FACILITY AUTONOMY IN THE AGE OF DEVOLUTION: COUNTY-LEVEL ARRANGEMENTS FOR MANAGING HEALTH FACILITY REVENUE IN KENYA

In Kenya, government-owned health facilities could retain the revenue they collected from user fees, health insurance reimbursements, and government transfers prior to devolution in 2013. Facilities would spend these funds to address their immediate needs, including sourcing for commodities, hiring casual workers, and paying for other operating costs. After devolution, their ability to retain and use own-source revenue became dependent on how the newly formed county governments interpreted the 2012 Public Finance Management Act. Most counties started requiring facilities to transfer all own-source revenue to the county treasury. Some have since put in place arrangements to grant financial autonomy to health facilities. Under the Strategic Purchasing for Primary Health Care (SP4PHC) project, ThinkWell reviewed facility financing arrangements in Kenya’s 47 counties. This brief summarizes the findings and offers reflections on potential implications for service readiness.

Publication Year:

2023

Publisher

Thinkwell

Author:

Thinkwell
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A message from the partners of the Strategic Purchasing Africa Resource Center (SPARC)

Since 2018, The Strategic Purchasing Africa Resource Center (SPARC) has been a unique and significant force in supporting countries within Sub-Sahara Africa (SSA) in crucial areas of strategic health purchasing (SHP), Healthcare Financing as they make progress towards the realization of Universal Health Coverage (UHC) goals. This initiative, a collaboration between Amref Health Africa and Results for Development (R4D), has made expertise in these areas more accessible and has been instrumental in the progress of the target countries. The initiative was designed to advance policy discussions and actions that strengthen the application of strategic health purchasing to strengthen African health systems and support countries as they address foundational reforms…