Evelyn Waweru

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2 nd Conference of the African Health Economics and Policy Association (AfHEA) Saly – Senegal, 15 th - 17 th March 2011 Characteristics and Operation of Health Facility Committees in Kenya’s Primary Care Facilities: Readiness for HSSF and implications for promoting universal access Evelyn Waweru Antony Opwora, Mitsuru Toda, Tansy Edwards, Greg Fegan, Abdisalan Noor, Sassy Molyneux, Catherine Goodman

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Characteristics and Operation of Health Facility Committees in Kenya’s Primary Care Facilities: Readiness for HSSF and implications for promoting universal access. Evelyn Waweru Antony Opwora, Mitsuru Toda, Tansy Edwards, Greg Fegan, Abdisalan Noor , Sassy Molyneux, Catherine Goodman. - PowerPoint PPT Presentation

Transcript of Evelyn Waweru

Page 1: Evelyn Waweru

2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

Characteristics and Operation of Health Facility Committees in Kenya’s Primary Care Facilities: Readiness for HSSF and implications for promoting universal access

Evelyn Waweru

Antony Opwora, Mitsuru Toda, Tansy Edwards, Greg Fegan, Abdisalan Noor, Sassy Molyneux, Catherine Goodman

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

BACKGROUND Community participation has re-emerged

as a top priority in health service delivery in sub-Saharan Africa Initiatives are focussed on the establishment

of Health Facility Committees (HFCs) which bridge the gap between the facility and the community

In Kenya, the role of HFCs will be expanded with the introduction of the Health Sector Services Fund (HSSF)

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

HEALTH SECTOR SERVICES FUND A nationwide GoK fund to support a sector wide

approach to resources for primary care facilities HSSF resources are credited directly to each designated

facility’s bank account, and managed by the HFC The HFC has 7-9 members, including at least 3 females:

4 catchment area residents (‘ordinary’ community members)

4 ex-officio members (health facility in-charge and representatives of: provincial administration; DMOH; and local authority facilities)

Committee prepares a work plan based on guidelines Funds can cover operations and maintenance, refurbishment, support staff,

allowances, utilities, community based activities

Enhances community/facility/district management communication

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WITHOUT HSSF WITH HSSF

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

STUDY OBJECTIVES• Broad Objective

– Collect and present nationally representative data on HFCs in Kenya in advance of the introduction of HSSF nationally

• Specific Objectivesi. Document HFC characteristics and operationsii. Assess patient awareness of their activitiesiii.Describe roles and benefits of HFC membersiv.Explore HFC members motivation and job

satisfaction

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

STUDY DESIGN Cluster randomized sample of facilities Randomly selected 24 districts

Three non-municipal districts per Province (excl. Nairobi)

Three municipal districts

Selected random sample of facilities in each district, stratified by facility type Facility sampling frame included all facilities

eligible to receive HSSF Selected up to 7 health centres and 7

dispensaries in each district

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DATA

COLLECTION

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

DATA COLLECTION Data collected: July – September 2010 Structured survey at each facility:

Interview with the facility in-charge Self-administered questionnaire for the In-

Charge on motivation and empowerment Interviews with 2 HFC members Exit interviews with 3 outpatients (curative

care) Collection of contextual data at the

district level

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

DATA ANALYSIS Used Stata v. 11 for cleaning and

analysis Used survey commands to account

for: Variation in sampling probability across

facilities using pweights Stratification by province and health

facility type Clustering at the district and facility level

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

SUMMARY OF DATA COLLECTED

Non-Municipalities Municipalities Total

Dispensaries Health Centres

Dispensaries Health Centres

In-charge questionnaire 144 65 21 18 248

In-charge SAQ 141 65 21 18 245 HFC members 279 126 32 27 464 Exit interviews 400 192 53 53 698 District context tool 21 3 24

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

HFC MEMBERSHIP AND SELECTION 97.2% of the facilities sampled had

HFCs

Median of 10 members per HFC 23.3% HFCs included all types of

members in the Government Gazette 58.8% joined the HFC between 1 and 5

years ago 18.5% in the last year Most HFC members reported being

selected at a Baraza (72.2%)

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

HFC MEMBERS’ CHARACTERISTICS Age: all 25 years or over, with just over half

aged 45 years or above Occupation: mostly business/trade (25.6%)

and subsistence farming (24.4%) Education: half (53.2%) completed secondary

school Residence: Most (65.1%) lived less than 30

minutes walk away from the facility they served

Gender: 30.0% of all HFC members were female

CHW training: Just under half (44.8%) reported having been trained as community health workers

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

HFC MEMBER TRAINING

Training in facility/financial management: In 26.7% of facilities, one or more health

workers were trained (24.4% in non-municipal dispensaries to 82.4% in non-municipal health centres)

About half of HFC members (50.1%) reported having received training, slightly more in health centres than in dispensaries

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Patient Awareness of HFCs

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

PERCEPTIONS OF HFC ROLES (CONT.)• In-charges described HFC roles in similar ways,

but only 34.5% considered supervision of facility staff an HFC role (as opposed to 61.9% of HFC members)

• Users of facilities often did not know HFC responsibilities. For example, many did not know whether it was HFCs’ role to:– Set the level of user fees (24.7% users) – Contribute to the development of annual work plans

(22.3%)– Decide on how facility funds are utilized (19.3%)

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

HFC MEETINGS AND ALLOWANCES (IN-CHARGE RESPONSES) Of facilities with HFCs:

77.9% held a full committee meeting in the last quarter (median n=1)

Half held smaller executive meetings (median n=1)

53.1% received allowances for full meetings; 29.5% received allowances for executive meetings

Median allowances where paid were KES 200

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RELATIONSHIPS

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

RELATIONSHIP BETWEEN HFC MEMBERS AND THE IN-CHARGE: POSITIVE > 80% of HFC members agreed/strongly

agreed: “It is useful to hear the views of the facility in-charge

during HFC meetings” “I believe that the in-charge works in the interest of

this facility”

> 80% of in-charges agreed/strongly agreed: “The health workers and the community members of

the HFC work well together” “If I have better knowledge, the HFC are willing to

accept advice from me”

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

RELATIONSHIP BETWEEN HFC MEMBERS AND THE IN-CHARGE: CONCERNS 13.9% of HFC members and 47.9% of in-

charges agreed with the following statement:• “Tensions between the in-charge and committee

members undermine the committee’s achievements”

11.5% of HFC members agreed with the

statement:• “The facility in–charge sometimes looks down

on community members in the HFC”

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

SUMMARY Presence of minimum

requirements Bank account Health facility

committees HFC members

awareness of their roles

Positive relationships : in-charges and HFC members

HFC seem highly motivated

Supportive supervision was not as frequent

HFC were not content with their allowances

Concern of some tension between in-charges and HFC members

Training

Positive Findings Significant Challenges

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2nd Conference of the African Health Economics and Policy Association (AfHEA)Saly – Senegal, 15th - 17th March 2011

SUGGESTIONS FOR FOLLOW-UP Monitor and evaluate of HFCs functions (audit) Sustainability: funding, HFC member

incentives Feasibility of performance based financing as a

reward/incentive for high achieving facilities Emphasis on community participation and

reporting HFC members ability to fully participate in

HSSF planning and follow HSSF financial procedures

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BETTER HEALTH

BETTER DAYS