FACILITY IMPROVEMENT FUND

DEPARTMENT OF HEALTH

KIRINYAGA COUNTY

BY

GITARI NORMAN NJERU

INTRODUCTION

• Facility improvement fund (FIF) refers to financial resources that are ring fenced in health facilities for utilization in running the day to day operations of the health facility.
• The fund is crucial in enabling health facilities manage their day-to-day expenses and manage situations where emergency supplies are required.
• The fund also helps in expansion of the package of services offered in health facilities.

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INTRODUCTION. CONT’D

• FIF was first introduced in Kenya on the 1^st December 1989 when public health facilities started to levy user charges which were deposited into an FIF account.

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• These revenues supplemented government allocations to the health facilities.

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• Each facility retained 100% of the cost sharing revenue generated as Appropriations-in-Aid.

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• These user charges were used by each health facility to improve the quality of health services.

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INTRODUCTION. CONT’D

• They were also used in supporting promotive and preventive health care.
• Health facility management boards/committees were established through Legal Notice No. 162 of the Public Health Act cap 242 to provide oversight for these funds.
• The Health facility management committees were established to specifically plan, manage and monitor the utilization of user charges.

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KIRINYAGA COUNTY HEALTH FACILITIES IMPROVEMENT FUND

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• The County government of Kirinyaga established a Fund known as the Kirinyaga County Health Facilities Improvement Fund in the year 2023 which aimed at ring-fencing health resources for efficient and effective service delivery

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• To operationalize the fund, the County Executive Committee Member for Finance developed regulations to define procedures for management, operation and winding up of the Fund, and for planning delivery of healthcare services in County health facilities

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• Kirinyaga County health services act, 2016, provides for the establishment of various management committees; to oversee efficient and effective utilization of Facility improvement funds.

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SOURCES OF FUNDS

1. such monies as appropriated by the County Assembly;

b) grants or donations;

3. monies received as user charges;
4. income generated from the proceeds of the service Funds

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e)Funds received as reimbursements from the Social Health Authority and other health insurance reimbursements.

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GOVERNANCE STRUCTURE

The management of the fund will comprise of;

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• Kirinyaga County health Facilities improvement Fund Board

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• Hospital Management Committees

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• Health Facility Management Committees

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• The structure and roles of various management committees will be discussed in the next slides.

KIRINYAGA COUNTY HEALTH FACILITIES IMPROVEMENT FUND BOARD (KCHFIFB)�

• The board comprises of not more than 9 members as follows;
• a chairperson appointed by the Governor with the approval of the county assembly;
• the Chief Officer department of medical services;
• the Fund Administrator appointed CECM in charge of the county treasury; who shall be the secretary to the Board; and
• the County Director of Medical Services; and
• Five other persons appointed by the CECM in charge of Health, with the approval of the County Executive and County Assembly

COMPOSITION OF KCHFIFB

ROLE OF THE BOARD(KCHFIFB)

1. Provide oversight of the administration of the money drawn from the Fund;
2. Mobilize resources for the fund;
3. Develop the criteria for the allocation of funds
4. Prepare annual distribution of resources by health facilities;
5. institute prudent measures for the proper utilization of monies deposited in the Fund using suitable internal controls and appropriate mechanisms for accountability including audit of accounts by internal auditors of the department responsible for matters relating to finance;

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ROLE OF THE BOARD(KCHFIFB) CONT’D

f)Guide the County Executive committee on proposals on user fees where the management board seeks to propose new user fees or changes to the old fee structure;

g)Monitor the utilization of the Fund; and

h)Receive reports from the health facilities management committees for consideration and adoption; and

i)Develop criteria for the granting of waivers and exemptions;

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QUALIFICATION FOR MEMBERSHIP TO THE BOARD & TERMS OF OFFICE��

1. The appointment of the Chairperson and members of the board shall be subject to such persons:
1. satisfying the requirements of Chapter Six of the Constitution; and
2. holding a minimum of a bachelor’s degree from a university recognized in Kenya; or
3. account of their training or experience relevant to the management of the fund.

