importance of annual operational plans (aops)importance of annual operational plans (aops) ......

HEALTH RIGHTS TODAY [1] EDITION 9

continued on next page

E D I T I O N 9 / A U G U S T 2 0 1 1

Importance ofAnnual Operational Plans (AOPs)in Ensuring Provision of Health Services at the Community Level By Livingstone Ngwara, Information Officer Kwale DMOH

The annual operation plan framework was initiated with the adoption of the National Health Strategic Plan (NHSSP) II and has evolved through phases 1 to 6. While meant to improve health service provision at the grass root levels, the NHSSP II was also meant to enhance the use of the bottom up approach in determining the priorities of the national Annual Operation plans of the health sector. As such, the AOP 7, which is currently in operation focuses less on the top down approach.

AOP 7 addresses the following challenges as faced in the implementation of AOP 1-6The implementation of AOP 1 to 6 encountered several challenges. These included:

•The top down Approach While previous AOPs were meant to

change the bureaucracy of the top down approach in the making of plans and distribution of resources, they did not alleviate the problem of the top down approach. If anything, it was realized that not all health facility needs as existent on the ground were featured on the overall national health sector AOP. The approach

Mr. Patrick Mbugua, DCO Nyeri North District explaining the importance of AOPs during a training facilitated by HERAF in Nyeri North District

only involved the members of staff at the district level and left out the members of health centers and dispensaries.

• Theresourceenvelope The communication of resources

available to health facilities as allocated by the budget through the MTEF methodology was not made in time. As such the resource envelope was delayed in its release and in most cases was not enough to commensurate the AOP budget of most health centers and dispensaries.

• Trainings The trainings on how to go about

preparing AOPs were not carried out well. In most cases, the numbers of staff from each facility were neither adequately trained nor capacitated

enough to educate their work mates and community members on the required procedures and how to make plans relevant for each health facility in accordance with the set regulations.

• Planningforfacility specific needs The previous AOPs tended to enforce

the adoption of nationally recommended planning formats irrespective of the individual needs of different health centers and dispensaries. However, for the success of NHSSP II, there is need to ensure that each health facilities develop their specific facility annual operation plans ,which though eventually determining the final outcome of the national sector of health annual

EUROPEAN UNION

DISCLAIMER

This newsletter is developed by HERAF with support from European Union (EU). The contents of this newsletter are the sole responsibility of HERAF and can in no

way be taken to represent the views of European Union.

HEALTH RIGHTS TODAY [2] EDITION 9

Aboutus:HERAF is an NGO that brings together health professionals,

NGOs, FBOs and PLWHA organizations to advocate for health as a

fundamental human right in Kenya. It was established in 2006, as a

project of Kenya Human Rights Commission (KHRC), and registered as

a non governmental organization in Kenya by the NGO coordination

board in 2007

OurVisionA Kenya where health is upheld and enjoyed as a fundamental human

right

OurMissionTo be a leading human rights organisation that promotes and

empowers Kenyans to realise the right to health for all

OurGoalTo be a visible leader in promoting, protecting and empowering

Kenyans to enjoy the right to health at all times.

OurProgrammes Health Rights Awareness and Education

Evidence Based Advocacy for Reforms in Health Policies

Promoting Health Sector Management and Governance

Promoting an efficient Health Care Financing system

OurMembershipOur membership is open to civil society organizations and other key

stakeholders involved in health, HIV and AIDS and human rights. These

include health professionals, on governmental organizations (NGOs),

organizations of people living with HIV and AIDS (PLWHA), Faith

Based Organizations, Research Institutions and universities involved in

health issues and health, HIV/AIDS and Human Rights Networks.

AboutUS

The views contained in this newsletter are not necessarily HERAF’s but the reporters.

This newsletter has been produced with the financial support of the European Union.The contents of this newsletter are the sole responsibility of HERAF and can in no way be taken to be the views of the European Union.

Disclaimer

continued from page 1

Welcome to this edition of the HERAF Newsletter. As an

unrelenting advocate for the increased awareness on the right to health, use of the human rights based approach to accessing and provision of health to all Kenyans, and sensitive health policies and legislations, HERAF has increasingly become a visible leader and supporter of activities aimed at increasing access and availability of better health services for all.

Through our programme activities, we are continually seeking to ensure that health care providers, health care management committees and the intended beneficiaries of the health services are aware of their rights, duties and that there is dialogue among them for increased understanding of the various challenges faced by all the stakeholders in the health sector.

In this edition, we focus on increased participation by the public in health sector governance, paying special attention to the budget, the Annual Operation Plans, the medium term

expenditure framework and the health sector services Fund.

