Resource Mapping and Expenditure Tracking for Health

 The problem:

Kenya adopted a devolved system of governance in 2010, which established 47 county governments charged with providing and financing healthcare through monies received from the national government as equitable share, Own Source Revenue and donor monies. Kenya has a mixed health financing system with funding from government (47%), donor funds (18%), out of pocket payments (24%) and private (11%). The incidence of catastrophic expenditure was estimated at 7% with between 1 and 1.1 million individuals pushed to poverty annually due to out-of- pocket spend. Policymakers today face significant challenges in ensuring that limited available resources are allocated and spent efficiently. Understanding funding levels and flows between these actors is critical to improve planning, policy, and management.

 Despite the increased contributions to health by the Government over the years, Kenya is facing an increased reduction in the health fiscal space coupled with a lack of visibility into health allocations and expenditure particularly due to the devolved system of governance. The change of status in Kenya from an LIC to an LMIC has further compounded this problem as there has been a drastic reduction in available funds from donors to finance the health sector case in point: reduction in DANIDA funds that supported operations and maintenance in PHC facilities,the end of Transforming Health Systems (TSS) funding that supported SRMNH activities, GAVI transition etc. While the Government has oversight of on-budget funds, the extent of off budget donor financing remains largely unknown. This can be attributed to many of the donors and implementing partners funding health related activities directly in counties and facilities as well as lack of a clearly defined donor coordinating mechanism at the national level. This has led to a myriad of challenges, key among them: lack of access to donor related commitments and subsequent available resources, duplication of partner support in health leading to no value for money and inefficiencies. Furthermore, information on donor related commitments and spending on priority health programs is usually available retrospectively usually towards the end of funding cycles. Timely and accurate information is not readily available on domestic financing.

Proposed approach:

For successful implementation and to ensure sustainability of the Social Health Insurance (SHI) in Kenya,the Government isfaced with an urgent need to ensure that existing resources are well aligned and coordinated per the sector’s priorities while establishing a case for additional resource mobilization. The two main sources of funds for SHI are envisioned to be: tax funding and donor funding. Currently, Health Products and Technologies (HPT) and Human Resources for Health (HRH) are the largest cost drivers in health spending in Kenya greatly impacting on health service delivery.

Resource mapping and expenditure tracking (RMET) is a key policy tool for the health sector with the integrated and detailed presentation of health financing information. RMET has become an essential source of information, guiding the policy process and informing decision makers. The RMET exercise will inform the Government of the resources available for health from both Government and external partners (i.e., donors and partners) with an emphasis on identifying the current donor support in relation to Health Products and Technologies (HPTs) and Human Resources for Health (HRH) as these are critical to ensuring effective service delivery. The exercise will likely focus on donor funding in the first phase, and may broaden out to more detailed implementing partner and Government resources in future phases. The exercise will seek to answer the following questions:

Potential impact:

The results from the resource analysis will empower the government and stakeholders with information on how to efficiently utilize funds, while providing for better coordination of stakeholders therefore reducing duplication in resource allocation and ensuring alignment with the National Health Sector Strategic and Investment Plan. Other impact areas are:

•   Reduced duplication of support offered by the government and external partners;

•   A detailed gap analysis against costed national plans demonstrating the need for targeted resource mobilization. This will also include carrying out an analysis to identify government funding versus donor funding for priority interventions;

•   Improved resource allocation to priority health areas where funding is scarce; and

•   Targeted financial and programmatic data requests from MOH to partners related to available funds.