Terms of Office

• The Chairperson and Members of the Committee shall hold office for a term of three years and shall be eligible for reappointment for one further term upon satisfactory performance

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�TERMINATION OF MEMBERSHIP�

• A member shall vacate his/her position as a member of the Management board if he/she;
• is absent from three (3) consecutive meetings of the board;
• violates Chapter 6 of the Constitution;
• voluntarily resigns from the board;
• Dies
• suffers from Physical or mental incapacitaty to perform the functions of the office
• is bankrupt; and
• is Convicted of an offence whose imprisonment term exceeds six months.

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CONDUCT OF BOARD MEETINGS

• During the first meeting, members shall elect a vice chairperson who shall not be of the same gender as the chairperson

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• The chairperson will convene meetings through the fund administrator who will be the secretary to the board

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• Quorum: The quorum for board meetings shall be two-thirds of the members of the board, one of whom must be the secretary

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• Agenda: For efficient conduct of business, there shall be an agenda drawn by the Secretary in consultation with the chairperson

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CONDUCT OF BOARD MEETINGS CONT’D

• Minutes: To Keep track of business conducted and follow up decisions, it is important that accurate and comprehensive minutes of all meetings are kept.

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• The minutes should be in the form of an action plan indicating; Actions to be taken; Who will carry out these actions? By when? With what resources?

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• Meetings: There board shall meet not less than four and not more than 8 times in a year.
• Meetings shall be held within two weeks after the close of every quarter

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CONDUCT OF BOARD MEETINGS CONT’D

• At least 7 days notice shall be given before the meeting of the board

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• The chairperson shall preside all the meetings of the board; in his absence, the vice chairperson presides the board meeting.

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• If both Chairperson and Vice Chairperson are absent, members present shall elect a member to preside the meeting of the board

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CONDUCT OF BOARD MEETINGS CONT’D

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• Voting; A decision on any matter before the board shall be decided by a simple majority of votes from the members present.
• In case of equality of votes, the chairperson or the person presiding shall have an extra casting vote
• Special Meetings: It may be necessary occasionally to hold special meetings to discuss urgent matters such as crises by giving a notice to the members of not less than three days
• The board can only hold one special meeting per quarter; and it must be approved by CECM for health

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HOSPITAL MANAGEMENT COMMITTEES(HMC)

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• Every County and Sub county hospital shall have a Hospital Management Committee

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• The hospital management Committee shall have not less than 7 and not more than 9 members as follows;

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a)A chairperson appointed by the Governor

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b)Hospital Manager who shall be the secretary to the Committee

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COMPOSITION OF HMC

c) The following persons shall also be appointed by the CECM-Health;

• A designate of the Chief officer
• One person with experience in finance and administration from within the Sub County
• One person representing youth
• One person representing faith-based organizations; and
• One person representing persons living with disability nominated by a joint forum of their organizations in the County or Subcounty
• One person nominated by joint forum of health professional bodies in the County or Subcounty, who is not a public officer
• One Person nominated by women organizations involved in provision of health services in the county or subcounty

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TERM AND CONDITIONS OF APPOINTMENT

1. The appointments of the members to the committee shall be in such a manner that the respective expiry of their terms shall fall at different dates
2. The appointment of the Chairperson shall be subject to–
1. satisfying the requirements of Chapter Six of the Constitution; and
2. holding a minimum of a bachelor’s degree from a university recognized in Kenya; and
3. has at least five years’ experience in management, leadership and administration.

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TERM AND CONDITIONS OF APPOINTMENT CONT’D

3) A person shall be eligible for appointment as a member of the hospital management committee subject to-

1. Holding a diploma from a recognized institution
2. Has at least five year’s experience in community health, development, administration, management, accounting, finance or any other relevant training; and
3. Is a resident of the county

4) Terms of Office; The Chairperson and Members of the Committee shall hold office for a term of three years and shall be eligible for reappointment for one further term upon satisfactory performance

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ROLE OF THE HOSPITAL MANAGEMENT COMMITTEE

1. Represent community interests in the management of the hospitals;

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b) Approve the annual work plan and budget to be adopted by the County FIF Board;

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c) Formulate strategies on resource mobilization by hospital management teams;

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d) Resolve any conflicts that arise within the health facility whose nature is the allocation of resources, membership of the committees or joint programmes;

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ROLE OF THE HOSPITAL MANAGEMENT COMMITTEE

e) Regularly review relevant hospital governance and management policies, and make recommendations to the CECM for Health

