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
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)
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
WITHOUT HSSF WITH HSSF
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
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
8
DATA
COLLECTION
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
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
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
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%)
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
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
Patient Awareness of HFCs
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%)
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
RELATIONSHIPS
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”
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”
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
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
BETTER HEALTH
BETTER DAYS
Top Related