Health & Fitness

Is devolved healthcare financing better under the current budget?

Going through the 2016 Budget by Treasury secretary Henry Rotich two weeks ago and comparing it to previous years’, shows a few notable changes.

For starters, since the devolved system of governance was implemented, there has been a commendable increase in healthcare budgetary allocation both at the national and county governments.

Looking at the figures from the 2010/11 Budget speech, the allocation to the then Ministry of Medical Services was a paltry Sh23 billion. As a proportion of the entire budget, the total allocation to healthcare was not anywhere near even 10 per cent.

One obvious notable change in all this is that the national government’s healthcare allocation has been increasing but not as proportionately as to the budget.

At the county levels, some remarkable observations have been seen in terms of healthcare allocation. In the financial year 2013/2014 the average health county allocations was 13 per cent.

A year later in the 2014/2015 budget, the average county health allocation was 22 per cent of the allocated funds. In the recently passed Lamu County budget, healthcare was amongst the top allottees.

Medics have previously been fighting the government to increase funds to our sector to no success. This is now, however, happening.

The National County Budget analysis up to last year shows that out of the 47 counties, 22 allocated more that the Alma Ata Declaration recommendation of 15 per cent of government revenue to go to health systems.

It seems counties and citizens there have prioritised healthcare given that the above figure for 2014/2015 averaged 38 per cent an increase of 16 per cent in one year.

Critics of the former national health system argued about the disproportionate and unprioritised budgetary allocation sharing. The counties are trying to reverse this though an uphill task still faces many as they have inherited huge workforces and absent or poor infrastructure.

This means that despite having more funds at their disposal, the proportion that goes towards improvement of health outcomes as interpreted by non-recurrent expenditure such as wages is low.

On average about 65 per cent of many counties’ health allocations go towards payment of salaries and trying to increasing their human resource capacity by recruitment of specialised personnel or training. Obviously one implication is that set targets will take longer to be achieved.

A way out of this is to increase the total allocation to counties which will ultimately translate to more funds being allocated to healthcare.

However, with a national government strained by its own needs this is not really achievable in the short term

The second alternative for counties is to generate revenue from the services they offer. Unfortunately, many have since done away with the cost sharing model where patients paid for some services. These funds previously went a long way towards supporting revenue deficits in allocation.

Perhaps the county administrators should reconsider this if any meaningful outcomes are to be achieved.

A notable observation from the latest Kenya Demographic and Health Survey indicates that populations are growing across all counties.

Similarly our own epidemiology data shows that the medical conditions are now demanding more resources from service providers. Therefore, our allocations should take cognisance of this.

Buying medicine for malaria and leaving patients with renal diseases unserved is not a good measure of adequate financing.

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