Background on Demographics, H/ Financing and Quality of Service Delivery

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TYPE OF SERVICE

% OF FACILITIES WITH THE SERVICE

Delivery services

30%

Delivery services 24 hours

23%

Cesarean section

5%

HIV testing/ART

75%

Pediatric ART

17%

Water supply all year

58%

Electricity /generator

74%

Kenya Service Provision Assessment, 2011.modified by Risper Murunga Jan 2015.

This indicates that the county government and the CHMT need to invest more finances in infrastructure to improve the overall quality of care. Bearing in mind those patients will assess their satisfaction based on all departments that served them. Finances are required to buy quality drugs, if a patient finds no drugs or generic or at the laboratory/radiology if they lack some services and have to be send elsewhere either because allocated money was inadequate or embezzled, they will lack satisfaction. The same applies to the wards there could be low quality beds, linen, food and toilets dirty due to no toiletries or water.

PREVIOUS INTERVENTIONS TO ADDRESS THIS PROBLEM AND DEGREE OF SUCCESS

- Ensuring medical supplies are ordered from KEMSA and returns prepared in time to avoid delays. Those not available at KEMSA are speedily procured through open tendering as per PPDA, 2005.This is still a major problem since some drugs from KEMSA to tier 1/2 facilities do not reach the community as some medical personnel at those levels steal the drugs( Y.M.Angima:Anatomy of corruption in H/care Sector in Kenya Oct 2010) . Procured drugs not in KEMSA reach only the county and sub county hospitals.

- In public health, policies have been laid down by the County Health Management Team (CHMT) like the Community Led Total sanitation Program (CLTS). Last year, the county was ranked 2nd well sanitized county of the total 47 with indicators being number of people using pit latrines, number of open defecation places, ratio of pupil toilet in schools and budget allocation to sanitation (Nakuru county Health office publication 2014).Though Kaizen practices and finances for the course needs to be maintained.

- The County has made projected plans and requires a total of ksh.102, 381,835,337 generated from all sources to achieve its planned projects for 2013- 2017 including health projects (County Strategic Development Plan 2013/17).This planning in advance will enable health sector continuous improvement and improve quality of care.

- The county 2014/15 budget is est. ksh9,872,659,542, est. revenue to be collected for the same FY from all sources est.Ksh9.8B( county 2B,central government 7.2B, rural electrification 288M,loans/grants 138M,AIA from h/facilities 540M and county hospital 620M).Health will receive Ksh. 3,475,968,141(35.2% of whole budget). Of this, 86.8% H/planning/adminstratin,10.24% curative and 2.88% preventive/promotive services (cedgg:Analysis of Nakuru County 2014/15 budget to h/sector) .This will be used to improve the general infrastructure in the h/ facilities in terms of wards, theaters for all tiers 3, specialized clinics (CCCs, MCH, diabetes) though tier 1 and 2 are not yet. This can be attributed to constraint finances and prioritizing at the CHMT level

- The Ministry’s strategic plan is to reduce distance to h/facility by 50% by 2017 to near WHO recommendation of 5 kms and increase the number of tier 2 and 3 facilities to 322 from the current 138 (County Strategic Development Plan 2013/17).

BARRIERS TO EFFECTIVELY ADDRESS THIS PROBLEM

- Misplaced priorities/ corruption whereby at times machines are procured not on needs but based on “kickbacks”. “Kenya is still corrupt, ranked 147 and 148 in 2008 and 2009 respectively of all 180 countries surveyed” (KACC report Feb 2010) .There is theft of drugs, inflation of hospital bills for insurance and bribery in procurement(Y .M. Angima: Anatomy of corruption in H/care Sector in Kenya Oct 2010) This is enhanced by the culture of see, hear and say no evil which must end for proper h/care to be conceived.

- Beauracracy- PPDA procedures delay procurement and delays service delivery.

- Nepotism- Relatives handling h/ finances may be arm twisted to inappropriate actions.

- Politicking within the county-(Daily Nation Oct 23rd 2014) .This may influence procurement of h/ products and technologies negatively and may lower morale/quality.

- Dogmatism/ tradition- Following in steps of previous office holders like procurement of drugs from a company despite knowing well that that drug is of low quality.

PROPOSED RECCOMMENDATIONS ON HOW TO ADDRESS THE WEAKNESSES

- Prioritization-Buying what is really needed by the patients and not otherwise?

- Reduce beauracracy in procurement- Government needs to initiate low budget execution to realize its targets and outputs by initiating amendments on PPDA Act of 2005 to address issues of lengthy procurement” (Institute of Economic Affairs: Budget guide June 2014) .To ensure medical products are available always.

- Stop nepotism- This will enhance professionalism and quality service delivery.

- Stop corruption and enhance accountability-Curbing loopholes for conspired overpricing and other vices ensures finances are used for service delivery and not embezzled.

- Enhance critical thinking to avoid dogmatism/tradition and persistent errors.

REFFERENCES

- Kenya Service Provision Assessment, 2011. 6.Commission on Rev .Allocation 2009/14

- KACC report Feb 2010 7. Transparency international Kenya 2011

- Institute of Economic Affairs: Budget guide June 2014

- County Strategic Development Plan 2013/17 8.National H/insurance Statistics

- cedgg:Analysis of Nakuru County 2014/15 budget to h/sector.