FIF GUIDELINES

25^th February 2025

Fee Collection and Accounting Procedures

• Fee structure will be provided to all health facilities as guided by Kirinyaga county finance act
• When fee changes are announced, staff should be comprehensively informed through meetings and circulars
• Revenue must be collected in a way that causes minimum inconvenience to Patients and ensures maximum collections and can be easily accounted for.

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Fee Collection and Accounting Procedures

General Fee Collection Guidelines

OPD flow:

• Step One: Patient details are fed into the system/recorded in an outpatient register at the records desk and mode of Payment is selected
• Patients Pays the consultation fee
• Patient Proceeds to the triage
• Patient seen by RCO;

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• Patient prescribed diagnostic investigation / medicine;

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• Step two: Patient pays for drugs and lab tests.
• Step three: Patient proceeds to service points with the official receipts and obtains service.

Inpatient Billing

• An Inpatient Summary Form/Charge sheet must be opened for every patient on admission. This form is maintained in the ward with the patient records.
• All charges are recorded in the form when services are carried out

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Fee Collection and Accounting Procedures

When the patient is discharged;

• the ward in charge should ensure that all charges are reflected in the form and submits it along with supporting documents (e.g., laboratory slips) to the billing Officer
• The billing officer computes the total hospital charges and issues one copy of the charge sheet to the patient for payment at the Cashier’s/Fee office

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• The Patient pays the total bill and the revenue clerk issues a receipt.
• The patient returns to the ward and shows the receipt or evidence of payment to the nurse and details of payment are entered in the Inpatient Register.
• Discharge papers are then issued by the nurse.

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Health Facilities Accounting Procedures�

• Accounting will be done in accordance with the requirement of the Exchequer and Audit Act Cap. 412.
• The following procedures helps to ensure that revenue is maximized, funds are looked after, and expenditures are properly made;
• Receipt Books: Only official receipt books and automated cash registers (where in use) may be used for collecting money from facility users.
• Receipt books are issued to health facilities by the County revenue officer and must be recorded in a counterfoil Receipt Books Register (F.O.13).

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• Departmental Registers: Each department that provides chargeable services must record fees earned and services provided.
• Health facilities must record daily collections for each department in a cash collection register.

b) Custody of Funds: Safe custody of funds in Health facilities must be ensured through the use of cash boxes obtainable from the Fund administrator.

c) Banking: All money collected must be banked intact and receipt vouchers surrendered monthly to the Fund administrator. NB. Spending revenue at source is illegal.

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Health Facilities Accounting Procedures

d) Standing Imprest: A standing imprest will be maintained by the officer in charge to meet petty expenses.

• It shall be applied for from fund administrator using F.O. 24 ( Imprest Warrant Form) and shall be recorded in the FIF imprest register.
• All expenses arising from the use of imprest shall be processed at the County Treasury using F.O. 21 for reimbursement and shall be surrendered on or before 30th June of every financial year and balances banked

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e) Administration of AIE

• The chief officer shall be the accounting officer
• The hospital managers and facility in charges of the health centre and dispensary shall obtain AIE from the chief officer health..
• With respect to the hospital, the mandatory signatories to the account shall be the hospital manager, chief officer health and fund administrator
• With respect to the health centre and dispensary, the mandatory signatories to the account shall be the facility in charge, chief officer health and fund administrator

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Health Facilities Accounting Procedures

• The AIE holder is instructed to ensure that the AIE is recorded in the vote book and the expenditure incurred does not exceed the amount authorized.
• You will be held personally responsible if you incur expenditure in excess of value/amount of the AIE authority.
• The cheque book shall be under the custody of the fund administrator as well as:
• ¤ Copies of payment vouchers;
• ¤ Revenue reports; and
• ¤ Copies of banking slips.

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1. Bank Reconciliation Statement: The officer in charge of the health facility must reconcile the health facility bank account on a monthly basis with the cash book with the assistance of the fund administrator .
2. Vote Book: Health facilities must maintain a Vote Book control in which payments and commitments are recorded in line with types of expenditure approval on AIEs.
1. (j) Bank Charges: when bank charges are incurred, payment vouchers (F.O. 21) should be raised to debit the charges into the health Facility’s cash book.

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�FIF Planning Cycle �

• Planning for expenditure of FIF revenue should follow a routine schedule in line with the GoK budget cycle.
• Two types of plans are required:
• An Annual FIF Expenditure Plan; which sets out the health facilities’ financial needs over the coming fiscal year taking into account areas where there are generally deficiencies in recurrent budget allocations.
• It is based on the uncommitted balance of funds available at the beginning of the year and the revenue targets for the coming year

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b) Quarterly AIE Requests; that state specific expenditures to be made during the next quarter. The AIE request should follow the priorities shown in the annual plan but is based on the uncommitted balance of funds available to the health facility at the time the request is submitted.