For the successful provision of health services, it is important for the public to be involved in governing and managing the funds available in the health facilities in their respective areas and in plans deciding on the activities the resources will be spent on.

In line with the theme of this edition, we have also given insight into the first ever Nyeri North District Stakeholders forum whose main objective was to increase partnerships between various stakeholders in Nyeri North District.

It is our hope that the articles and content of this newsletter increases and broadens your view of the health sector in Kenya, and further amplifies your knowledge about our activities as an organisation. We thank you as our readers because without such a dedicated audience, we would not be able to continually improve on our articles. Thank you and welcome.

Editorial Team

EditorialEDITORIAL

operation plan, are implemented with the resources as allocated by government pending approval from DMOH.

NB: In AOP 7, ways of addressing the above challenges are effectively applied so as to improve the quality of service provision in all health facilities,especially health centers and dispensaries

Importance of AOPto a Health FacilityAll health facilities, health centers and dispensaries included, are expected to

prepare facility specific annual plans which are guided by the overall national health sector AOP 7 guidelines.

Through the individual health facility annual operation plans, a clarification on the available resources, their availability and dates of disbursement, is provided as determined through MTEF, and allocated in the national budget.

Through the AOP 6 and 7, the capacity of health facility staff to prepare and implement realistic AOPs is built. This is because the cascading style of training is emphasized on.

This entails training the DMOH and PMOH representatives, who in turn are expected to train those under the wings in groups,so as to increase knowledge, understanding and grasping of the concepts in annual planning and its frameworks. The end result is expected to be improved capacity for staff at health centers and dispensaries to make realistic and facility specific annual operation plans guided by the nationally recognized AOP 7, and intended to achieve the goals of the NHSSP II.

HEALTH RIGHTS TODAY [3] EDITION 9

Why citizens should understandBudget Making Process in KenyaByLucasFondo,CLARION

In this article, a brief on the legal framework for the budget,the sources of revenue, types of expenditure and

the various functions of the budget are elaborated on.

Budget expenditure is divided into two broad categories;• Therecurrentexpenditure which

includes the running costs of the government such as salaries and wages for public service.

• Thedevelopmentexpenditure which includes the costs of implementing longer-term projects such as putting up new roads, bridges and hospitals which are aimed at reducing the poverty and its effects in our country.

Sources of RevenueTo finance both recurrent and development expenditure, the government generates revenue from a wide range of sources which include: • Ordinary revenue – Value Added Tax

(VAT), exercise duty, stamp duties, income and corporate tax such as Pay As You Earn (PAYE)

• User charges-fees charged to consumers and users of government goods and services for example birth certificate, driving license, passports, and registration of property.

• Grants from development partners and foreign governments

• Sale of assets including shares of State Corporations and Parastatals

• Investment income such as interest and dividends from bonds through Central Bank and State Corporations

• Domestic and external borrowing

The Constitutional Basisfor the BudgetThe constitution of Kenya is the first Law of the land that provides for the national budget. The provision specifies in part the responsible persons for its reading in parliament,the time frame and guidelines on who should what and how in the budget making processes,including authorisation of the use of resources as indicated in the budget. Section 48 of the Constitution reserves the power of imposition of taxes, withdrawal of money from the consolidated fund or any other fund, remission of government debt to the President through the Finance Minister with approval from parliament.

As per the Constitution of Kenya, Parliament holds the powers for discussing and approving the budget estimates as presented by the Minister for Finance. This ensures that available resources are used in ways that maximize benefits for all Kenyans all the while ensuring accountability.

What is the role of Parliament in the budget making process?The involvement of parliament offers assurance to Kenyans that the systems employed by the executive to mobilize, allocate and utilize resources are effective and sensitive to the needs of the public.

The national budget spells out the governments plans for revenue collection, and what expenditure activities the revenue will be used on. As such,depending on how effectively revenue is used to curb the increasing costs of living,increase economic stability and enhance equal and increased access to resources,the national budget is used as a tool of monitoring the government in power.

Lucas Fondo, CLARION listening to contributions by participants during a training session on MTEF and Budget making in Kwale District

As the citizen’s representatives, it is the responsibility of the parliamentarians to check on the executive according to the principle of separation of powers as provided for by the Constitution, i.e. parliament is the sole authority on taxation, borrowing and spending of public funds.

In order to deal with the budget, parliament has established three standing committees• The Fiscal Analysis and Appropriations

Committee (FAAC)• The Public Accounts Committee (PAC)• The Public Investments Committee (PIC)

Major players in the budgeting processThe budgeting process is a collective function that benefits from the contributions and inputs of a wide variety of economic players and actors. They include;• Government Ministries• Treasury (Ministry of Finance)• Kenya Revenue Authority (KRA)• The Central Bank of Kenya (CBK).• Parliament• Interest groups and the citizens in general.

