Transitioning from donor aid for health: perspectives of national stakeholders in Ghana

Mao, Wenhui; McDade, Kaci Kennedy; Huffstetler, Hanna; Dodoo, Joseph Nii Otoe; Abankwah, Daniel Nana Yaw; Coleman, Nathaniel; Riviere, Judy; Zhang, Jiaqi; Nonvignon, Justice; Bharali, Ipchita; Bandara, Shashika; Ogbuoji, Osondu; Yamey, Gavin

doi:10.1136/bmjgh-2020-003896

Cited by 18 publications

(20 citation statements)

References 11 publications

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“…This is alarming as there is a plan for donors to progressively transition from supporting the Kenyan health sector generally, and primary healthcare facilities specifically. Donor transition is expected to put additional fiscal pressure to LMIC health systems, threatening service delivery, and thus requiring them to device ways replace diminishing donor support with domestic resources [21,22]. Third, consistent with previous findings [12,23], funds flow to public health facilities from prepaid sources (county and national government allocations, and NHIF disbursements), are characterized by delays in disbursements.…”

Section: Discussionsupporting

confidence: 74%

Examining health facility financing in Kenya in the context of devolution

Kairu

Orangi

Mbuthia³

et al. 2021

BMC Health Serv Res

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Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

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Section: Discussionsupporting

confidence: 74%

Examining health facility financing in Kenya in the context of devolution

Kairu

Orangi

Mbuthia³

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…This is alarming as there is a plan for donors to progressively transition from supporting the Kenyan health sector generally, and primary healthcare facilities speci cally. Donor transition is expected to put additional scal pressure to LMIC health systems, threatening service delivery, and thus requiring them to device ways replace diminishing donor support with domestic resources (20,21).…”

Section: Discussionmentioning

confidence: 99%

Examining Health Facility Financing in Kenya in the Context of Devolution

Kairu

Orangi

Mbuthia³

et al. 2021

Preprint

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Background: How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.Methods: We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no=20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data.Results: Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion: The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

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“…Adding more components of vertical programmes has important financial implications: in a recent survey of key stakeholders from the government in Ghana, respondents expressed concerns about the financial gap left by donors and consequently possible interruptions of care for the beneficiaries. 31 They suggested that covering more through to the National Health Insurance Agency could be a solution, although recognising the existing concerns about the scheme's financial sustainability as it had been running a deficit over several years. 32 A recent review of JKN in Indonesia also highlights that while the integration of HIV and TB services into the HBP is 'preferable' (p 19), careful consideration of the costs, resource implications, feasibility (eg, given health system constraints) and sources of funding will need to inform what services are included.…”

Section: 6mentioning

confidence: 99%

The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review

Regan¹,

Wilson

Chalkidou

et al. 2021

BMJ Glob Health

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BackgroundCountries are recommended to progressively work towards universal health coverage (UHC), and to make explicit choices regarding the expansion of priority services. However, there is little guidance on how to manage the inclusion of vertical programmes, funded by external partners, in health benefits packages (HBP) in low and middle-income countries (LMICs).ObjectiveWe conducted a scoping review to map the inclusion of six vertical programmes (HIV, tuberculosis, malaria, maternal and child health, contraceptives, immunisation) in 26 LMICs.MethodsWe identified 26 LMICs with an HBP that was not aspirational (eg, with evidence of implementation or funding). For each HBP, we collected information on the corresponding UHC scheme, health financing at the time of establishment, revisions since inception and entitlements. For each vertical programme, we developed a list of tracer interventions based on the Disease Control Priorities 3 and the 100 Core Health Indicators List. We then used this list of tracer interventions to map the coverage of the six vertical programmes.ResultsThe review shows that there is no common starting point for countries embarking into UHC. Some HBPs were almost three decades old. Whole package revisions are rare. The inclusion of vertical programme does not follow a given pattern based on health financing indicators or country’s income group. Maternal child health services are the most often included and family planning the least. Six countries in our sample covered all vertical programmes, while one covered only one of six.ConclusionsThis review has shown that there has been a long history of countries facing this question and we have provided the first mapping of inclusion of vertical programmes in UHC. The results of the mapping can inform decisions in countries embarking in UHC.

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Transitioning from donor aid for health: perspectives of national stakeholders in Ghana

Cited by 18 publications

References 11 publications

Examining health facility financing in Kenya in the context of devolution

Examining health facility financing in Kenya in the context of devolution

Examining Health Facility Financing in Kenya in the Context of Devolution

The journey to UHC: how well are vertical programmes integrated in the health benefits package? A scoping review

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