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• Quarterly requests should reduce emergency requests for AIEs and allow more timely expenditure of funds.

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�Budget Preparation�

1. Budgets should be prepared based on the needs of the facility. It should be a service driven budget.
2. Budgets should be prepared carefully with involvements of all head of department to avoid shortfall when spending.
3. Budgets should be signed by all Head of Departments and health facility management team involved in budgets making.
4. Budgets should be derived from Annual Work plan thus making it a very important documents since it will guide you on what the facility will do the whole financial year.

5. Health Facilities In-Charges Should submit quarterly budgets to Office of chief officer health for review and issuance of AIE’S.

6. AIE’S - means authority to incur expenditure

7. Any kind of spending without AIE’S is illegal.

8 Once the facility In-charge is issued with an AIE, he/she is required to spend within the limit and any spending beyond the authority will be personally held responsibly.

9. Once payment is done, it should be recorded in vote book to ensure spending does not exceed budgets.

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Budget Preparation

• The Health facility management team is responsible for preparing budget for the 80% allocation and AIE requests.
• The plan is submitted to the health facility management committee for verification and onward forwarding to the County facility improvement Fund board.
• The Fund administrator then combines all health facilities plans into a single Annual FIF Plan or Quarterly AIE Request.

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• The schedule for submission of these plans and requests is:

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WAIVERS�

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• It is important to ensure that everyone has access to health services.
• It is Government policy that people who are too poor to pay can get a waiver.

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• However, the waiver system must be implemented with care: if it is too easy to obtain a waiver, the system will be abused and revenue will be lost; on the other hand, if the existence of the waiver system is not known, or if it is too difficult to obtain a waiver, patients who need health care may be turned away.
• Information noted on the waiver form (occupation, number of children, means of transport, alcohol and cigarette consumption, and type of clothing) should be carefully considered.

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Recording waivers �

• A book is used to record all waivers granted. The following information are recorded in the book for each waiver:

• Waiver number, running consecutively from 1;

• Patient's name, age, sex, marital status, occupation, address;

• Inpatient or outpatient number;

• Date of treatment or discharge;
• Services provided;
• The total amount charged

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• The amount of money waived; and
• Name and designation of the person granting the waiver.

Monthly review of waivers granted

• The value of waivers granted is checked by the HMT when reviewing the monthly Revenue Summary Report.
• SCHMT members should also review the level of waivers granted during supervision visits.
• NB: When reviewing the level of waivers, it is important to remember that too many waivers may mean that the system is being abused; too few waivers may mean that hardship cases are not being identified and that patients who need care may not be receiving it.

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�PROCUREMENT OF GOODS AND SERVICE�

• Cash payments will be done for small items that are below ksh 30,000
• Cheque payments will be done for Purchase of small items above ksh 30,000. This will require Quotations in order to justify the prices.
• Any service will require quotation since it’s difficult to quantify service.
• For petty cash expenditure, the facility in-charge should only withdraw the required amount to a maximum of Kshs. 20,000.

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Cheque Payment

1. For the cheque payment the following procurement process should be followed;
1. Head of the user department raises a requisition.
2. Facility In-charge to float request for quotation for different goods and services provider with clear specification, at least 3 quotation are required.
3. Bid Evaluation: The health facility management team/procurement in charge evaluates received quotations or proposals based on predetermined criteria, considering factors such as price, quality, delivery time, and vendor reputation.
4. The health facility management team/procurement in charge issues an opinion on who won the bid and why and writes minutes.

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Cheque Payment

• The facility In-charge who is the secretary of the team writes an award letter and regret letter to those that didn’t win the bid.
• The qualified bidder writes an acceptance letter within seven days
• Upon Receipt of Acceptance letter, the facility In- charge raises a local purchase order for purchase of goods and local service order for services.
• The Supplier delivers goods to the facility accompanied with delivery note.
• The persons receiving goods inspects whether the goods ordered are the same as those delivered and should sign delivery
• Goods received should be entered in the bin card in order to monitor their movements.
• The supplier raises an invoice to facilitate payment.

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Cheque Payment Cont’

• N.B: Since local procurement procedures can be time consuming and FIF funds are no-year funds, it is expected that facilities may be expending money on two or three FIF AIEs at the same time. However, all pending AIEs expire at the end of the fiscal year and the unspent amounts are re-programmed in the annual plan and first AIE request for the following year.
• Funds may be reallocated within an AIE with the approval of the COH. The request should identify the AIE number and state from which item(s) funds will be taken and for what new expenditures they will be used in accordance to the approved budget line

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ANNEXURE

• CASH BOOK

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Statement of Receipt & Expenditure

Bank Reconciliation

THE END.

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THANK YOU!