Financing Kenyan health centres and dispensaries: exploring the implementation and effects of direct facility funding

Abstract

Following evidence that user fees present a barrier to accessing health services, especially for poor and vulnerable people, there has been increasing pressure for user fees to be reduced or abolished. In 2004, Kenya removed high and variable user fees for health facilities, replacing them with flat rate fees of KES 10 (approximately US$ .15) at dispensaries, and KES 20 (approximately US$ .30) at health centres. However, there have been concerns that these lower fees limit the money available to health facilities for daily expenditures. To avoid shortfalls in funding, the Kenyan Government and the Danish International Development Agency (DANIDA) have piloted an innovative scheme of directly funding health facilities in Coast Province. With direct facility funding (DFF), health facilities receive money directly into their bank account. The funds are managed by a health facility committee (HFC) consisting of community members and the health worker in charge of the facility. The items on which DFF can be used include: salaries, water and electricity supplies, communications, staff travel costs, office and general supplies and routine maintenance of vehicles, equipment and buildings. This policy brief highlights the impact of Direct Facility Funding in Coast Province Kenya and provides recommendations for the Kenyan government and for policy makers in other countries and development partners involved in advising on health financing policy