Doctors leave the Health ministry headquarters in Nairobi after failing to meet the minister during their strike to demand higher pay and better working conditions. Reforms are necessary to get Kenya’s public health working efficiently. BILLY MUTAI
The government’s attempt at solving some of the commonest complaints from health analysts and reformers has spurned several initiatives. Some recent ones like the little known HSSF counts as one of the most potentially useful.
What these programmes seek to do is empower health facilities to have a direct role in managing their funds. And its practicality is more suited to smaller health facilities – dispensaries and health centres. These are set to benefit more from this program if they embrace it fully.
Analysts found that the old system where funds were periodically channelled from central government, to the provincial, district and finally the health centres was cumbersome and expensive. The multiple layers of bureaucratic fund administration with each level “using up’ some of the money meant huge losses.
What these reforms, the financial ones in particular, are aiming for is having each facility receive a small quarterly budgetary allocation in form of facility improvement funds FIF, to augment the small amount collected from patients. Though measly, the amount is aimed at inculcating local decision making and leadership.
In well managed facilities the difference has been notable. In others, the ease of pilferage means no change in the prevailing conditions.
As a regular visitor to rural health facilities, I was gladly surprised to see one such facility using the new ETR receipt system. The people in charge of the HSSF funds have come up with a brilliant standardised receipt system with less room for abuse than the old manual systems.
For a first time attempt, this is a smart move that deserves kudos. Hopefully the second generation of such machines will come in handier and have more controls and possibly be directly linked to the central monitoring office. What’s even better is that the entire system was an initiative of smart “business men” from the area.
The next step should be to have finance managers overseeing several such units as opposed to having the amorphous hospital committees in charge of the funds. Besides their inefficiencies, the numerous meetings just gobble up funds meant for real health expenditure.
Other phases of these ongoing health sector reforms should aim to concentrate funds into the health facilities. The doctors’ strike was sadly misconstrued to have been about salaries. Health sector reforms were a huge component of the demands made by the union.
We need to curb wastage and inject more money into direct health care provision. As one of the union doctors aptly puts it, we need to get more money away from hotels and into the hospitals. The amount of money spent on conferences, workshops and seminars is mind-boggling.
Maybe the Treasury and the Ministry of Health should think about restructuring the systems to create leaner, meaner (in terms of pilferage) and more efficient ones. Allocating more money to a system that does not achieve set targets with what it has is not the way to go. Treasury should demand more stringent management and accountability of the health ministry funds. The private sector can teach us a thing or two about this.
Omete is a medical practitioner. Feedback www.healthinfo.co.ke
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