Health Budgets in Government and Counties: More Questions than Answers!

[Guest guest]

Health Budgets in Government and Counties: More Questions than Answers!

One needs not ask the tough questions, but the simple ones which will give you

the answers most elusive. In Kenya, how really do we at the National, Provincial

and at the County level, (best) apportion funds based on diseases that are of

prime importance in our societies?

Since the World Health Organization proposed decentralization as a way to

empower communities to take ownership and control of their own health in 1978,

the strategy has been variously pursued and implemented in both developed and

developing countries as a key management approach on the belief that it enhances

efficiency in public sector performance. Kenya has yet to reap these benefits,

and with the onward movement to implementing the new constitution, this

dispensation should probe to how best counties can benefit from decentralization

concepts that has been sired from a genetic pool of proper planning. Indeed the

opportunity is ripe for Kenyan planners to ask and answer on how

decentralization in health care can help alleviate the daunting task of health

budget allocations and resources.

Indeed the problem is systemic in government, but at the third tier of

governance which concerns this missive most, Local government, budgeting being a

policy reform direction under the larger decentralisation framework, suggests

that the once obsolete exercise where resources were (un)wittingly misplaced,

should be buffed against needs, wants and downstream uses and these should

become completely entangled. It would benefit many a counties to invest valuable

human resources in simple health models based on what diseases are both present

and dominant in their respective areas. Be it independently in Northern Turkana,

or in Southern Amboseli, or in villages in Port . At the risk of

(un)popular debate, health planners should ask if they have lost touch with

planning of health care and deliberately given the baton to donors! If not, how

do we consumers then answer the following questions?

• What are the tools used by health care workers to budget and to assess the

effectiveness of resource allocation at the different levels of government? Are

these tools available for the provincial level of governance, and will they be

available for counties, alongside technical support?

• When resources (particularly monies) are allocated in any budget, what

criteria is the prioritization based on?

• Is there a logical disease burden influence that the allocation of funds

within a health department will rely on?

o If there is, what are the principles that these follow, and/or what are the

best practices that counties can adopt?

• Why is it that some health budgets are returned to treasury as unused funds?

• And, finally, suppose one gets the 15% allocation asked for in any National

health budget (as signed in the Abuja declaration) how do you apportion these

monies against mortality and morbidity in order to reduce incidence of the

disease. This is almost linked to the point immediately above, but is more

inclined towards prevention strategies.

When one re-synthesizes these questions in view of current health policies,

budgeting and their compounding effects on service delivery, then there is an

inevitable cataclysmic collusion in the making. The genesis of this is found

superficially in " pillarization " of programs and engrossed in the workings of a

malfunctioned decentralized health care system, with prima-facie evidence from

other developing nations of unavoidable breakdowns in the very primary health

care systems that supports the rest of the healthcare in the country. More so,

as is seen with the after effects of many AIDS programs, the much touted lessons

learnt are not easily transposed to other diseases. With current health care

service delivery models, the reliance is on treatment, rather than prevention

(except HIV and AIDS) and this leads to much higher expenditures

(notwithstanding morbidity and mortality) than would have otherwise been

prevented.

My instinct charts an accusation against policy planners (particularly those at

the provincial level who are now empowered through schedule four of the

constitution), that rather than actually budget for a need in health care

delivery and then source of funds for that project, the reverse is true, where

policy planners end up with a given amount of money (most likely from donors)

and the budgets, whether they like it or not, will be appended to those

resources. Any deviations, or plans outside these parameters will have to be

funded from elsewhere.

The natural question to ask at this point is, " where else does one expect to get

money to fund your health budget if you cannot raise the money internally? " The

irony of this very question then is, how do you expect to control your health

allocations if someone else controls how much, where and on what you can spend

on? Indeed, what are the implications when there are health (budget) cuts in the

donor countries as is currently in the American offing? There are however other

options, for instance, general taxes, social health insurance, private health

insurance, medical savings accounts and out of pocket spending (which has become

the most common source of financing in many low income countries).

Finally, as the country negotiates the twists and turns of the new dispensation,

the benefits of proper policy planning based on systematic methodology

particularly at the county level of health governance have never been viewed in

better prospects. Consider the options:

1. Better care for people with severe and debilitating illness

2. More coordinated services through local organizational structures and the

provision of tailored multidisciplinary care plans

3. Expanded and strengthened primary health care services

4. Established single county based e-health portals

5. Increased and integrated prevention and early intervention strategies

particularly for the vulnerable populations of children and young people (for

example, extend health and well being checks though community health care

workers to 3 year olds)

6. Encouraged and monitored economic and social participation, including jobs,

for people with both communicable and non-communicable illness

7. Improved quality, accountability and innovation in all health services

8. And the opportunity to establish a new independent county level health

Commission to independently monitor, assess and report on how the system is

performing.

It is through this publication, although watered down, that county level

governance can be ignited to better plan for health service delivery,

particularly now that it has become a necessity rather than a luxury.

By Dr. Isaac A. Choge

The writer is the Monitoring and Evaluation Specialist at the AMPATH-USAID

Partnership. This article is written in his own personal capacity, and does not

reflect the views in any way of the Organization(s) mentioned.

http://www.africanexecutive.com/modules/magazine/articles.php?article=6362 & magaz\

ine=373

[Guest guest]

Health Budgets in Government and Counties: More Questions than Answers!

