Resource Tracking on a Health Voucher Program in Kenya: a Need-based Resource Allocation Perspective

Abstract

Briscombe, Brian et al (2010) noted that there are issues of lack of fairness in financing health in Kenya, Ministry of Health resource allocation being based on an incremental basis without due consideration to varied health needs of districts, a practice tended to benefit the relatively well endowed regions at the expense of the poor ones. This study was undertaken to track resources in the reproductive health voucher programme to establish if the resources were utilised based on the needs of the counties based on number of women of reproductive age and the poverty levels. The importance of this study is that this was an off-budget funding thus the need to establish if it is following considering needs of population in allocating resources. The study used the need-based resource allocation model by comparing the allocation per woman of reproductive age, and then per poor woman of reproductive age. The study also used the Lorenz curves and Gini coefficient to establish the level of inequity in resource utilisation. The Gini coefficient for the Voucher programme target counties of Kiambu, Kisumu, Kitui, Kilifi and Nairobi are all the below 25% compared to the national figure of 47.7% Human Development Report (UNDP, 2014)meaning there is low inequality in resource allocation from the programme. This was an expected outcome since the programme was targeting only the poor. In terms of average per capita allocation for women of reproductive age we find that there was a wide range attributable to the varying poverty levels in each of the county. For the average per capita for poor women of reproductive age Kilifi had the least at Sh. 1,064.65 followed by Kitui at Sh. 3,245.73. Kiambu was at Sh. 5,130.34 followed by Kisumu at Sh. 5,328.30 while Nairobi had a figure of Sh. 32,922.48. This shows that the resources allocation and absorption was demand-based as opposed to being need-based. The approach is recommendable for targeting the poor, however, more needs to be done to ensure that resource allocation is based on the needs of the population.