HEALTH SECTOR SERVICES FUND (HSSF) PERFORMANCE FYs 2011-2013

PRESENTATION OUTLINE WHY HESSF ? HOW IT WORKS STATUS AS PER JUNE 2013 AUDIT OF FIRST 21 MONTHS OF OPERATION RESULTS CONCLUSIONS RECOMMENDATIONS

BEFORE HSSF Approved national budget MoH requests ↔ Treasury authorizes MoH Issues AIEs to P/D/SD Hospitals &P/DMOHS DAs control funds Resources spent according to items Balances returned to Treasury DAs Prepare reports for treasury with cc to account holders

WHY HEALTH SECTOR SERVICE FUND? BOTTLE NECKS TREASURY $ ↘ DISTRICT ACCOUNTANT  DMOH   HF 

HEALTH SECTOR SERVICES FUND WHAT IS IT? A GoK FUND $ APPROPRIATED BY PARLIAMENT + GRANTS & DONATIONS +(USER CHARGES) AND OTHER INCOMES FUNDS DISBURSED DIRECTLY TO UNITS (based on approved plans) POSITIVE BALANCES RETAINED BY THE FACILITY

PURPOSE Improve QUALITY of services by increasing PREDICTABLE RESOURCES AVAILABILITY for: Health supplies, equipment, & maintenance of recipient units Increasing staff management capacity Increasing community participation

STRUCTURES HF MANAGEMENT COMMITTEES NATIONAL HEALTH SERVICES COMMITTEE HESSF SECRETARIATE

FLOW OF FUNDS ( GoK + DP funds) ↓ HSSF AC @ Central Bank MOH Requests ↔ Treasury authorizes ( GoK + DP funds) ↓ HSSF AC @ Central Bank ↓ →Informs DA & DMOH Credits directly each individual units bank ACs.

REPORTING ↑ NHSC for approval HSSF Secr. for checking and collating Report to Treasury ↑ NHSC for approval HSSF Secr. for checking and collating ↑ ↗ to DA for information → to DAUD for action DMOH for checking Committee approved HF quarterly financial reports

TOOLS A simplified form of GoK official tools and Standard official tools where necessary and/or possible

THE FIRST 21 MONTHS (OCTOBER 2010 TO JUNE 2013) Recipients: 3,362 How much: 2,110 Mio KShs 751 HCs: 1,104 262 DHMTs: 416 2,349 Disps: 534 1 HSSF Secr.: 54

HSSF AUDIT RESULTS 1 (October 2010 to June 2012) Two audits were conducted by the Internal Auditor General and by Deloitte & Touche in 2013. The first audit found a total of 296.6 Mio of questionable expenditures. 137.3 Mio of which were immediately justified by the MOH and cleared

AUDIT RESULTS 2 (October 2010 to June 2012) Of the remaining 159.3 Mio the MOH provided adequate justifications for 63.1 Mio in April 2014. The remaining questioned expenditures amounting to 128.6 Mio relating to 689 recipient units were investigated during the scheduled IIFRA audit in June 2014. Independent Integrated Financial

AUDIT RESULTS 3 (October 2010 to June 2012) Of the 128.6 Mio 95.3 Mio were cleared. Of the remaining 33 Mio and considering only amounts > 100,000 19.1 Mio are still questioned, of which: 4.73 Mio are clear theft in 9 units 14.45 Mio are probable theft/poor financial management in 33 units

AUDIT RESULTS 4 (October 2010 to June 2012) 2,100 millions disbursed to 3,362 units 297 million were questioned of which 264 million were cleared, of the remaining 33 million or 1.6% of the total disbursement is still questioned in 247 units

HSSF CONCLUSIONS Is a viable funding mechanism Its funding predictability is vital for FACILITIES continued functionality Has demonstrably improved quality of care, staff motivation, and patient satisfaction It stimulates community participation

RECOMMENDATIONS Maintain direct financing to facilities 2. Continue with the current approach while searching for, and testing user more friendly financial, reporting, and control mechanisms 3. Adjust it to the devolved landscape 4. Increase GoK funding to include 1,000 more facilities including FBO owned

ASANTE SANA