One needs not ask the tough questions, but the simple ones which will give you

the answers most elusive. In Kenya, how really do we at the National, Provincial

and at the County level, (best) apportion funds based on diseases that are of

prime importance in our societies?

Since the World Health Organization proposed decentralization as a way to

empower communities to take ownership and control of their own health in 1978,

the strategy has been variously pursued and implemented in both developed and

developing countries as a key management approach on the belief that it enhances

efficiency in public sector performance. Kenya has yet to reap these benefits,

and with the onward movement to implementing the new constitution, this

dispensation should probe to how best counties can benefit from decentralization

concepts that has been sired from a genetic pool of proper planning. Indeed the

opportunity is ripe for Kenyan planners to ask and answer on how

decentralization in health care can help alleviate the daunting task of health

budget allocations and resources.

Indeed the problem is systemic in government, but at the third tier of

governance which concerns this missive most, Local government, budgeting being a

policy reform direction under the larger decentralisation framework, suggests

that the once obsolete exercise where resources were (un)wittingly misplaced,

should be buffed against needs, wants and downstream uses and these should

become completely entangled. It would benefit many a counties to invest valuable

human resources in simple health models based on what diseases are both present

and dominant in their respective areas. Be it independently in Northern Turkana,

or in Southern Amboseli, or in villages in Port . At the risk of

(un)popular debate, health planners should ask if they have lost touch with

planning of health care and deliberately given the baton to donors! If not, how

do we consumers then answer the following questions?

• What are the tools used by health care workers to budget and to assess the

effectiveness of resource allocation at the different levels of government? Are

these tools available for the provincial level of governance, and will they be

available for counties, alongside technical support?

• When resources (particularly monies) are allocated in any budget, what

criteria is the prioritization based on?

• Is there a logical disease burden influence that the allocation of funds

within a health department will rely on?

o If there is, what are the principles that these follow, and/or what are the

best practices that counties can adopt?

• Why is it that some health budgets are returned to treasury as unused funds?

• And, finally, suppose one gets the 15% allocation asked for in any National

health budget (as signed in the Abuja declaration) how do you apportion these

monies against mortality and morbidity in order to reduce incidence of the

disease. This is almost linked to the point immediately above, but is more

inclined towards prevention strategies.

When one re-synthesizes these questions in view of current health policies,

budgeting and their compounding effects on service delivery, then there is an

inevitable cataclysmic collusion in the making. The genesis of this is found

superficially in " pillarization " of programs and engrossed in the workings of a

malfunctioned decentralized health care system, with prima-facie evidence from

other developing nations of unavoidable breakdowns in the very primary health

care systems that supports the rest of the healthcare in the country. More so,

as is seen with the after effects of many AIDS programs, the much touted lessons

learnt are not easily transposed to other diseases. With current health care

service delivery models, the reliance is on treatment, rather than prevention

(except HIV and AIDS) and this leads to much higher expenditures

(notwithstanding morbidity and mortality) than would have otherwise been

prevented.

My instinct charts an accusation against policy planners (particularly those at

the provincial level who are now empowered through schedule four of the

constitution), that rather than actually budget for a need in health care

delivery and then source of funds for that project, the reverse is true, where

policy planners end up with a given amount of money (most likely from donors)

and the budgets, whether they like it or not, will be appended to those

resources. Any deviations, or plans outside these parameters will have to be

funded from elsewhere.

The natural question to ask at this point is, " where else does one expect to get

money to fund your health budget if you cannot raise the money internally? " The

irony of this very question then is, how do you expect to control your health

allocations if someone else controls how much, where and on what you can spend

on? Indeed, what are the implications when there are health (budget) cuts in the

donor countries as is currently in the American offing? There are however other

options, for instance, general taxes, social health insurance, private health

insurance, medical savings accounts and out of pocket spending (which has become

the most common source of financing in many low income countries).

Finally, as the country negotiates the twists and turns of the new dispensation,

the benefits of proper policy planning based on systematic methodology

particularly at the county level of health governance have never been viewed in

better prospects. Consider the options:

1. Better care for people with severe and debilitating illness

2. More coordinated services through local organizational structures and the

provision of tailored multidisciplinary care plans

3. Expanded and strengthened primary health care services

4. Established single county based e-health portals

5. Increased and integrated prevention and early intervention strategies

particularly for the vulnerable populations of children and young people (for

example, extend health and well being checks though community health care

workers to 3 year olds)

6. Encouraged and monitored economic and social participation, including jobs,

for people with both communicable and non-communicable illness

7. Improved quality, accountability and innovation in all health services

8. And the opportunity to establish a new independent county level health

Commission to independently monitor, assess and report on how the system is

performing.

It is through this publication, although watered down, that county level

governance can be ignited to better plan for health service delivery,

particularly now that it has become a necessity rather than a luxury.

By Dr. Isaac A. Choge

The writer is the Monitoring and Evaluation Specialist at the AMPATH-USAID

Partnership. This article is written in his own personal capacity, and does not

reflect the views in any way of the Organization(s) mentioned.

http://www.africanexecutive.com/modules/magazine/articles.php?article=6362 & magaz\

ine=373