By Boniface Mbuthia, Janet Keru, Geredine Kandie, Felix Murira, and Anne Musuva
The availability of essential medicines and supplies is critical for accelerating progress towards universal health coverage (UHC). Since Kenya embraced devolution in 2013, its 47 newly formed county governments have become responsible for allocating financial resources for health supplies on behalf of public sector health facilities in their jurisdictions. Exactly how they go about this and its implications for the availability of commodities—which include essential medicines, reagents and non-pharmaceutical supplies—has not been well documented.
To fill this gap, ThinkWell collaborated with inSupplyHealth and the Chartered Institute of Procurement & Supply (CIPS) to holistically map processes for forecasting and financing existing bottlenecks, procurement of commodities, and the implications for the availability of health supplies. The team undertook a rapid landscaping analysis in four focus counties during the last quarter of 2022 and spent the first quarter of 2023 validating findings with each county government.
On March 28th, ThinkWell, inSupplyHealth, and CIPS organized a meeting in Nairobi, Kenya where officials from the Ministry of Health (MOH), Council of Governors, delegations from the four counties, development partners, and other stakeholders met to discuss emerging insights from the county deep-dives. The MOH delegation included officials from the country’s Division of Health Products and Technologies. Isiolo, Nakuru, Trans-Nzoia, and Kakamega Counties all sent teams to join the meeting. Supply chain partners such as Africa Resource Centre (ARC), Kaizen joined the discussion. The dialogue focused on three key themes:
- Insufficient allocation for health supplies: Counties are not allocating sufficient resources for health supplies. In collaboration with partners, MOH developed a systematic, step-by-step approach to forecasting and quantifying health commodity requirements and costs; however, counties are not following these guidelines. Consequently, their allocations are lower than the need.
- Low execution of the budget for health supplies: Less than 50% of the budget allocated for health supplies is being spent. This is attributed to several factors including pending bills from previous financial years, delays in the government transfers, and delays in the approval process for local purchase orders.
- Health facilities with financial autonomy are better positioned to fill gaps: A best practice was observed in Nakuru County where the public hospitals were able to use their own-source revenue to source funds for health supplies. The county government has established health facilities as procurement entities so that they can engage suppliers directly and account for their expenditure using processes that follow public procurement and public financial management regulations of the country. Hospitals in the county were noted to have better availability of health supplies as a result compared to hospitals in counties that did not allow autonomy.
The team is now working on a detailed technical brief documenting the findings from the landscaping analysis on these three topics. We expect to publish it later this year. So, stay tuned!
Header image: From left to right, Dr. Claver Kimathi (Isiolo County), Dr. Eunice Gathitu (MOH), Dr. Emmanuel Wamalwa (Council of Governors), Dr. James Riungu (Chemonics), Mr. Josephat Ngesa (CIPS), and Dr. Anne Musuva (ThinkWell)