CLAUDIO SCHUFTAN
schuftan@gmail.com
PHC receives far more lip service than needed decentralized funds. PHC programs are overwhelmingly vertical, that is, planned and financed from the capital. Local health decision-makers have little control over centrally budgeted PHC activities and seldom are allocated local program funds.
To remedy this, a novel local PHC financing scheme was introduced in Kenya in 1990. Historically, districts’ health development funds had only contained budgetary item lines with funds for construction, vehicles and equipment. No funds were made available locally for independent district program needs.
The scheme now incorporated into the budget calls for each district to set aside a core amount from their allotted ceiling in the development budget for “district-level PHC activities” -thus foregoing some of the funds traditionally mostly allocated to construction projects. This core amount is allocated to a new item line in the development budget, negotiated with the Treasury, and created for this purpose in the Health Centers and Dispensaries Head. To give district health authorities an incentive to shift some of the funds within their ceiling to this new item line a matching fund was. simultaneously negotiated and set up in the same Head of the development budget using donor money (in this case, USAID Counterpart Funds coming from sales in their commodities program) – This fund will match dollar for dollar (actually shilling for shilling) the core amount budgeted by the districts for PHC activities that year. (There is a minimum of around U$ 2,000 equivalent for the core amount set aside by districts and a maximum of around U$ 5,000 equivalent for the matching fund to match). The resulting matched funds are “year-funds” and have to be spent within the fiscal year. It has been a pleasant surprise to see how so relatively small amounts of total funds (mostly less than U$ 6,000 per year) have dynamized local PHC activities.
Districts become eligible to use the resulting matched funds only upon the presentation and approval by the PHC Unit at the Ministry of a plan for the PHC activities being considered. This has assured some uniformity and adherence to published general guidelines on what the money can be used for.
A very beneficial side-effect of the creation of this new “district-level PHC activities” item line in the development budget under the same head than all the construction/vehicles/ equipment items has been that, if towards the end of the fiscal year, districts are running behind schedule in expending those year-funds and risk to loose them back to the Treasury they can request reallocations of those funds to the “district-level PHC activities” item and spend those funds in programmatic PHC activities before the end of the fiscal year thus avoiding loosing that money. (Spending funds on program activities is more controllable than on contractors and vendors).
I think a scheme like the one presented here has potential for application elsewhere and has the potential to interest donors, central Ministry of Health authorities and local health officers.
Claudio Schuftan
Saigon, Vietnam.