The suspension of aid by the US government for a publicly funded health programme has raised concern among doctors over expenditure of the projects. Mounting concern over rising national debt makes more scrutiny from unbiased viewpoints necessary not just for donor grants but especially loans to know if we are getting value for money or not.
While development loans are refundable by taxpayers, conditional grants also need scrutiny. Sadly the utilisation of such funds has not received desirable levels of input from the two main Kenyan doctors’ bodies: the Kenya Medical Association (KMA) and the Kenya Medical Practitioners, Pharmacists and Dentist Union (KMPDU).
Because their interests are unbiased and as the ultimate custodians of patient’s welfare, they need to be proactive in the scrutiny of such agreements, their spending and also be part of the impact evaluators.
For instance, the $50 million National Safety Net Programme (NSNP) and the Transforming Health Systems for Universal Care a $150 million could be starting points. Both are funded by the World Bank with the NSNP objective being to widen, improve governance and sustainability of the universal healthcare coverage fund.
With about 60,000 participating households queries arise as to whether counties will afford to take over as envisaged when the funders exit in three years. Most are already struggling to meet current healthcare budgets.
The Transforming Health Systems for Universal Care project as designed has multiple components all geared towards the improvement of the quality of care with a focus on maternal reproductive health related focal areas.
One of the key components of this fund is “strengthening the monitoring and evaluation” capacity of the health system. While standard practice is to have mid-term or end-point evaluators of projects like these, the manner in which it often happens means not all angles are captured.
Often missing is the “critic’s viewpoint” offered by a group not directly benefiting. As a rural health worker, one weakness of such projects is that they do not emphasise on developing easily accessible external and publicly visible impact evaluation reports. Perhaps by oversight or intentional design to reduce roadblocks from independently interested parties.
For both the government and the funders, while such an approach may potentially slow or derail project timelines, it ensures a well-rounded approach.
The KMA and doctors’ union need to reach out and seek support to strengthen and improve their capacity to give independent input in such programmes since they have the patient welfare at heart and members are often the implementers on the ground.
Disclosure: Dr Omete is not affiliated to the KMA or the KMPDU.