Transparency and Accountability in Kenya’s Health Financing Models

Abstract

Transparency and accountability on processes in the health sector in Kenya has been waning. In 2017, for instance, the health sector witnessed major challenges ranging from internal turmoil caused by health practitioners over corruption to poor service delivery leading to wastage of public funds. The U.S. Embassy in Kenya announced the suspension of approximately $21 million (2.1 billion KSH) funds to the Kenyan Ministry of Health on May 9, 2017 . According to the U.S government, these drastic measures were a result of to ongoing concerns about reports of corruption and weak accounting procedures within the Ministry.

In view of the shortcomings identified in achieving Kenyans’ health goals set out in the Constitution and other policy and legal frameworks, the need to assess the effectiveness of health financing models in Kenya is necessary. The research paper contributes to identifying the various health financing models including through the Kenya National and County Budgets, the National Health Insurance Fund, Private Health Insurance Companies, Development Partners(Including Donors, Faith Based and Non-Governmental Organisations) and Public Private Partnerships. The research paper also sought to determine how much each of the identified models and pathways for health financing are in line with the transparency and accountability principles stipulated in the Constitution, which include access to information, public participation and value for money.

Methodology

i. Identify and explain the various health financing models applied in Kenya.

ii. Evaluate the feasibility and attractiveness of the various models according to the following categories:

a. Enabling Environment: Any laws, policies, rules, or regulations, at both national and county-level, that might impede the effectiveness of the various health financing models.

b. Access to Information: The extent to which the identified health financing models are structured towards ensuring the realisation of the highest attainable health standards including ensuring equitable, affordable and quality health care for all citizens.

c. Public participation: The extent to which public health financing models allow for effective public participation in their design and implementation including transparency, accountability and feedback mechanisms.

d. Value for money: How the various health financing models respond to the need to get value for money in provision of services and health resources.

e. Recommend the most appropriate model(s), if any, with workable strategies to enhance people-centred transparency and accountability principles in the health financing models.

Findings

1. Delays in auditing of expenditures at facilities due to ineffective accounting systems leading to wastage and misappropriation of public funds.
2. There is lack of reliable data to inform the planning process, formulation of objectives, and development of a need-based assessment of budget requirements at the facilities.
3. Insufficient human resources at facilities as well as insufficient capacity of members of Health Facility Management Committees to carry out their oversight and also lack formal coordination of their work at Sub-County and County level.
4. There are 6 health financing models applied in Kenya: 1. Tax-based financing 2. Social health insurance (NHIF) 3. Private health insurance 4. Community-based health insurance 5. Donor funding 6. Out-of-pocket payments: car

Recommendations

1. Governments should carry out a comprehensive needs analysis for the Primary Health Facilities and ensure adequate allocation and disbursement of funds on a quarterly basis.
2. Adopt comprehensive health information systems also on financial management.
3. Enhance capacities of health stakeholders for financial management and social accountability.
4. Streamline budgeting, accounting and auditing processes.