What are the vital functions performed by the National Budget? • Allocation – this function ensures that

the different needs identified through public representatives are categorized, divided among different departments in government and properly satisfied.

• Distribution–the budget helps government Ministries and their respective offices to know which regions of the country need attention, what sectors of the economy need to be re-evaluated in order to favor the public, and how to ensure that in the course of all this, policies are pro-poor.

• Stabilization -the budget acts as a stabilizing tool for the government enabling it to understand the dynamics between expenditure, income and resources available. It is through the budget that such calamities such as recession which results in high prices for commodities and unbearable living for Kenyans are averted.

HEALTH RIGHTS TODAY [4] EDITION 9

Mapping Decentralized Government Fundingavailable for Health in Kenya and Organizations involved in Monitoring ByEdwardMunene,HealthRightsAdvocacyForum

One of the reforms recently introduced is the adoption of “devolution” approach that allocates funds and responsibilities for delivery of health care to dispensaries, health centres and hospitals. The process of instituting these health financing reforms in Kenya has been confronted by a number of challenges. These include poor understanding of the devolved health sector funds and lack of committed or incapacitated champions to monitor the funds.

Participants during a HERAF facilitated training on devolved funds at the Coast Province

Stimulus Package (ESP).

Devolved health funds have provided innovative mechanisms for increasing access to health services for all including the poor. Indeed new health facilities, constructions, rehabilitation, equipment and employment of health care providers have been fuelled by the availability of the Constituency Development Fund (CDF) and the ESP that was channeled through the Ministry of Public Health and Sanitation.

The study established that the monitoring of health sector decentralized funds is urgently required. Indeed such monitoring is recognized as the missing link in the government efforts in establishing and improving the management of decentralized funds. Many of the health management committee members representing communities are handpicked

and may have little knowledge on how the funds should be managed hence the need to establish a strong oversight institutions.

The citizen groups that were identified for their involvement in monitoring decentralized funds can collectively be termed as the Civil Society. This encompasses a wide range of organizations which are not under the control of governments and which are not for profit. They include Non Governmental Organizations (NGOs), Community Based Organizations (CBOs), Faith Based Organizations (FBOs), Residents Associations and Professional Associations among others. These organisations are involved in tracking and reporting on allocation, disbursement and utilization of the decentralized funds. They demand for compliance with laws, rules, and regulations regarding financial control and management of each fund.

Why should citizensunderstand the budget?The national budget is a key determinant on whether or not each citizen is able to enjoy the benefits of goods and services available for their consumption.. Indeed, the budget is a determinant of citizen’s lives. As a result of budget policies,the citizens of a country are either able to afford basic commodities, borrow loans for investment, import

resources necessary for economic activities, or not.

Understanding the budget helps citizens to have an insight into the amount of funds allocated to their respective areas of residence, the projects targeted and how they are to benefit them. In recent years,the government has called on the public to actively engage in the budget making process so as to promote accountability

and transparency in the use of resources and funds in each locality. The end goal of emphasizing on increased public participation in the budget process is meant to be increased identification of the public with the development projects in their respective areas. This has effectively reduced the use of public funds to implement projects that do not address the people’s needs and priorities.

It is on this background that, Open Society Initiative for Eastern Africa (OSIEA) in collaboration with the Public

Health Watch Project (PHW) of the Open Society Foundation’s Public Health Program supported Health Rights Advocacy Forum (HERAF) to map decentralized funds available for health services in Kenya and document the organizations engaged in monitoring the utilization and accountability of these funds.

This was with the aim of equipping civil society groups, particularly those representing marginalized and underrepresented communities, with the tools, information, arguments and capacities to hold governments and national leaders accountable to uphold international standards and policies in health.

Among the reforms enacted by the government include the establishment of Health Sector Services Fund (HSSF) and the Hospital Management Services Fund (HMSF). HSSF is a direct transfer of funds to dispensaries (level 2) and health centres (level3) while HMSF is direct financing to level district (level 4) hospitals and Provincial General (level 5) hospitals.

The health sector has also benefited from the HIV and AIDS funds disbursed by National Aids Control Council (NACC) through Calls for Proposals (CfP). The other devolved funds that have benefited the health sector include the Constituency Development Fund (CDF), Local Authority Transfer Fund (LATIF) and the Economic

HEALTH RIGHTS TODAY [5] EDITION 9

The first ever District Health Stakeholders Forum (DHSF) for Nyeri North District was held on Friday, 27th May 2011 at Caritas Nyeri Development Centre. The meeting was supported by Health NGOS Network (HENNET) and convened by Basic Needs UK-Kenya.

