Social determinants of health


Kenya developed an Action Plan and obtained commitment from the President's Office to establish a National Commission in 2006. The focal point was the Minister of Health. The Action Plan developed included:

  • a focus on improving maternal mortality in a particularly disadvantaged province;
  • linking urban planning and health action to improve conditions in Kenya's slums; and
  • work to introduce equity monitoring into the Medium Term Expenditure Framework (possibly expanding to other planning processes such as SWAps, the health sector's Annual Operational Planning, and the National Health Insurance Fund).

Kenya hosted the fifth meeting of CSDH Commissioners in June 2006. Commissioners meet with local government policy makers, representatives from civil society organizations, and academics and discussed issues and policies to effectively address social determinants.

Underscoring these meetings catalytic importance for SDH action nationally and across the African region, President Mwai Kibaki endorsed the creation of a Kenyan National Commission on SDH to spearhead the eradication of health inequalities in the country.

President of Kenya Mwai Kibaki and Commissioners


Activities of the national commission could include:

  • production and dissemination of evidence, knowledge and information, including a baseline diagnosis of equity in health and SDH, and a review of cost-effective approaches to improving population health.
  • review and make recommendations on policies, programmes and development frameworks in terms of impact on SDH and HE, including cross-cabinet inquiry into health inequities and development of National Objectives and Targets on Health Equity and Social Determinants.
  • provide recommendations to Government on: (1) how spending in other sectors and in macro-level development policies and financing frameworks can reduce health inequities; and (2) how to ensure than spending decisions can be taken as cost-effectively and consistently as possible.
  • strengthening institutional mechanisms to adopt a whole of government approach, including introduction of equity indicators into routine health information systems and into monitoring of development plans.
  • mobilizing civil society for advocacy and action, including a meeting of national and regional stakeholders and development of a national advocacy strategy on health equity and SDH.
  • support regional and international work in cooperation with the WHO Regional Office for Africa, especially focused on major African institutions, including the African Union Council for African Health Ministers; Southern African Development Forum; and the East African Development Forum

The commission would be supported by an intersectoral technical working group on SDH (to coordinate and manage commission activities and products) and a Cabinet Committee on SDHE (charged with institutionalizing processes within government). The Ministry of Health would function as the secretariat.

Additional specific activities under examination as part of national action on SDH and HE include:

  • reviewing the resource allocation criteria for the government’s grant system to assess how these criteria relate to key social determinants of health and health inequities;
  • reviewing current MOH expenditure and health outcomes using a social determinants lens;
  • developing a national process of workshops with key stakeholder groups involved in Health Facility Committees to sensitize the Committees to the social determinants of health and health equity issues; and
  • evaluating the impact of reducing user fees on poverty and health status among vulnerable groups.