Tanzania: The eHealth Strategy was guided by the Tanzania Health Sector Strategic
Plan (HSSP) III (2009-2015), which identifies health sector priorities (RTI International,
2023).

Mozambique: The introduction and use of new medical technologies in the sector, such
as eHealth, etc. is fragmented and still in the initial stages. The lack of clear policies
limits sector capacity to take full advantage of recent technological developments.

Uganda: In the case of Uganda, high population growth is a serious concern since the
country's population is growing at a rate of 5% annually, one of the fastest inthe world.

Nigeria: Nigeria has made use of technology well in the past as evidenced from the fact
that it has Africa’s one of the biggest media markets. It houses thousands of radio stations
and TV networks. Technology has been heavily introduced in its many industries such as
banking, energy, agriculture, health, and finance. Technological disruptions are creating
new target markets in Nigeria. Online shopping is very rapidly increasing and
interestingly, many sellers are promoting themselves in social media such as Facebook
and Instagram. Many tech entrepreneurs are coming up with their startups to solve
different problems. The government of Nigeria also has made technological development
a priority. However, poor tech infrastructure, electricity shortage, and lack of skilled IT
workforce are stalling the technological growth. Inadequate infrastructure, particularly in
the areas of power and transportation, is a massive problem in Nigeria. This has made it
difficult for businesses to operate efficiently in the country. However, the government has
been making efforts to improve the country’s infrastructure, such as the construction of
new roads and the privatization of the power sector.

Environmental Factors

Kenya: Kenya has adopted Universal Health Coverage (UHC) as one of the big four
priority agenda by His Excellency the President, Uhuru Kenyatta. His aspiration is that
by 2022, all persons in Kenya will have the means to use the essential services they need
for their health and well-being. This will be achieved through a single, unified benefit
package without the risk of financial catastrophe. [3] The process of devolution is one of
the main pillars of the Kenyan constitution, which partly means that the public decision-
making process and a significant part of implementation falls under regional leadership.
The country has been divided into 47 sub-regions also referred to as counties. [4]
Consequently, the broader health system adapted to a new reality whereby county leaders
control the resources of the county.

Uganda: Uganda’s health system has both private and government funded facilities. The
government regulates operations of all healthcare facilities. Private companies invest in
hospitals, clinics, and pharmacies. There is no national health insurance coverage,
however there is private health insurance provided by insurance companies. Health
insurance coverage is low, estimated to be under 0.5% of GDP. Several hospitals also
run their own health insurance schemes. Uganda’s medical facilities are attracting U.S.
investors, especially in private medical care and oncology. Health received 6% of the
2023/24 national budget, but donor funding comprises nearly 80% of resources.
Increasingly, the government is considering public-private-partnerships for healthcare
investment, where government contributes land, and private investors build and operate a
facility. Uganda has 23 sites licensed for the manufacture of medicines and health
supplies, although only 13 of these are involved in commercial production of
pharmaceuticals.

Tanzania: Tanzania is progressing towards universal healthcare, in 2020/2021 the

government allocated $387.9 million for the health sector. Tanzania's healthcare
system ranks at 156th place on the WHO league table, with healthcare financing
dependent on contributions from international organizations. Tanzania is a pre-
demographic dividend country with a high population growth rate and a large number of
young individuals. In 2017, the population was estimated to be 57.3 million, with women
comprising 50.5% of the total population. Over the past three decades, Tanzania's
population has grown steadily and is predicted to double in size by 2040. The majority of
the population is under the age of 19, while the working-age population (i.e., individuals
between the ages of 20 and 59) is expected to increase by 2050.

However, Tanzania faces significant health challenges, including high rates of child and
maternal mortality, as well as infectious diseases such as HIV/AIDS, tuberculosis, and
malaria. Despite economic growth, poverty remains widespread, particularly in rural
areas, and access to healthcare is a significant barrier. The healthcare system faces
numerous challenges, including underfunding, chronic staff shortages, and a lack of
medical technology.

The government has made progress in improving health services, but the quality of
healthcare facilities remains low by global standards. The government has a universal
healthcare program, but the scarcity of facilities means that private medical insurance
may be necessary for comprehensive coverage, including medical evacuation to countries
with higher standard facilities.

Zambia: Zambia has over 250 for-profit private health facilities: Mostly clinics attending
to outpatients mainly in the urban districts. The private sector accounts for just 14 percent
of all health facilities nationally.

Nigeria:
The Nigerian health care system is poorly developed and has suffered several backdrops,
especially at the Local Government Levels. No adequate and functional surveillance
systems are developed and hence no tracking system to monitor the outbreak of
communicable diseases, bioterrorism, chemical poisoning, etc.

