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Strengthening Evidence Around Funding Flows to Health Care Providers

When a pregnant woman in Kenya or a child with fever in Indonesia visits a clinic, a purchasing agency will pay a health provider for the services the patient receives. For a single service, funds often flow from different purchasing agencies to health providers through a mix of payments.

Many countries are trying to change purchasing arrangements so clients don’t incur out-of-pocket payments and health providers are incentivized to deliver high-quality services at lower costs. The goal for such reforms is to get national health insurance agencies, ministries of health, and other purchasing agencies to think strategically about what types of services to buy, which health providers to contract, and how to pay health providers. Without data-backed insights into how much facilities receive from different sources and the relative strength of different incentives, it is difficult to ensure that health spending is efficient and effective.

How strong are data that track the flow of funds to health facilities? ThinkWell explored this question through a landscaping study in Kenya, as part of the Strategic Purchasing for Primary Health Care project supported by the Bill & Melinda Gates Foundation. Results from this assessment are published in the latest issue of the Bulletin of the World Health Organization.

We focused on the flow of funds to public health facilities from different sources in three Kenyan counties. As we explored the complex web of flows—which varied considerably across counties—we uncovered information gaps throughout the process. These gaps left us with several questions, including: How much revenue do public facilities generate from user fees and insurance claims? How much autonomy do facilities have to spend funds? What costs do facilities incur? As Kenya plans for upcoming health resource tracking activities, we urge the Ministry of Health and other stakeholders to collect more granular data about fund flows.

The Kenyan example offers an important lesson for ministries of health, policy analysts, and development agencies everywhere. While there are many tools for tracking funding flows, many countries still lack comprehensive data on how public facilities are financed. Existing health resource tracking tools don’t provide insights into an average hospital’s revenue from different purchasers or how they spend the funds they collect. Such information is vital to guide strategic purchasing reforms and help countries to achieve universal health coverage.

To read our article, “Purchasing reforms and tracking health resources, Kenya” published in the Bulletin of the World Health Organization, click here.

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