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f) Provide strategic advice and direction on matters relating to hospital operations

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g) Promote good relationship between the hospital, partners and the community

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h)Any other function as may be assigned by CECM for Health

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TERMINATION OF MEMBERSHIP�

• A member shall vacate his/her position as a member of the Management committee if he/she;
• is absent from three (3) consecutive meetings of the committee;
• violates Chapter 6 of the Constitution;
• voluntarily resigns from the committee;
• Dies
• suffers from Physical or mental incapacitaty to perform the functions of the office
• is bankrupt; and
• is Convicted of an offence whose imprisonment term exceeds six months.

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CONDUCT OF HMC MEETINGS

• During the first meeting, members shall elect a vice chairperson who shall not be of the same gender as the chairperson

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• The chairperson will convene meetings through the hospital manager who will be the secretary to the committee

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• Quorum: The quorum for board meetings shall be Five members of the committee, one of whom must be the secretary

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• Agenda: For efficient conduct of business, there shall be an agenda drawn by the Secretary in consultation with the chairperson

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CONDUCT OF HMC MEETINGS CONT’D

• Minutes: To Keep track of business conducted and follow up decisions, it is important that accurate and comprehensive minutes of all meetings are kept.

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• The minutes should be in the form of an action plan indicating; Actions to be taken, Actions to be taken; Who will carry out these actions? By when? With what resources?

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• Meetings: There shall be four meetings in a year held within two weeks after the close of every quarter

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CONDUCT OF HMC MEETINGS CONT’D

• At least 7 days notice shall be given before the meeting of the committee

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• The chairperson shall preside all the meetings of the committee; in his absence, the vice chairperson presides the committee meeting.

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• If both Chairperson and Vice Chairperson are absent, members present shall elect a member to preside over the meeting of the committee

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CONDUCT OF HMC MEETINGS CONT’D

• Voting; A decision on any matter before the committee shall be decided by a simple majority of votes from the members present.
• In case of equality of votes, the chairperson or the person presiding shall have an extra casting vote
• Special Meetings: It may be necessary occasionally to hold special meetings to discuss urgent matters such as crises by giving a notice to the members of not less than three days
• The can only hold one special meeting per quarter; and it must be approved by CECM for health

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HEALTH FACILITY MANAGEMENT COMMITTEES

• Every Health Centre and dispensary shall have a Health facility management committee
• The health facility management committees comprises of the following members appointed by the executive committee member for health;
• A Chairperson
• Facility in charge who shall serve as the secretary
• One person, a resident of the area, representing youth

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COMPOSITION OF HFMC

iv. One person, a resident of the area, representing faith-based organizations; and

v. One Person, resident of the area, representing persons living with disability

TERM AND CONDITIONS OF APPOINTMENT

1. The appointments of the members to the committee shall be in such a manner that the respective expiry of their terms shall fall at different dates
2. The appointment of the Chairperson shall be subject to–
1. satisfying the requirements of Chapter Six of the Constitution; and
2. holding a minimum of a diploma from a recognized institution;
3. has at least three years’ experience in management, leadership and administration; and
4. a resident of the ward

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TERM AND CONDITIONS OF APPOINTMENT CONT’D

3) A person shall be eligible for appointment as a member of the health facility management committee subject to-

1. Possessing at least an O-Level
2. Has at least three year’s experience in community development, leadership; and
3. Is a resident of the ward

4) Terms of Office; The Chairperson and Members of the Committee shall hold office for a term of three years and shall be eligible for reappointment for one further term upon satisfactory performance

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ROLE OF HMFC

a) Represent community interests in the management of the health facility;

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b) Approve the annual work plan and budget to be adopted by the County FIF Board;

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c) Formulate strategies on resource mobilization by health facility management teams;

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d) Resolve any conflicts that arise within the health facility whose nature is the allocation of resources, membership of the committees or joint programmes;

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ROLE OF HMFC

e)Regularly review relevant health facility governance and management policies, and make recommendations to the subcounty health managemet team

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f) Provide strategic advice and direction on matters relating to health facility operations

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g) Promote good relationship between the health facility, partners and the community

and

h)Any other function as may be assigned by CECM for Health

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END.

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THANK YOU!