Ms. Cynthia Macharia, Programme Officer – GIZ Health Sector Programme, Kenya
The missing link? How Good Financial Governance Helps Strengthen Health Systems, Country Case Kenya
Which was the rationale for developing an initiative on Good Financial Governance in the Health Sector?
Firstly, making use of allocated funds is obviously a good precondition for achieving good health outcomes.This also implies the importance of tracking fund flows and utilization of the funds.
Secondly, as GIZ Health Sector Programme in Kenya we had the very good opportunity to build on an already existing collaboration with another GIZ programme in Kenya, the promotion of good governance programme, commonly referred to as “GoGo”. Both programmes were already collaborating with the Kisumu county, in addition to this the anti-corruption project at GIZ headquarters spark the specific collaboration on good financial governance in the health sector.
Which particular governance areas does this initiative address?
In particular it addresses four areas: firstly, strengthening planning and budgeting processes, secondly, ensuring public participation in management of health services and thirdly, strengthening complaint mechanisms and lastly, increasing awareness on rights to health and patients’ rights.
Which Particular challenges are you addressing with this initiative?
To mention just two challenges, there are funds flow challenges; normally funding is supposed to flow from the national government to the county government, and from the county government to the hospital level, if we take the example of free maternity services funding, the funds are supposed to come from the national government to the hospitals, however our experience on the ground is that some facilities complain that they do not receive their reimbursements on time and sometimes their reimbursements are insufficient and not regular.
There is also the issue of public participation, the constitution of Kenya provides for public participation in issues of governance both at the national and county level, this is however not happening effectively, there are instances when people are called to meetings they either do not understand their role or they do not understand the content sufficiently and therefore their participation is not very effective.
What is the initiative doing to address such challenges?
To give just a few examples, GIZ is training Civil Society Organizations (CSOs) on carrying out funds tracking surveys, in the example of free maternity services, they are empowered to carry out the tracking survey to analyse how the funds flow from the national level to the hospital level, they are also empowered to analyse how these funds are utilized at the hospital level and therefore the impact that the funds are having on the quality of services delivered. Secondly, we are building the capacity of Civil Society Organizations and community through Community Health Workers to carry out social audits at the hospital level. Social audit is an important tool as it enhances citizen led accountability mechanisms for service delivery, thirdly, we are building capacity of hospital boards, hospital boards membership is drawn from the community and they are mandated to carry out oversight on management of the hospitals by building their capacity, they are then better able to carry out this mandate and provide strategic direction to the hospitals. Lastly, we are strengthening complains mechanisms structures at the county level, here we work closely with senior county officials, we sensitize them on existing legal framework and constitutional requirements on handling complains, they are then able to come up with very strong structures that are responsive to the complains from the community.
How do you see the sustainability?
As far as Kisumu is concerned, the county sees a lot of value in this initiative and fully supports it, indeed at the request of the minister for health in Kisumu, a tripartite task force on good governance in health has been formed, this task force comprises senior officials from Kisumu county and representatives from the two GIZ programmes, Health Sector Programme and Good Governance programme, we are therefore convinced that the county will be able to carry on this initiative. From the experiences we have gain in Kisumu we expect that Kisumu is very well placed to scale up these initiative in other counties in Kenya.2017-01-25
August 9, 2018
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