Friday, 10 May, 2019
In a ground breaking move to increase investments in health towards universal health coverage (UHC), West Pokot County has enacted Kenya’s first stand-alone County Facility Improvement Fund (FIF) Bill.
With the support of Amref Health Africa in Kenya, West Pokot County set out to ring-fence revenues generated by health facilities for use in improving health infrastructure and other essential services towards UHC through the FIF bill.
Following a consultative meeting by health stakeholders where the bill was birthed, it was tabled to the West Pokot County Assembly in March 2019 for its first reading after which it went to public participation to collect views from the public. The bill was tabled for the second reading on Tuesday, 30 April 2019 and was passed unanimously by the members of the West Pokot County Assembly.
Following assent of the bill by County Governor John Lonyangapuo, County Director of Health Dr Norbert Abuya said, “This bill provides health facilities in West Pokot an opportunity to invest in infrastructure and other service delivery areas including purchasing pharmaceutical and non-pharmaceutical supplies, leading to better quality of services for the people of West Pokot County.”
“The passing of this bill aligns with the UHC target of increasing spending on health care. When facilities have autonomy over the resources they generate, they can increase investments in health care, while also ensuring that spending is efficient and targeted for impact,” said Amref Health Africa in Kenya Country Director Dr Meshack Ndirangu.
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 submitted to the County Revenue Fund (CRF) from where facilities request for funds. This brings bureaucracies and often less funding than what was remitted presenting reduced autonomy of health facilities over their financial management.
Without much say in how revenues collected by them are used, health facilities continue to experience delays in the procurement of essential supplies and reduced staff motivation due to the inability of health facility management teams to provide a favourable working environment. This reduced autonomy has also resulted in a decline in donor support for many facilities due to their limitations in dealing directly with donors.
However, as demonstrated by West Pokot County, the PFM Act also provides for county governments to develop laws that allow them to give financial autonomy to units such as health facilities.
This landmark bill presents an opportunity for other county governments to exercise the rights provided for by the Public Finance Management Act to develop and implement bylaws that provide for sub-county units such as hospitals and health facilities to have residual rights over the revenues that they generate.