Are Health Facility Management Committees in Kenya ready to implement financial management tasks: findings from a nationally representative survey

Abstract

BackgroundCommunity participation in peripheral public health facilities has in many countries focused on including community representatives in Health Facility Management Committees (HFMCs). In Kenya, HFMC roles are being expanded with the phased implementation of the Health Sector Services Fund (HSSF). Under HSSF, HFMCs manage facility funds which are dispersed directly from central level into facility bank accounts. We assessed how prepared HFMCs were to undertake this new role in advance of HSSF roll out, and considered the implications for Kenya and other similar settings.MethodsData were collected through a nationally representative sample of 248 public health centres and dispensaries in 24 districts in 2010. Data collection included surveys with in-charges (n = 248), HFMC members (n = 464) and facility users (n = 698), and record reviews. These data were supplemented by semi-structured interviews with district health managers in each district.ResultsSome findings supported preparedness of HFMCs to take on their new roles. Most facilities had bank accounts and HFMCs which met regularly. HFMC members and in-charges generally reported positive relationships, and HFMC members expressed high levels of motivation and job satisfaction. Challenges included users’ low awareness of HFMCs, lack of training and clarity in roles among HFMCs, and some indications of strained relations with in-charges. Such challenges are likely to be common to many similar settings, and are therefore important considerations for any health facility based initiatives involving HFMCs.ConclusionMost HFMCs have the basic requirements to operate. However to manage their own budgets effectively and meet their allocated roles in HSSF implementation, greater emphasis is needed on financial management training, targeted supportive supervision, and greater community awareness and participation. Once new budget management roles are fully established, qualitative and quantitative research on how HFMCs are adapting to their expanded roles, especially in financial management, would be valuable in informing similar financing mechanisms in Kenya and beyond.

Overcoming barriers to access and utilization of maternal, newborn and child health services in northern Nigeria: an evaluation of facility health committees

“…As similarly reported elsewhere [ 7 , 15 ], despite the generally good relationship between committee members and service providers in our study, there were a few instances of tension, especially during initiation of facility health committee activities. Committee members described instances of negative attitudes among service providers toward their recommendations on certain areas of service delivery, such as facility opening hours and staff dedication to duty.…”

Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana

“…However, potential for improvement was identified within certain areas, i.e. time planning, conflict handling and resource management (financial, material and human), converging with other studies on district health management [46,49,53]. Further research should look into the most effective ways to enhance such skills.…”

“…Additional areas with room for improvement include the extent of supervision provided to DHMs. Supervision plays a critical role in creating an enabling work environment where DHMs are appraised and incentivized to perform better [47][48][49]. Moreover, regular meetings and structures to enable community involvement should be present to a larger extent.…”

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

“…Clarity in the roles of stakeholders and implementers, and the nature of relationships between key actors, are recognized as critical to policy implementation ( Bossert 1998 ; Conyers 2007 ). Beyond some concerns regarding relationships between HFMCs and in-charges (see also Waweru et al . 2013 ), and between DHMTs and CBAs, a specific area of discussion and debate in HSSF was the level of involvement of the District Treasury in HSSF, with views ranging from the lack of district involvement being ‘the Achilles heel’ of HSSF, to an argument that HSSF was purposively designed to be a parallel system—and at least initially—precisely to avoid the failings of the District Treasury.…”

“… Allocating decision-space for HSSF across key domains for decision making . Once decision-making space for key decisions is agreed, accountability systems downwards to communities and users, and upwards to managers and funders can be considered, including making sure that the total accounting responsibilities for each key actor are reasonable, and do not undermine their ability to achieve their roles ( Waweru et al . 2013 ).…”