CUTS Nairobi with the support from Akiba Uhaki Foundation implemented a project on participatory governance in Kisumu County of Kenya. The project was to empower the participation of the marginalized community groups for inclusive governance in Kenya’s health service delivery.
The project goal was to ensure equitable and quality health service delivery to the marginalized groups through community monitoring in Kenya. The objectives included empowering the participation of marginalized groups (women, PWDs, PLWHAs, vulnerable youths) in demanding better governance and social accountability of public health service delivery in Kenya, enhancing equitability and quality of public health service delivery through the use of a replicable community based health service monitoring model and establishing challenges and constraints bedeviling the delivery of quality public health services and equitability in the distribution of resources in the rural public health centers in Kenya.
The project had two components comprising national health budget analysis and the Kisumu county level health service provision survey with community members and monitoring of health facilities. The project study was premised on both primary data from interviews with beneficiaries of public health services and key stakeholders, direct facilities observations and reviews of secondary literature including policy documents; reports and articles as well as evidence based primary data from the field.
The study analyzed the allocation and expenditures for the health sector in Kenya with the reflection on the specific priority needs of marginalized groups including disabled, youths and women in the national budgetary allocation and the corresponding expenditure over the last 5 years, the factors considered in the health sector budgetary allocations including who decides budgetary allocation and expenditure, state of involvement/ participation of marginalized groups women, PWDs, PLWHAs, vulnerable youths in the health sector budgetary process, considerations for specific allocations in the health sector, existing parliamentary and departmental (including at the institutional level of county governance) accountability mechanism on allocation and expenditure and effectiveness of the existing accountability mechanism within the health sector. It also highlighted on the challenges and opportunities for the realization of equitable and quality health service delivery to the marginalized groups in Kenya through budgetary allocations.
The county level component of the project involved community training on social accountability tools and community monitoring process, the perception survey on users of public health services at the community level and the state of play in terms of physical structures, equipments and other infrastructure available within the public health facilities. Among the key findings is the below par national health budget allocation, lack of participation of community members in the health service decision making, absence of essential health service delivery equipments, medications/ drugs and high disease burden within the Kisumu county. It is therefore necessary that community members are empowered to be able to participate in ensuring accountability within the health sector and that both the national and county health budget to be increased to meet the current health needs in both the county and national level.
Kisumu Citizen Report Card on Health Services
Kenya News Agency, October 17, 2014
Over seven percent of Kisumu County residents have confirmed having engaged in bribery to secure health services at public health facilities.
This is according to a study focusing on consumer feedback on health service provision that was launched in July 2013 by a non-governmental organisation, Consumer Unity and Trust Society (CUTS) under the project ‘Empowering Marginalised Community Groups for Inclusive Governance’ in Kenya’s Health Service Delivery (EMACIGHES).
The findings revealed that about 69 percent of bribe payment was demanded by health service providers while 31 percent were voluntary bribes to facilitate action by health service providers.
CUTS Program Officer In-Charge of Consumer Protection and Governance, Daniel Asher told journalists in Kisumu on Thursday that a majority of respondents paid Shs. 100 for while 20 percent paid Shs. 500 as bribes.
Asher pointed out that though the County Government was aware of the study, research assistants were disguised and respondents and health care staff were never aware that a study was on going.
In the report, Asher stated that community members in the county are over burdened with curative diseases at 47.26 percent followed by child health.
The study was also done at a national level where it emerged that all 47 counties are below the country’s targeted doctor’s population ration of 36 doctors per 100,000 people.
Asher noted that the country has a little more than 8,600 registered medical doctors of a population of more than 40 million people with only 4,500 of the doctors currently working according to the Medical Practitioners and Dentists Board.
Chapter 56 of the Constitution outlines that the state has the responsibility of putting in place affirmative action programmes designed to ensure that minorities and marginalised groups have reasonable access to health services.