Result Based Finance (RBF), a health support scheme funded by the World Bank is improving essential service delivery in many public health facilities in Mandera County.
Universal Health Coverage
Under the Universal Health Coverage (UHC) vision, the national government aims to make health services accessible to all Kenyans especially the poor who may not have the alternative – seeking private health services.
The approach which was, for the first time, piloted in Samburu County in 2011 produced good results, the scaling up of the project to other arid and semi-arid counties followed, according to the RBF website.
In Mandera County, the success of the RBF support is yielding and aiding the health sector.
Neboi dispensary, Mandera East Constituency is one of the facilities, courtesy of the approach, which is expanding its health service provision.
AfyaSmile Kenya caught up with the facility in charge, Mr. Mohamed Abdirahman at the dispensary. With new floor tiles visible in some of the facility structures, the renovation has been taking a toll.
Mr. Mohamed says that the financial support has seen major tremendous improvement in the facility which has a catchment population of over 20,000.
“RBF helped in supporting the major primary healthcare and in line with the approach, 10 indicators are taken care of – family planning, deliveries, child welfare clinic, cancer screening, and Antenatal care (ANC) among others”.
Other indicators, he adds, include over five years’ treatment, antiretroviral drugs (ARVs), HIV/AIDS testing and counseling. These services greatly eased patients’ suffering in terms of health access and reduced the cost of private facilities.
“The fund from the scheme is divided such that 60 percent is used as health worker’s motivation – giving them incentives while the remaining 40 percent are for refining the facility health delivery”, he says adding that the forty percent has, for the past one year, improved the service delivery and enhanced introduction of services which weren’t available before.
Mr. Abdirahman says that because of the RBF fund, with payment depending on the number of patients handled with indicator cases, they managed to build a pharmacy and laboratory – both well equipped.
“Previously, we didn’t have the laboratory and the pharmacy. Patients were forced to seek diagnostic services outside health facilities and purchase drugs. It is not the case anymore”.
Additionally, the support scheme, according to the facility head saw an increase in health service seekers in the area especially the maternity where they used part of the fund to purchase delivery packs.
For the ANC, he states, mothers were relieved of suffering and burden at equal measures when seeking the service.
“Before ANC service provision, mothers used to seek the service in the County Referral Hospital which is far from the facility. This also reduced the transportation cost incurred and most importantly, time is saved”, notes Mr. Abdirahman.
Other aspects of the facility development, he expresses, include renovation of the facility structures, purchasing medical equipment like sterilization machine and microscope, office furniture, non-pharmaceutical materials and stationeries.
Since all the indicators are free of charge, uptake of the services in the facility doubled and accessing service delivery has never been easy.
In up-scaling the indicators, the staff, with sixty percent set aside as performance motivation, the facility charge believes staff commitment is hundred percent at the dispensary.
“Most health workers, with the incentives as encouragement, stay at the facility providing service to the population thus reducing the absenteeism gap and lessening patient’s suffering”.
Once the fund is released to the county revenue, the department of health pays the selected facility based on the records and in line with the health indicators.
“After every three months or quarterly, a verification process is conducted. Led by the county health department, a joint verification team goes through the records and confirms the claim after which the payment is processed” he sums up the RBF payment process.
At the national level, The Ministry of Health (MOH) ensures policies and compliances related to the supporting scheme are strictly adhered to, in order to attain universal health coverage for all Kenyans.
According to the Mandera County governor, the maternal mortality rate stood at 3,795 per 100,000 live births compared to the national average of 488 per 100,000.
As a successful measure, Ali Roba added that the county has made maternal and neonatal child healthcare a top priority by increasing the number of health facilities that provide Basic Emergency Obstetric Care (BEMOC).
In that regard, the county provides regular training on BEMOC to nurses, medical officers and clinical officers.