Burkina Faso: The state of health of the Burkinabé is generally poor. Most hospitals are
in the larger towns, but the government has improved access to primary health care
by increasing the number of village clinics. Burkina Faso suffers from a severe lack of
qualified health workers at all levels including support staff. There is less than 1 (0.45)
physician per 10,000 people, 3.57 nurses per 10,000 people, and 2.39 midwives per
10,000A landlocked sub-Saharan country, Burkina Faso is among the poorest countries
in the world—44 percent of its population lives below the international poverty line of
US$1.90 per day

Legal Factors

Kenya: The Constitution of Kenya in the Bill of Rights assures every person in Kenya to
the highest standard of health which includes the right to health care services. Towards
this end, the Government, through the Ministry of Health, embarked on the creation of a
fund to ensure lower cost of health since many Kenyans will have access to affordable
health care. Social Health Insurance Act, No. 16 of 2023 (“SHIFA”) was assented to on
19th October 2023 and came into force on 22nd November 2023. It establishes the Social
Health Authority and a framework for managing social health insurance to give effect to
Article 43(1)(a) of the Constitution. The Social Health Insurance (General) Regulations,
2024 (“the Regulations”) have been published to operationalize:

i. The Social Health Insurance Fund (SHIF);

ii. The Primary Health Fund (PHF);
iii. Emergency, Chronic, and Critical Illness Fund (ECCIF);
iv. Mandatory registration of every person resident in Kenya as provided for in the
SHIFA; and
v. The mode of payment of contributions as provided for under the SHIFA.
The Kenya Health Policy, 2014 - 2030 gives directions to ensure significant improvement
in overall status of health in Kenya in line with the Constitution of Kenya.

Zambia: Since 2005, the National Health Service Act of 1995 was repealed to pave way
for the dissolution of the CBOH and restructuring of the health sector. However, since
that time, this Act has not been replaced, presenting a major gap.

The overall health policy was developed in 1992, the National Health Policies and
Strategies of 1992 (NHP&S-1992), with the vision to develop a health care system that
provides Zambians with equity of access to effective quality health care as close to the
family as possible, through the Primary Health Care Strategy. The policy advocates for
decentralization to the districts and promotes peoples’ power in health care through
popular representation on area-specific health management boards, thus creating a health
care system that is responsive to local and national interests and needs. In order to
operationalise the Policy, in 1995, through the Health Services Act 1995, the Central
Board of Health (CBOH) was established to be responsible for implementation of health
services, while the MOH was responsible for policy, financing and regulation. However,
following 10 years of implementation, the Act was repealed in 2006, leading to the
abolition of the CBOH structures and creation of a unified four-tier health system under
the MOH. The four levels include: the MOH Head Office at the Centre, responsible for
policy guidance and oversight, regulation and defining standards; the Provincial Health
Offices (PHOs), responsible for coordination, monitoring, technical supportive
supervision, and quality assurance and performance management at provincial level; the
District Health Offices (DHOs) at district level, as the focal point for services delivery,
providing supervision, coordination, planning and management support to Health Posts,
Health Centres and 1st level hospitals; and the health service delivery facilities, which are
the backbone of the system, providing “treatment and care services” to the general
population. It is recognised that the NHP&S-1992 is old and needs replacement with a
new comprehensive and up to date overall health policy. This process was commenced in
2010.
Mozambique: From a legal perspective the MoH and NHS (network of health facilities
providing services) functions are separate, however, in practice the MoH, DPSs and
SDSMASs share financing, supervisory and service provider functions, complicating
inspection of the NHS. Sector planning is aligned with Government planning cycles. The
PARP is orientated by the Government’s Five-Year Plan – which is the government’s
medium term strategic planning document. The PESS allows implementation of the Five
Year Plan, despite the fact its timing is out of step with both these overarching
Government plans. Legal and political context in Mozambique favours the achievement
of health objectives. However, overlap, fragmentation and weak coordination between
laws and policies within and between sectors are still common. A measure of this is that
certain sector initiatives do not take health system capacity into account, especially HR
implications.

Health Care Funding

Zambia: Despite improvements in nominal allocations by government to the health

budget, the resource envelope is still far below the minimum required for the delivery of
an optimum package of health care. Over the years, there have been massive increases in
the flow of funds to the health sector, mainly in support of vertical programs such as
HIV/AIDS, Malaria and TB. The effect of such flows has been the reduction in the share
of government expenditure in the total health expenditure and an increase in the donor
component. Such funds are, however, rigid and unpredictable and may not be moved to
other priority areas, less favored by donors. Government spending on health accounts for
60% of total public health sector funds. This represents 10.7% of the central government
discretionary budget or 8.5% of the total national budget, which is way below the Abuja
Target of 15%. As a percentage of the Gross Domestic Product (GDP), health care
spending represents between 5.4% to 6.6%, which translate to approximately US$ 28 per
capita. Other sources of health care financing include user fees, which until the
introduction of the User Fees Removal Policy for rural and peri-urban areas in 2006
represented about 4% of total health care financing. User fees are a source of flexible
financing for major hospitals like the University Teaching Hospital (UTH), Ndola and
Kitwe Central Hospitals. Government also collects an earmarked 1% tax on interest
earnings, which contributes about ZMK8 billion to the Health Sector basket annually. For
the vast majority of the population there are no prepayment schemes, leading to high out
of pocket expenditures on health care. It is important to note that there are some pre-
payment arrangements in Zambia, with employer and private insurance schemes.
However, it has been observed that private health insurance is not working well, due to
lack of a guiding health care financing policy and adequate market regulation.

Conclusion

This review mainly covers the PESTEL analysis for six African countries in relation to
health sector environment: Kenya, Uganda, Tanzania, Burkina Faso. The review presents
summarized environmental highlights of the health sector, along the “PESTEL Factors”,
PESTEL Analysis presents opportunities for logical analysis of the African countries to
enable Thinkwell develop a regional health strategy.
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