Brief Introduction �of �the Project for Strengthening the Accountability in the Management of County Health Services��JICA-SAMACH�

TOT session @ Nakuru　

4 June 2024

Background

Organizational County Capacity Development Project (OCCADEP 2014-19) contributed to strengthening the planning and performance review of CDOH and strengthened county coordination by supporting IGF.

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After completion of OCCADEP, MOH requested further support on financial management of CDOH to ensure accountability and transparency of health finances for improved health service delivery.

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Particularly, there is an urgent need for CDOH to secure and properly manage funds such as budget allocated by the central and county governments, and reimbursement from NHIF. This is in line with the six principles in the Kenya Health Sector Strategic Plan, which puts emphasis on performance reporting, raising public awareness, fostering transparency and public participation in decision-making on health-related matters.

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Outline of the Project

Project Period

5 years (2022-2027)

• 1st phase: February 2022 to April 2023 (study phase to determine concrete activities and indicators)
• 2nd phase: April 2023 and April 2027

Project Sites

• Kericho County and Kirinyaga County.
• Other Counties (applied to Nakuru and Kiambu as of June 2024) which will need opportunities to showcase. This will be done in collaboration with Public Health Sector Coordination & Intergovernmental Relations (MOH).

Project Design Matrix （PDM)

https://sites.google.com/view/jica-samach/home

Developed AWP Development & Monitoring Online Tool �& Receipt & Expenditure Management Online tool

Purpose:

• To enable CHMT, SCHMT, and HFs check their planned activities and budget (in their AWPs) from their PCs or smartphones and monitor the progress of AWP activities any time. If the activities are not implemented as planned, the managers can intervene in a timely manner. R&E tool captures financial transactions once finance is available for each CDOH unit.

Functions:

• The tool allows CHMT, SCHMT, and HFs to enter planning and budgeting information for each activity. All the information is compiled in a tabular format of the AWP template (planning and budgeting section) provided by MOH. The individual HFs’ AWPs can also be consolidated into sub-county or county AWPs.
• This tool is available for the registered users with ID to view and use the information of the county to which they belong. The monitoring function is used by each HF for every quarter

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Developed NHIF-SAMACH Online Tool

The FICs enter data monthly such as "claimable amount (estimated reimbursement)," "claimed amount," and "actual reimbursement" based on the number of people served by individual HFs and the type of service delivered. A table listing and comparing HFs within the county will be auto-generated.

The tool enables:

• CHMT, SCHMT, and HFs to monitor the number of services, number of claims raised, and amount of reimbursement received that are related to Linda Mama and EduAfya.
• CHMT, SCHMT, and HFs to analyze and intervene rapidly when the percentages are low.
• The tool allows the HFs to enter the actual delivery of health services covered by Linda Mama and EduAfya for reimbursement.

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Now, the managers can identify bottlenecks to obtain more resources

Developed HR Status Reporting Online Tool

Purpose:

• The tool aims to enable the CHMT, SCHMT, and HFs to monitor monthly whether the composition and number of staff at each HF are adequate to serve their target population. By addressing the gaps, it is expected that the CHMT, SCHMT, and HFs would take actions such as reviewing the HR plan or taking budgetary measures where there are shortages of HR. It is expected that CHMT be specific about which cadre is essential to provide a certain health service and plan for allocation.

Functions:

• The tool can provide monthly updates on the over/under staffing of individual HFs over the course of the year and show the fluctuations. The tool can auto-generate a list of all HFs in the county to identify HFs with high shortages and positions of HR.

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Now, the managers can see what essential HR is lacking.

The tool is also used for AWP planning.

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Developed Equipment Status Reporting Online Tool

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Purpose:

• The tool aims to enable the CHMT, SCHMT, and HFs to identify shortages of essential equipment for certain health services and make managerial decisions, including necessary budgetary measures by addressing the gap between the current availability and the requirement.

Functions:

• Similar to the HR tool. it can show the availability and shortage of essential equipment, especially for MCH services. The tool can auto-generate “equipment availability table” for all HFs in the county

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>> Creating an Environment to enable ”Evidence-informed decision making”through data analytic tools and communication materials �

• SAMACH is conducting AWP Quarterly Review Meetings in Kericho and Kirinyaga. This is very innovative as AWP is usually only used while planning and never looked back. In SAMACH’s partner counties, CHMTs SCHMTs and Level 2/3 FICs review the AWP every quarter and discuss the achievements utilizing the tools. The tool gives you a red light if activities are not implemented as planned. This enables the managers to act promptly and make decisions based on evidence.
• At this moment, we have been conducting activities and developing tools to improve the management in terms of planning, monitoring, and resource mobilization based on evidence. From FY 2024/25, SAMACH will identify cases that can prove that good management leads to good service delivery.

Scaling up the project approaches and products to other counties.�

• SAMACH together with the Project Managers (especially the PHSC/IGR of MOH) will present the lessons learned, best practices, and demonstrate tools to other counties utilizing the existing inter-county mechanisms.
• The online tools will be useful for other counties. SAMACH are looking for opportunities to showcase out tools.
• In case there are any CDOH that would be interested in the tools (online tools and SOPs) developed by the Project, the Project will provide support in introducing the tools and train instructors on how to use the tools in their targeted counties. So far Nakuru county has gotten on board as new county.

Now�Let’s check how to operate the online tools using AWP online tool �(Sample: Kirinyaga county’s experiences)

• AWP online tool
• Data Entry form (HFs’ FICs and other users use their smartphone)
• Plan by each activity and add the progress information per quarter (Note: The tool covers the planning and budgeting aspects of the Annual Work Plan (AWP) as it falls under the management domain)
• In the common drive, the generated file for each HF, a consolidated one and even SCHMT and CHMT departments are stored.
• The progress with color codes makes the progress easily identified.
• “Summary sheet” of all the plans of CDOH’s units and the “Status sheet” to monitor the data entry work progress are available.
• NHIF online tool
• Data entry per every month and check sheet
• Each HF’s and County consolidated file of NHIF claimable data and claimed data with reimbursed amounts in comparison are generated and stored in the Drive.
• HR and Equipment tools

<Similar arrangements just as above other tools>

Smartphone Data Entry

Generated forms of AWP

THE END

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Asante ni sana