The Public Finance Management (PFM) Act 2012 took away the freedom of health facilities to retain, bank and spend revenues collected from user fees. Under the Act, revenue collected is supposed to be submitted to the County Revenue Fund (CRF), from where resource distribution to all county sectors is done. This has resulted in a lot of bureaucracies and, more often than not, less funding to the health sector than what was remitted, translating to reduced autonomy of health facilities over their financial management.
Traditionally, health has not been viewed as a resource generating sector, which makes it difficult for health facilities to purchase small lifesaving commodities such as gloves. For instance, most health facilities have to wait for the rather lengthy and unpredictable county budget approval processes to procure lifesaving commodities.
Against these challenges, Taita Taveta County initiated the process developing the County Health Services Bill. The primary objective of the process was to provide for the achievement of the highest attainable standards of health. The County Assembly passed the bill in March 2021. However, the institutional framework and regulations to guide its implementation was not developed.
To jump-start the process of formulating the necessary regulations and framework, USAID Stawisha Pwani, convened a high-level meeting with Members of the County Assembly (MCA) Committees of health and finance to have discussions and chart a way forward on the same.
LVCT Health is the prime partner implementing USAID Stawisha Pwani, a five-year program funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID) to increase the use of quality county-led health services support and sustainability in quality of health services and systems. The program seeks to strengthen county health systems with a focus on HIV Prevention & Treatment, Family Planning, Reproductive, Maternal, Child and Adolescent Health (FP/ RMNCAH) and Nutrition. The project is implemented in Kilifi, Kwale, Mombasa and Taita Taveta counties in the Coastal region.
By utilizing best practices and lessons learnt in health service provision, USAID Stawisha Pwani presented compelling evidence to compel the Members of County Assembly (MCAs) to pass the proposed amendments.
“We are glad that today the County Assembly has approved the County Health Services Amendment Act and its Regulations, 2021,” said Patrick Mulwa a resident in Voi town.
The new law will effectively provide health facilities with the structures and systems necessary to utilize the resources generated within the same health facilities for improved health care service delivery in the county.
The approval aligns with Kenya’s Universal Health Coverage (UHC) target of increasing healthcare spending. When facilities have autonomy over the resources they generate, they can increase investments in health care while also ensuring that any expenditures incurred are efficiently targeted towards long term impact. The regulations have since been signed into law by the County Governor, Granton Graham Samboja.
Number of public health facilities
supported in Taita Taveta County
The law is set to unlock the operationalization of health management in the County. As required by the Act, the Governor appointed the County Hospital Management and the County Health Management Boards pursuant to sections 16 and 7, respectively, of the Taita Taveta County Health Services Act, 2021.
Subsequently, Jacob Lenjayo a program staff working for the Stawisha Pwani project, was appointed to the County Health Management Board. The boards will provide, among other responsibilities, oversight over administration of health under their jurisdiction, facilitate prudent utilization of resources and provide a framework to ring-fence health financing in the County.
The County Health Executive John M. Mwangeka praised the members of the county assembly for their role in the enactment of the new law. He noted that the new law will not only improve service delivery but also promote access, including reproductive healthcare services and the right to emergency medical treatment for the locals of Taita Taveta County and neighbouring counties.
He called on health personnel to take advantage of the new regulations to ensure efficiency in service delivery across the county managed facilities.
USAID Stawisha Pwani will leverage the County’s commitment to train the new boards on leadership, management, and governance to improve the overall management, resource planning and allocation, and performance monitoring of health services.
The USAID Stawisha Pwani project is implemented by a consortium composed of four organizations. LVCT Health as the Prime Partner, the Center for International Health Education and Biosecurity – Kenya (CIHEB-K), Amref Health Africa in Kenya, and Population Reference Bureau, Inc.-Kenya (PRB) as the sub-partners.