Purchasing reforms and tracking health resources, Kenya

Abstract

As low-and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved.

The costs and financing needs of delivering Kenya’s primary health care service package

“…Limited government spending combined with existing inefficiencies within the health system, remain key challenges in expanding access to affordable and quality PHC services. Following Kenya’s transition to a devolved government system in 2013, county-level governments are responsible for mobilizing the majority of funding for primary and secondary health service delivery ( 11 , 12 ) while the national government provides strategic commodities (e.g., vaccines, family planning commodities, HIV and TB medicines) to primary care facilities. Although there have been incremental increases in health budget allocations ( 4 ), county-level budgets are largely considered “wishlists” and lack local-level input to inform realistic target setting ( 13 ).…”

Universal health coverage: time to deliver on political promises

“…Various papers in this theme issue address technical and operational dimensions of UHC implementation: pooling of resources to increase risk sharing; 2 improving governance of UHC through voice and accountability in UHC legislation; 3 understanding the political economy of tax-financed systems; 4 the roles of immunization and human immunodeficiency virus programmes in relation to UHC; 5,6 the health workforce; 7 and resource-tracking tools. 8 Although the growing volume of scientific evidence contributes to reducing the knowledge gap in relation to UHC, the challenge of stimulating collective actions to move closer to this goal remains.…”