The Convening of the First Nyeri NorthDistrict Health Stakeholders Forum ByMilkahChege,HealthRightsAdvocacyForum

It was attended by stakeholders implementing health programmes in Nyeri North including APHIA Plus,

Caritas, Food for the Hungry International (FHI), Population Services International (PSI) Kenya, Health Rights Advocacy Forum (HERAF), officials from Ministry of Public Health and Sanitation drawn from provincial and district offices and health care providers among others.

The meeting was opened by Christopher Wan’gang’a, District Medical Officer for Health (DMOH), Nyeri North District. He underscored the demand for more information and activities aimed at increasing awareness on the right to health, - the roles of duty bearers (government including health care providers) and the obligations of the citizens (right holders) in increasing access to health services.

He noted that the district was witnessing an upsurge of non communicable diseases such as diabetes, cancer and hypertension unlike other parts of the country that are mainly affected by high rates of HIV/AIDS, Malaria, TB and high child and maternal death rates. Alarmed by this trend, Mr. Wang’ang’a stated the need for more programme activities and increased awareness on these lifestyle diseases.

While acknowledging that the district faced shortages of staff in charge of health care provision, Mr. Wang’anga also highlighted the need for responsibility, ownership and partnership among stakeholders in the health sector in the region, so as to ensure that their activities complemented each others efforts and those of health care workers and medical personnel, while in the long run aiming to improve the health of residents in the region. In particular he singled out the need to address the 20% gap in the immunisation of children, and the 1% gap in the access to maternal health services which had resulted in the dealth of one woman due to prolonged labour.

As a resolution of the meeting, it was concluded that the Nyeri North District Stakeholders should be meeting on a quarterly basis. As such, the next forum will be held on 26th August 2011, at the St. Josephs HIV Self Help Grounds in Mweiga. To enhance greater partnership and collaboration, the District Medical Office for Health was requested to provide a list of organisations implementing health programmes in Nyeri North District, indicating activities currently going on, problems of focus with regards to health, geographical region covered and the objectives of the activities.

Roselyn Mburu, HENNET and Mr.Wang’ang’a, DMOH Nyeri North District during the Nyeri North Stakeholders Forum

Nonetheless, the district has shortages of health care providers which remains a major challenge at the District Medical Office for Health, thereby making supervision of all health stakeholders and their activities an uphill task.

The meeting was closed by Mr. Erastus Wakinumba, representing the Director, Public Health and Sanitation, Central Province. He congratulated HENNET on its role in organising the first ever Nyeri North Health Stakeholders Forum. He also called on the stakeholders in the health sector in the district to acknowledge and respect the supervisory role of the DMOH by updating the respective officials on their activities and needs. All stakeholders were requested to encourage the participation of local residents in their planned activities to ensure that they identify with the deliverables and make use of them maximally.

As part of the closing remarks, Mr. Wakinumba emphasised on the need for exit strategies in the process of completing programme activities. He stated that there was need to formulate clear exit strategies with the participation of community to ensure continuity of programme activities even after the departure of sponsors or partners in the projects.

HEALTH RIGHTS TODAY [6] EDITION 9

Background

Due to the lack of an explicit and clear link between budget policies and planning that can effectively lead

to development for all citizens, the MTEF was established as a tool for providing the “linking framework” that allows expenditure to be “driven by policy priorities and disciplined by budget realities”. This three year rolling budget framework was born out of the recommendations of the 1997 Public Expenditure Review (PER 97).

MTEF is a tool for translating governments’ national agenda into public expenditure programs with a coherent multiyear financial framework. It allows citizens to participate in policy making in order to ensure that development priorities are determining public expenditure in all sectors of the economy. These include education, health, agriculture and trade among others.

The purpose of MTEF is to:• Provide a link between the annual budget

and the long-term development policies, objectives and plans

• Improve macroeconomic growth targets by developing consistent and realistic resource envelopes which target the small

scale and individual development and guarantee access to resources

• Improve the allocation of resources to agreed strategic priorities both between and within sectors so as to achieve the end result of equitable development and pro poor economic policies

• Increase incentives for more effective and efficient utilization of resources by ministries/departments, by providing these agencies with predictable funding levels and increased autonomy.

What are the benefits of MTEF?• MTEF provides a link between policy,

planning, budgeting and implementation of programmes and projects.

• It helps to maintain fiscal discipline by establishing hard budget targets for Ministries and their various departments.

