In a bid to improve the coverage of health care to Kenyan, the government has launched a scheme that will provide operational funds directly to health institutions, which will in turn enjoin local communities in managing the funds and prioritizing their health needs.

The Health Sector Services Fund (HSSF) comes into effect this month, with initial beneficiaries being 610 health centres throughout the country.

Making adequate healthcare services universally available has always called for striking of a delicate balance between population's health needs and available resources. It also requires the equitable and efficient allocation and use of those resources.

Two decades ago, the government of Kenya introduced cost sharing in an effort to bridge the growing gap between health sector expenses and available resources. Since that time, the government has strived to achieve a mix of healthcare financing strategies and systems that will enable the country to provide its citizens with universal access to adequate basic health services.

Currently, the health system relies on government revenue, user fees, the National Hospital Insurance Fund, private and employer-sponsored health plans and individual resources.

The family unit in Kenya bears the greatest burden in financing of health care, with studies showing that families have an out of pocket expenditure of about 50%. Public expenditure takes up about 34% with donors taking up the other 16%.

This scenario makes access to health a big problem for many Kenyans, almost half of whom live below the poverty line. The result is that about four in every ten Kenyans who fall sick do not seek medical care due to the high cost of healthcare.

Of additional concern is the ineffective planning and management of finances at the health service facilities and lack of community participation.

In response to this, Government is implementing various strategic reforms to improve management of health, to increase access to health care and to engage the community in the provision of health care.

This approach was informed by the realization that hitherto, only about 50 per cent of targeted funds would reach the facilities. The manifestations of that weakness at the service provision level have included inadequate and poorly maintained equipment and infrastructure, unreliable drug supplies, staff shortages, poor quality health care and low staff morale.

The HSSF therefore will provide a framework for better management of finances at the hospital level and consequently empower the facilities to respond adequately to community needs for preventive, promotive and curative services.

HSSF was developed as part of the strategies to deliver the objectives of the country's National Health Sector Strategic Plan II Kenya. The Plan's overall objective is to reduce inequalities in health care and to reverse the downward trend in the impact of health programmes.

It is also in line with the vision of the Ministry of Public Health and Sanitation, which is "a nation free of preventable diseases and ill health" and with the provisions of Article 43 of the constitution which gives the state responsibility to provide to every citizen with the highest attainable standard of health. Another central tenet of the new constitution is decentralization, which the new scheme helps to foster.

HSSF was given legal backing in December 2007 through a gazette notice by the Minister for Finance. According to the gazette notice, the funds will be sourced from the government, from grants or donations, from cost-sharing revenue and from any income generated from the activities of the fund itself.

In a recent study, scientists from KEMRI and the Wellcome Trust examined a pilot scheme that funded health facilities directly in the Coast Province. The study indicated that the scheme was perceived to have a positive impact on utilisation and quality of care and to have led to a rise in outreach services.

Employment of extra support staff and payment of staff incentives in the form of allowances were reported to improve health worker motivation, the safety and cleanliness of facilities and reduced waiting times.

Eligible Beneficiaries

HSSF will initially provide direct financing to health centres (level 3), then to dispensaries and to community-run facilities. These three primary healthcare levels provide basic treatment services and health promotion. Public institutions and those managed by the community as well as faith-based organizations will all benefit from the fund.

Each facility will receive funds four times in every financial year. In the first financial year, 610 health facilities countrywide will each receive a total of Sh. 450,000, with a phased roll-out plan that will begin with health centres, followed by dispensaries and FBO facilities. The funds will be credited directly to the beneficiary's bank account and can be used for medical supplies, rehabilitation and equipment of health facilities

Management

Management committees have been established and trained at the district, provincial and national level. The committees shall oversight functions but day to day management will be in the hands of facility committees.

The National Committee (NHSC) in particular will approve the work plans prepared by health facilities, among other functions. The Ministry of Public Health and Sanitation has already published detailed guidelines that will support the committees in financial management of the fund.