• Through the introduction of the Economic Recovery Strategy for wealth and employment creation (ERS), MTEF facilitates expenditure prioritization as policies and expenditure proposals are now required to target poverty reduction

within the MTEF budgeting cycle.

• The cycle allows for wider consultations to ensure that budget formulation, implementation and oversight benefits from the inputs of diverse economic actors and interest groups in the economy, and includes outputs of both the national and district planning processes.

The Medium Term Expenditure Framework (MTEF)ByLucasFondo,CLARION

The Nyeri North District Health Management Team during the districts’ AOP 7 compilation that was facilitated by HERAF.

MTEF is a tool for translating governments’ national agenda into public expenditure programs with a coherent multiyear financial framework.

HEALTH RIGHTS TODAY [7] EDITION 9

news from the regions

Expectant mothers from marginalised areas in Coast Province will soon have access to free health services in a new

scheme spearheaded by the Ministry of Public Health and Sanitation and World Vision.

This was said by Coast Provincial Health Director of Public Health and Sanitation Dr. Anisa Omar while speaking at Mihirini Health Centre in Ganze Constituency during the launch of National Child Survival and Development Strategy (CSDS). She said expectant mothers would only need to buy

Ksh 200 voucher to access the services in any Government health facility. She further revealed that health facilities will receive Kshs 5,000 for each delivery and Kshs 20,000 for every delivery made through caeserean operation.

ImprovingaccesstomaternalservicesinCoastProvince

Only two in every five pregnant women are delivering in hospitals!

Less than half of pregnant women are seeking delivery services in hospitals, greatly putting their lives and those of unborn babies in danger. Only two in every five are delivering in hospitals.

This was said by the Minister for Planning and Vision 2030, Hon. Wycliff Oparanya in a speech read by Economic Planning Secretary Dr Steven Wainaina during the launch of the 2010 Kenya Service Provision Assessment (KSPA) Report.

Inadequatefundingistoblameforpoorservicedeliveryinpublichospitals

Reacting to the 2010 Kenya Service Provision Assessment (KSPA) Report that has put public health facilities

on the spot for poor service delivery, health workers at the Rift Valley Provincial General

Hospital in Nakuru said inadequate medical equipment and supplies had affected service delivery. The amount allocated to meet the hospital supplies including non pharmaceuticals equipment is handily

enough, forcing the hospital to charge user fees which in return hiders accessibility to health services. They also attributed poor service delivery to demoralized staff due to poor pay.

NationalHealthStakeholder’sForum

The Ministries of health (both the Ministry of public health and sanitation and the ministry of medical services) have organized a national stakeholder’s forum to be held on 9th

and 10th August 2011 at KICC. The main agenda of the conference will be to disseminate; ;(i) The proposed health sector position paper on the

implementation of the new constitution,(ii) The draft policy framework 2011-2030,

(iii) The proposed road map on drafting new health laws,(iv) Macro plan to cover the period up to August 2012, and(v) Way forward.

These documents will guide the health sector for the next 20 years. Interested stakeholders within the health sector are invited to participate in the forum on 10th August 2011.

2010KenyaServiceProvisionAssessment(KSPA)forthehealthsectorLaunchofReport2010

The Kenya Service Provision Assessment (KSPA) report was launched on Tuesday 25th May 2011

at the Hilton Hotel. The Kenya Service Provision Assessment was designed

to provide national and sub-national information on the availability and quality of health services from a representative sample of 708 health facilities in Kenya. The survey is a follow-up to the 1999 and 2004 surveys.

The document is extremely useful to policy and program managers in the health sector as it outlines the various challenges in quality health service delivery.

announcements

Contacts: TheExecutiveDirector,HealthRightsAdvocacyForum(HERAF),Muthangari Road off Gitanga Road, Valley Arcade, P.O Box 100667-00101, Nairobi, KenyaTel: 254 - 20 -3861482/3 | Fax: 254 - 20 -3861483 | Email: info@heraf.or.ke | Website: www.heraf.or.ke

Concept & Design: GraphiteLoungeLtd | info@graphitelounge.com

mini album

EUROPEAN UNION

CAPTIONS1. A member of the HERAF staff

displaying fact sheets and flyers developed by HERAF during the Nyeri North Stakeholders Forum

2. A presentation on Annual Operation Plans during a training workshop in Kwale District

3. Participants engaging in an energizer during an afternoon training session in Nyeri

4. Mita Manek of the EU delegation Kenya consulting with a DHMT member during the Kwale EU mission

5. Participants engaging in an energizer during an afternoon training session in Kwale

4

2

3

1

5